Category: Plantar

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Hyperhidrosis: Prevalence, Diagnosis, and Stepwise Treatment

Dtsch Arztebl Int. 2026 May 1;(Forthcoming):arztebl.m2025.0229. doi: 10.3238/arztebl.m2025.0229. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperhidrosis, or sweating beyond the physiological amount, can be either focal or generalized and sometimes runs in families. The prevalence of primary idiopathic hyperhidrosis is 2-5%. Secondary hyperhidrosis is associated with specific illnesses and medications. In this article, we discuss the diagnostic evaluation of hyperhidrosis and treatments for it, along with their efficacy and side effects.

METHODS: This narrative review is based on publications retrieved from the Medline and Cochrane databases with the search term “hyperhidrosis” and other specific terms relating to treatment. Expert recommendations and guidelines were considered as well.

RESULTS: The diagnostic evaluation consists of a clinical history, a Minor (starch-iodine) test, gravimetry, and dynamic sudometry. There have been no more than a few high-quality published studies on specific interventions. Depending on the severity and symptom burden, aluminum chloride and anticholinergic drugs are used first, followed by botulinum toxin injections and subcutaneous curettage for axillary hyperhidrosis. These treatments reportedly bring about marked improvement in 60-70 % of patients; their side effects, depending on the particular treatment used, include local reactions such as itch, pain, and cutaneous irritation and anticholinergic effects such as dry mouth, mydriasis, urinary retention, and headache. Further therapeutic options are tap water iontophoresis; radiofrequency, focused ultrasound, and microwave treatment; systemically administered anticholinergic drugs; and thoracic or lumbar sympathectomy for palmar or plantar hyperhidrosis, respectively.

CONCLUSION: A variety of methods can be used to relieve hyperhidrosis and improve these patients’ quality of life. There have been no more than a few high-quality studies on their efficacy and long-term results.

PMID:41572865 | DOI:10.3238/arztebl.m2025.0229

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Thoracoscopic Sympathectomy for Primary Hyperhidrosis: A 3 mm Two-Port Approach

J Laparoendosc Adv Surg Tech A. 2025 Dec 12. doi: 10.1177/10926429251405812. Online ahead of print.

ABSTRACT

Background: Primary hyperhidrosis is a debilitating condition characterized by excessive focal sweating, most commonly affecting the axillae, palms, and soles, for which surgical intervention provides a durable solution in patients refractory to medical management. Methods: We present our outpatient surgical technique for video-assisted thoracoscopic sympathectomy (VATS) using a two-port, 3-mm incision approach and evaluate its efficacy and outcomes. A case series of 33 consecutive patients undergoing outpatient VATS sympathectomy between 2016 and 2023 was reviewed, with 9 patients excluded for lack of postoperative follow-up. All procedures were performed with electrocautery at the third and fourth ribs posteriorly (T3 and T4). Results: The technique demonstrated consistent efficacy in symptom resolution with short operative times, low postoperative pain, and rapid recovery. Mean operative time was 22.0 ± 3.7 minutes, with same-day discharge achieved in all patients. The average pain score at discharge was 2.0 ± 2.6, and no intraoperative or immediate postoperative complications occurred. Symptom severity scores improved across all regions, most notably in the palms (8.8 ± 2.1 to 1.3 ± 2.1, P < .001) and axillae (7.1 ± 2.9 to 2.2 ± 2.3, P < .001), with improvement also observed in plantar sweating (8.6 ± 2.0 to 4.8 ± 3.0, P < .001), while facial sweating showed a modest, nonsignificant change (2.3 ± 2.8 to 1.5 ± 2.2, P = .21). At 2-4 weeks, complication rates, including compensatory hyperhidrosis and pneumothorax, were comparable to conventional methods. Conclusion: This minimally invasive two-port VATS sympathectomy with 3-mm incisions appears safe, effective, and patient-centered, supporting its use as a surgical approach for primary hyperhidrosis.

PMID:41467293 | DOI:10.1177/10926429251405812

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The effects of sympathectomy ganglion levels on late complications in the treatment of hyperhidrosis

J Minim Access Surg. 2024 Nov 29. doi: 10.4103/jmas.jmas_75_24. Online ahead of print.

ABSTRACT

INTRODUCTION: Pathologically excessive sweating in areas such as the palmar, axillary and/or plantar together with sympathetic hyperactivity that occurs independently of systemic causes is called primary hyperhidrosis. Although primary idiopathic hyperhidrosis can be seen at any age, the disease is most commonly seen in adolescents and young adults. The frequency of male and female genders is usually equal. Some medical and minimally invasive methods can be used in the treatment of primary hyperhidrosis. However, the known curative gold standard treatment method for the disease is thoracoscopic thoracic sympathectomy operation.

PATIENTS AND METHODS: In this study, a total of 150 patients who applied to Trakya University Health Practice and Research Center, Department of Thoracic Surgery, between 15 October 2008 and 15 June 2021 and underwent thoracoscopic thoracic sympathectomy due to the diagnosis of hyperhidrosis were evaluated retrospectively. The patients were separated into two groups. Thoracoscopic thoracic sympathectomy was performed on the T2-T4 in the first group (Group I – n : 88) and on the T3-T5 sympathetic ganglions in the second group (Group II – n : 62).

RESULTS: The median age of patients included in the study was found to be 24 (20.75-28) years. Group I and Group II were similar in terms of gender characteristics, but Group II was older. Our success rate was found to be 92% ( n = 138). There was no mortality, major complication such as bleeding requiring open thoracotomy, chylothorax or Horner’s syndrome in any of the patients. Minor complications were seen in the early and late period of the operation at a low rate. Our overall compensatory hyperhidrosis rate was 52% ( n = 78). Compensatory hyperhidrosis was detected more in Group I, although this was not statistically significant. We determined the overall satisfaction rate of our patients as 87.3% ( n = 133). The satisfaction rates of the patients in Group I and Group II were found to be similar.

CONCLUSIONS: Thoracoscopic thoracic sympathectomy is a fast, safe and minimally invasive treatment method with a low complication rate. More than 90% success and a significant increase in psychosocial condition and professional quality of life can be achieved with this procedure. Future studies are needed to reveal the relationship between operated ganglion levels and the development of compensatory hyperhidrosis.

PMID:39611563 | DOI:10.4103/jmas.jmas_75_24

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Sexual effects and long-term outcomes of endoscopic lumbar sympathectomy for plantar hyperhidrosis in men: a cross-sectional study

J Vasc Bras. 2024 Sep 27;23:e20240014. doi: 10.1590/1677-5449.202400142. eCollection 2024.

ABSTRACT

BACKGROUND: Plantar hyperhidrosis (PHH) is a disease with high psychosocial impact, and endoscopic lumbar sympathectomy (ELS) has been shown to be the best choice for treatment, but with some concerns such as compensatory sweating (CS) and sexual effects (SE), particularly in men.

OBJECTIVES: The aim of this study is to evaluate the long-term effectiveness of ELS for controlling PHH in men, its side effects, and perceived sexual modifications.

METHODS: A cross-sectional study including only male patients operated for PHH with ELS between 2014-2022 at a private practice. During remote interviews, patients were asked about symptoms before and after ELS and about the postoperative effects on PHH. They were also objectively asked about any SE during the postoperative period. Validated quality of life for hyperhidrosis and erectile function questionnaires were also administered.

RESULTS: 10 male patients averaging 4.26±2.86 years post-ELS were interviewed. Eight of them (80%) achieved complete response (≥80% of sweat reduction) in the first month after surgery and this response was maintained up to the interview date. Two patients had partial response. In six patients, CS occurred, with 5 reporting it as non-troublesome. Six patients reported some type of SE, but none reported erectile dysfunction. Regarding the functional results, all patients rated ELS from good (10%) to very good (30%) or excellent (60%).

CONCLUSIONS: Endoscopic lumbar sympathectomy was effective for treatment of plantar hyperhidrosis in these patients, improving their quality of life and providing lasting PHH control, with some transient sexual dysfunctions that did not impair their sexual life.

PMID:39421693 | PMC:PMC11486464 | DOI:10.1590/1677-5449.202400142

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The Influence of the COVID-19 Pandemic on the Addressability to Treatment of Children with Hyperhidrosis-A Retrospective Study and a Short Review

Life (Basel). 2024 Aug 10;14(8):995. doi: 10.3390/life14080995.

ABSTRACT

INTRODUCTION: This study was carried out to demonstrate the negative influence that the COVID-19 pandemic had on the ability of patients to treat hyperhidrosis with iontophoresis. The purpose of this study is to identify the annual distribution of patients with hyperhidrosis as well as elaborate a curve of cases within the time interval studied.

METHODS: It is a retrospective study initiated in the Department of Neuropsychomotor Rehabilitation of the “Sf. Ioan” Emergency Clinical Hospital for Children, Galati, Romania, in which we analyzed the electronic database, the treatment, and the consultation files of all the children who presented between January 2013 and December 2023. We found 111 patients who met the inclusion criteria.

RESULTS: During the 3 years of the pandemic, the number of patients who came to our clinic suddenly dropped to 0.

LIMITATIONS: This study was conducted on a relatively small number of patients in a Neuropsychomotor Recovery clinic. This study includes only patients with palmar and/or plantar hyperhidrosis who presented to the clinic for iontophoresis.

CONCLUSION: Although it is a disease that significantly influences the quality of life, patients and their families do not consider hyperhidrosis to be an urgent problem that can be improved by treatment.

PMID:39202737 | DOI:10.3390/life14080995

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Botulinum Toxin A and B for Palmoplantar Hyperhidrosis

Dermatol Ther (Heidelb). 2024 Mar 1. doi: 10.1007/s13555-024-01113-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Hyperhidrosis is characterized by unpredictable, uncontrollable and excessive sweating. It occurs at rest and is not related to temperature. Hyperhidrosis is a common disorder that has a negative impact on quality of life (QoL). The aim of this quality assurance study was to investigate how treatment of palmoplantar hyperhidrosis with botulinum toxin A (BTX-A) and botulinum toxin B (BTX-B) led to improvement of patient reported outcome measures related to QoL.

METHODS: A total of 35 patients with palmar and/or plantar hyperhidrosis who had received BTX-A (Dysport®) and BTX-B (NeuroBloc®) for palmar hyperhidrosis and BTX-B for plantar hyperhidrosis were included in this study. In total, palms were injected with a median dose (low to high) of 400 (100-550) units BTX-A and a median dose (low to high) of 200 (200-500) units. BTX-B was used in the thenar and hypothenar areas to avoid muscle weakness. In the soles a total median dose (low to high) of 600 (475-1000) units BTX-B was injected.

RESULTS: At follow-up 2 weeks post-treatment, patients’ Dermatology Life Quality Index (DLQI) score improved from 13 to 2 (p < 0.001).

CONCLUSION: We found that BTX-A and BTX-B treatment for palmar hyperhidrosis and BTX-B treatment for plantar hyperhidrosis led to a substantial improvement of QoL.

PMID:38424385 | DOI:10.1007/s13555-024-01113-3