Category: Sympathectomy

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Risk factors for compensatory hyperhidrosis following CT-guided percutaneous radiofrequency sympathectomy: A retrospective observational study

Medicine (Baltimore). 2026 May 22;105(21):e48976. doi: 10.1097/MD.0000000000048976.

ABSTRACT

Compensatory hyperhidrosis (CH) is a significant complication following surgery for primary hyperhidrosis, impairing patients’ postoperative experience and quality of life. Radiofrequency sympathectomy (RFS) is one of the main minimally invasive surgeries for hyperhidrosis, yet high-risk factors and patient experiences of postoperative CH are rarely reported. This retrospective observational study (Strengthening the Reporting of Observational Studies in Epidemiology compliant) aimed to identify significant risk factors for CH after RFS and to develop a dynamic nomogram for individualized risk prediction. A total of 410 primary hyperhidrosis patients who underwent RFS between January 2018 and March 2023 were enrolled. A CH database was established via systematic follow-up to track postoperative sweating patterns. Detailed clinical assessments included the Numeric Rating Scale (NRS), Hyperhidrosis Disease Severity Scale (HDSS), and Hospital Anxiety and Depression Scale (HADS). Advanced statistical techniques, including logistic regression analysis, were used to identify potential risk factors for CH. Of the 410 patients, 281 (68.5%) developed CH, with 105 (25.6%) reporting moderate-to-severe symptoms. Multivariate analysis revealed 4 significant predictors of CH: male gender (odds ratio [OR] = 1.69); higher NRS scores (OR = 1.16); lower immediate postoperative HDSS (OR = 0.48); higher preoperative HADS scores (OR = 1.11). A dynamic, web-based nomogram was also developed to provide personalized CH risk prediction. Male gender, higher intraoperative NRS scores, lower immediate postoperative HDSS, and higher preoperative HADS scores were identified as independent risk factors. The constructed dynamic nomogram enables individualized risk prediction and supports clinicians in providing personalized preoperative counseling and perioperative management for patients undergoing RFS.

PMID:42175438 | DOI:10.1097/MD.0000000000048976

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Analysis of all video-assisted thoracic sympathectomy for hyperhidrosis over 9 years in Brazil: trends, costs and in-hospital mortality over 200 million inhabitants

Ann Vasc Surg. 2026 May 19:S0890-5096(26)00376-6. doi: 10.1016/j.avsg.2026.05.070. Online ahead of print.

ABSTRACT

BACKGROUND: Primary hyperhidrosis (HH) causes substantial functional and psychosocial impairment. While anticholinergic therapy has become first-line treatment, video-assisted thoracic sympathectomy (VATS) remains the only definitive option for patients with refractory disease. Large-scale, real-world data on the safety and utilization of VATS for HH at a national level remain limited.

METHODS: We conducted a nationwide retrospective analysis including all patients who underwent VATS for HH in Brazil between 2015 and 2023. Data were obtained from publicly available governmental databases encompassing both public and private healthcare systems. Procedure volumes, demographic characteristics, regional distribution, reimbursement, in-hospital mortality, and healthcare-sector differences were analyzed.

RESULTS: A total of 26,980 VATS procedures for HH were performed during the study period. Most patients were female (64.5%) and aged 15-39 years (82.7%). Procedures were predominantly performed in the private healthcare system (75.3%), with marked regional concentration in the Southeast (48.3%) and South (29.5%) regions. Overall in-hospital mortality was extremely low (0.048%) and did not differ significantly between public and private sectors. Despite similar safety profiles, the mean cost per procedure in the private system was substantially higher, resulting in more than 90% of total national expenditures.

CONCLUSIONS: In this nationwide cohort of nearly 27,000 procedures, VATS sympathectomy for primary hyperhidrosis demonstrated an low mortality rate across both public and private healthcare systems, supporting its role as a safe definitive surgical therapy when appropriately indicated. The marked disparities in access and cost highlight important system-level differences but do not appear to compromise procedural safety.

PMID:42162859 | DOI:10.1016/j.avsg.2026.05.070

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The use of an objective method (continuous exosomatic electrodermal activity without external stimuli) to evaluate patients with hyperhidrosis undergoing video-assisted sympathectomy

Einstein (Sao Paulo). 2026 Apr 27;24:eAO1266. doi: 10.31744/einstein_journal/2026AO1266. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze continuous exosomatic electrodermal activity (EDA) without external stimuli (EDAcw) in patients with primary hyperhidrosis before and after sympathectomy.

METHODS: This prospective study included 28 participants, categorized into two groups. The first group comprised 18 patients with palmoplantar hyperhidrosis who underwent bilateral thoracic sympathectomy. The second group (control) consisted of 10 patients. Two questionnaires were administered: the Control Group completed them once, whereas the Sympathectomy Group completed them preoperatively, and on the first and thirtieth postoperative days. Sweating was evaluated by measuring EDAcw using an MP36R biosensor. Measurements were obtained from the hands and feet for 5 min without external stimuli in an air-conditioned environment and were performed preoperatively, and on the first and thirtieth postoperative days. Anthropometric, clinical, and surgical data were collected, and no significant sociodemographic differences were observed between the groups.

RESULTS: In the Sympathectomy Group, quality of life improved, and sweating reduced. During preoperative assessment, EDA was higher in the hands and feet of patients with hyperhidrosis than in the Control Group. Postoperatively, EDA in the hands decreased, with 100% of the patients showing a decrease in sweating. For the feet, 67% of the patients reported reduced sweating, and 44% showed a statistically significant decline in EDA.

CONCLUSION: Continuous exosomatic EDA measurement without external stimuli is a suitable method for assessing patients with palmoplantar hyperhidrosis and shows appropriate clinical correlation.

PMID:42054168 | DOI:10.31744/einstein_journal/2026AO1266

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Advances in pharmacological treatment and management of hyperhidrosis

Expert Opin Pharmacother. 2026 Mar 23:1-10. doi: 10.1080/14656566.2026.2642213. Online ahead of print.

ABSTRACT

INTRODUCTION: Hyperhidrosis is a functional disorder characterized by excessive sweat production beyond physiological needs for thermoregulation, significantly impairing quality of life, affecting physical comfort, psychological well-being, social interactions, and work productivity.

AREAS COVERED: This review focuses on evidence-based therapeutic options for hyperhidrosis. Topical treatments (glycopyrronium bromide, glycopyrronium tosylate, aluminum salts), systemic therapy (oral oxybutynin), injectable approaches (botulinum toxin), iontophoresis, and surgical interventions (local excision, sympathectomy) are discussed in detail. Clinical studies demonstrate that topical and systemic agents are effective for localized and multisite forms, respectively, while botulinum toxin offers strong efficacy for focal hyperhidrosis. The review also addresses combination strategies, treatment tolerability, cost-effectiveness, and patient-centered approaches.

EXPERT OPINION: Managing hyperhidrosis requires a nuanced, individualized strategy that balances symptom control, safety, patient preferences, and quality of life. Combination therapies and flexible treatment sequencing can reduce early reliance on invasive procedures. Despite therapeutic advances, widespread adoption is limited by heterogeneous guidelines, off-label use, and under-recognition of psychosocial impact. Future research should focus on prospective, large-cohort studies, standardized outcome measures, and development of selective, well-tolerated therapies. While a universal cure is unlikely, sustained symptom control and meaningful improvement in quality of life represent realistic objectives.

PMID:41871366 | DOI:10.1080/14656566.2026.2642213

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Prediction of compensatory hyperhidrosis severity after endoscopic thoracic sympathectomy in primary hyperhidrosis patients based on rough set analysis

J Thorac Dis. 2026 Feb 28;18(2):146. doi: 10.21037/jtd-2025-aw-2074. Epub 2026 Feb 25.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) remains the most prevalent postoperative adverse event following endoscopic thoracic sympathectomy (ETS) for primary hyperhidrosis (PH). Current predictive models lack reliability in estimating CH severity. This study introduces a novel predictive framework utilizing rough set theory to establish decision rules for CH stratification.

METHODS: In this single‑center retrospective cohort study, clinical data from 225 PH patients undergoing ETS were analyzed, including 37 predictive indicators. These variables were subjected to correlation analysis, regression analysis, and rough set analysis with CH severity.

RESULTS: There were 93.3% (210/225) of patients exhibiting CH following ETS, with 33.3% classified as grade III CH, and no grade IV CH was noted. Body mass index (BMI), the level of sympathectomy, and the temperature difference of the right hand after surgery and before anaesthesia were shown to be significantly correlated with CH on correlation analysis. However, no valid regression model was established with significant correlations involving indicators for further regression analysis. By switching to rough set analysis, four predictive rules for grade III CH were derived: (I) BMI >22 kg/m2 + initial onset age of PH >11 years, 84% accuracy; (II) BMI 19.5-22 kg/m2 + surgical age >28.5 years, 82% accuracy; (III) BMI 18.5-19.4 kg/m2 + postoperative right-hand temperature >36.6 ℃, 77% accuracy; (IV) BMI <18.5 kg/m2 + postoperative right-hand temperature <37.0 ℃ + initial PH onset age <10 years, 71% accuracy.

CONCLUSIONS: Rough set analysis provides a promising approach for exploring the patterns of CH severity following ETS in patients with PH, and thus which merits further investigation through multicenter, large-sample studies. The four preliminary decision rules for predicting grade III CH derived from rough set analysis show potential clinical relevance but remain tentative, as their utility requires validation in prospective cohorts prior to widespread clinical application.

PMID:41816421 | PMC:PMC12972784 | DOI:10.21037/jtd-2025-aw-2074

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Compensatory Hyperhidrosis After ETS: Temporal Evolution and Predictors

Thorac Cardiovasc Surg. 2026 Feb 24. doi: 10.1055/a-2819-1705. Online ahead of print.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis remains the most significant complication after endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. However, its temporal evolution and long-term predictors are not fully elucidated.

METHODS: This multicentre retrospective study included 226 patients who underwent bilateral clip-based ETS between 2009 and 2023. Patients were stratified by surgical level: R3 (n=60), R4 (n=72), R2-R4 (n=81), and asymmetric interruption (n=13). Compensatory hyperhidrosis severity was assessed at 6, 12 months, and final follow-up (mean 98 months). Logistic regression identified independent predictors of Compensatory hyperhidrosis, recurrence, and patient satisfaction.

RESULTS: Complete palmar dryness was achieved in 84.5% of patients. Compensatory hyperhidrosis occurred in 48.7%, exclusively within the first 6 postoperative months, with no late-onset cases. During long-term follow-up, spontaneous regression of compensatory hyperhidrosis was observed in 28.2% of affected patients. Compensatory hyperhidrosis incidence differed significantly across surgical levels (p=0.011): 38.3% (R3), 55.6% (R4), 63.0% (R2-R4), and 30.8% (asymmetric). Multivariate analysis confirmed multi-level R2-R4 sympathectomy as an independent predictor of compensatory hyperhidrosis (OR=2.18, p=0.042), while single-level R4 interruption provided the lowest persistent compensatory hyperhidrosis burden. Overall satisfaction was 79.6%, and recurrence-not compensatory hyperhidrosis -was the main determinant of dissatisfaction (OR=2.48, p<0.001). Smoking history independently predicted recurrence (OR=2.09, p=0.042).

CONCLUSIONS: Compensatory hyperhidrosis develops exclusively during the early postoperative period and shows partial spontaneous improvement over time. Multi-level interruption significantly increases compensatory hyperhidrosis risk without improving efficacy, supporting limited single-level approaches (preferably R4). These findings emphasize the importance of surgical level selection, smoking cessation, and realistic postoperative counseling.

PMID:41734813 | DOI:10.1055/a-2819-1705

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A significant gap between inadequate pharmacotherapy and substantial unmet needs in palmar hyperhidrosis management in China: insights from a questionnaire-based survey among outpatients

Front Pharmacol. 2026 Jan 8;16:1715189. doi: 10.3389/fphar.2025.1715189. eCollection 2025.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis, characterized by excessive sweating primarily affecting the hands, significantly impairs quality of life and psychological well-being. Although topical agents, iontophoresis, microwave therapy, and sympathectomy are established interventions, real-world treatment patterns and pharmacotherapeutic adequacy among Chinese patients remain poorly delineated.

METHODS: An anonymous, questionnaire-based survey was conducted among consecutive patients at a tertiary thoracic surgery clinic in China between March 2023 and October 2024. A total of 363 valid responses were collected and analyzed using SPSS 27.0. Descriptive statistics and multivariable logistic regression were used to evaluate treatment patterns, patient preference, and predictors of treatment selection.

RESULTS: The study cohort was composed predominantly of individuals with severe disease (87.3% HDSS grade 3-4), and nearly all participants (97.8%) presented with palmar hyperhidrosis. Regarding treatment history, only 38.1% had previously received pharmacotherapy, while 32.6% had utilized Traditional Chinese Medicine (TCM) therapeutic approaches, including TCM, acupuncture, massage and manipulation therapies. Antiperspirants (28.6%) and TCM (25.0%) were the most frequently used prior pharmacotherapies, yet both were associated with limited therapeutic efficacy. According to our survey, owing to high symptom severity, 52.9% had a general knowledge of surgical intervention before the outpatient visit. Primary concerns regarding previous pharmacotherapy included insufficient efficacy and localized adverse effects, particularly skin irritation. Notably, 50.0% of participants remained receptive to future pharmacotherapy, showing a preference for topical formulations (29.3%) and reduced dosing frequency (31.6%). Gender and disease severity were identified as significant determinants of treatment choice. Importantly, prior negative experiences – such as inefficacy and side effects – did not significantly diminish willingness to consider future pharmacologic treatment.

CONCLUSION: Inadequate management and suboptimal treatment outcomes represent considerable challenges in the care of palmar hyperhidrosis in China. Existing pharmacotherapeutic options are constrained by limited availability, inadequate efficacy, and a narrow range of approved agents – a reality that highlights a critical disconnect with substantial patient demand. These findings underscore an urgent need to accelerate drug development and clinical translation in this field.

PMID:41585901 | PMC:PMC12823788 | DOI:10.3389/fphar.2025.1715189

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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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A predictive model for postoperative compensatory hyperhidrosis in primary palmar hyperhidrosis: a retrospective cohort study

J Thorac Dis. 2025 Dec 31;17(12):11253-11261. doi: 10.21037/jtd-2025-1562. Epub 2025 Dec 26.

ABSTRACT

BACKGROUND: While sympathectomy remains the optimal surgical intervention for severe primary palmar hyperhidrosis (PPH), compensatory hyperhidrosis (CH) has emerged as the most significant factor contributing to postoperative patient regret. This retrospective study aimed to identify risk factors and develop a predictive model for moderate-to-severe compensatory hyperhidrosis (msCH) in patients with PPH.

METHODS: A total of 1,013 patients were retrieved from the institutional database between 2014 and 2024. Logistic regression modeling was utilized to identify risk factors for msCH. A nomogram for predicting msCH was developed accordingly.

RESULTS: Of the initial cohort, there were 903 patients included in the final analysis, among whom 182 (20.2%) developed msCH. The following factors were identified as independent risk factors for msCH: age >25 years [odds ratio (OR) 3.32, 95% confidence interval (CI): 2.23-4.95, P<0.01], smoking history (OR 6.46, 95% CI: 4.37-9.54, P<0.01), higher body mass index (BMI) (OR 1.68, 95% CI: 1.10-2.56, P=0.02), palmar-axillary hyperhidrosis (OR 2.37, 95% CI: 1.57-3.57, P<0.01), and T3 sympathectomy (OR 3.14, 95% CI: 2.03-4.85, P<0.01). A predictive nomogram for msCH was developed based on these factors. Receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.839, indicating good predictive performance.

CONCLUSIONS: Age >25 years, smoking history, higher BMI, palmar-axillary hyperhidrosis, and T3 sympathectomy were independent risk factors for msCH. Based on these factors, a predictive model for msCH was developed and showed high predictive accuracy.

PMID:41522169 | PMC:PMC12780405 | DOI:10.21037/jtd-2025-1562