Category: Sympathectomy

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Efficacy and Safety of Treatments for Primary Palmar Hyperhidrosis: A Systematic Review Assessing Patient-Centric Outcomes

Dermatol Res Pract. 2025 Aug 20;2025:8867838. doi: 10.1155/drp/8867838. eCollection 2025.

ABSTRACT

Background: Primary palmar hyperhidrosis (PH) is a chronic condition characterized by excessive sweating in the palms, significantly affecting the quality of life (QOL) of affected individuals. Despite the availability of various treatment modalities, the long-term efficacy and safety of these interventions remain unclear, warranting a comprehensive evaluation. This systematic review aims to assess the efficacy, safety and patient-reported outcomes of treatments for PH. Methods: A systematic search was conducted in PubMed, Embase and the Cochrane Library from their inception until March 2024, adhering to PRISMA guidelines. Inclusion criteria focused on prospective and retrospective studies examining PH treatments published in English. Data from eligible studies were extracted, analysed qualitatively and reported based on outcomes, including efficacy, QOL improvements and adverse effects. Results: Fourteen studies, including 1733 patients aged 4-77 years, were included in the final review. The treatments assessed included oral and topical oxybutynin, iontophoresis, botulinum toxin A injections, photodynamic therapy (PDT) and endoscopic thoracic sympathectomy (ETS). Oral oxybutynin demonstrated symptomatic relief in 60%-97% of the patients although anticholinergic side effects were frequently reported. ETS, while providing the highest rates of complete sweat cessation, was associated with compensatory hyperhidrosis. Noninvasive treatments like iontophoresis showed moderate efficacy with minimal side effects but required ongoing sessions for maintenance. Conclusion: This review highlights the efficacy of several therapeutic approaches for PH though most treatments are hindered by significant adverse effects or practical limitations. Future research should prioritize long-term studies and standardized outcome measures to guide clinical decision-making more effectively.

PMID:40881604 | PMC:PMC12390518 | DOI:10.1155/drp/8867838

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Effect of Radiofrequency Ablation and Comparison With Surgical Sympathectomy in Palmar Hyperhidrosis

Cureus. 2025 Jul 22;17(7):e88543. doi: 10.7759/cureus.88543. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis is a distressing condition characterized by excessive palm sweating that significantly impacts patients’ quality of life (QoL). Radiofrequency ablation (RFA) and surgical sympathectomy are effective treatment modalities. This study aims to evaluate and compare the effectiveness, patient satisfaction, and safety profiles of RFA and surgical sympathectomy in managing palmar hyperhidrosis.

METHODS: This retrospective study included 91 patients diagnosed with primary palmar hyperhidrosis who underwent either RFA or surgical sympathectomy. The primary outcome was the reduction in sweating severity. Statistical analyses were performed to compare treatment outcomes between the two groups.

RESULTS: Both RFA and surgical sympathectomy significantly reduced Hyperhidrosis Disease Severity Scale scores; however, surgical sympathectomy demonstrated greater symptom reduction at six months (p = 0.01) and 12 months (p = 0.002). Patients in the sympathectomy group reported a longer symptom relief duration (11.8 ± 3.1 vs. 9.2 ± 2.5 months, p = 0.003) and greater improvement in QoL scores at 12 months (p = 0.02). The incidence of compensatory sweating was higher in the sympathectomy group (34.0%, n = 16 vs. 18.2%, n = 8, p = 0.08), whereas recurrence of hyperhidrosis was more frequent in the RFA group (27.3%, n = 12 vs. 10.6%, n = 5, p = 0.03).

CONCLUSION: Both RFA and surgical sympathectomy effectively reduce sweating severity in patients with palmar hyperhidrosis. While sympathectomy provides longer-lasting symptom relief and greater QoL improvement, it is associated with a higher incidence of compensatory sweating.

PMID:40851706 | PMC:PMC12370239 | DOI:10.7759/cureus.88543

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20-Year Efficacy of Endoscopic Thoracic Sympathectomy for Primary Hyperhidrosis: A Cohort Study

J Clin Med. 2025 Jul 8;14(14):4831. doi: 10.3390/jcm14144831.

ABSTRACT

Background: Primary focal hyperhidrosis, characterized by excessive sweating primarily affecting the hands and axillae, can significantly impact quality of life. Bilateral thoracic sympathectomy is the gold standard treatment, providing permanent resolution of palmar hyperhidrosis. Most studies evaluating outcomes and patient satisfaction after sympathectomy focus on short- to medium-term follow-up, typically up to 5 years. This study aimed to assess anxiety, satisfaction, and sweat redistribution 20 years after bilateral endoscopic thoracic sympathectomy. Methods: Between January 2002 and December 2003, 106 patients with primary hyperhidrosis underwent bilateral endoscopic thoracic sympathectomy targeting ganglia T2-T3 at our center. The patients were contacted via telephone in 2023 and asked to complete the same survey they had filled out preoperatively and 12 months postoperatively. The survey evaluated sweat redistribution, anxiety, hyperhidrosis-related symptoms, and satisfaction. Anxiety, satisfaction, and perceived sweating were rated using a 5-point visual analog scale (VAS) ranging from 0 (unsatisfied/no symptoms) to 4 (very satisfied/severe symptoms). Results: Of the 106 eligible patients, 24 (22.6%) completed the survey. Most reported persistent anhidrosis (palmar or palmar-axillary) 20 years post-surgery. The survey results remained consistent with those at the 1-year follow-up. Significant sweat redistribution to the abdomen and back was observed. Patient satisfaction remained high, with no significant differences between the 1-year and 20-year assessments. Anxiety significantly decreased compared to preoperative levels (p < 0.001). Conclusions: Bilateral endoscopic thoracic sympathectomy is an effective long-term treatment for reducing excessive sweating. Patient satisfaction remains high over time, despite the persistence of compensatory sweating.

PMID:40725520 | DOI:10.3390/jcm14144831

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Primary hyperhidrosis: an updated review

Drugs Context. 2025 Jun 16;14:2025-3-2. doi: 10.7573/dic.2025-3-2. eCollection 2025.

ABSTRACT

BACKGROUND: Hyperhidrosis (HH) is a condition characterized by excessive sweating beyond the physiological needs of thermoregulation. HH can be classified as primary (idiopathic) hyperhidrosis (PHH) or secondary hyperhidrosis (SHH), which is associated with underlying medical conditions, medications or systemic disorders. This narrative review provides an updated overview of PHH, with a focus on epidemiology, aetiopathogenesis, clinical manifestations, diagnostic approaches and current management strategies, particularly highlighting pharmacological and procedural treatment options.

METHODS: A literature search was conducted in February 2025 across Ovid Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) using the key term “hyperhidrosis”. The review included observational studies, clinical trials, narrative reviews, guidelines and meta-analyses published in the past 10 years. Additional references were identified through manual searches of relevant bibliographies.

RESULTS: The global prevalence of PHH is estimated to range between 0.072% and 9%, with PHH accounting for 93% of all HH cases. Whilst the precise pathophysiology remains unclear, PHH is believed to result from sympathetic overactivity, whereas SHH is associated with endocrine, neurological, infectious, malignant and medication-induced causes. PHH is diagnosed clinically and distinguishing between primary and secondary forms is essential. Management options vary based on severity, ranging from topical therapies (antiperspirants, anticholinergics), systemic medications (oral anticholinergics, adrenergic modulators), device-based interventions (iontophoresis, microwave thermolysis), injectable therapies (botulinum toxin) and surgical approaches (sympathectomy, excision, liposuction/curettage). Whilst these interventions can significantly improve symptoms and quality of life, long-term efficacy, recurrence and adverse effects remain concerns.

CONCLUSION: PHH significantly impacts the quality life of patients contributing to both physical discomfort and psychosocial distress. An individualized, multi-modal approach is crucial to optimizing management. Further research is warranted to refine existing therapies and evaluate emerging treatment modalities for improved long-term outcomes.

PMID:40575073 | PMC:PMC12201942 | DOI:10.7573/dic.2025-3-2

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T3 Endoscopic Thoracic Ganglionectomy Using Cutting Mode Cautery for Palmar Hyperhidrosis

Ann Thorac Surg Short Rep. 2024 Dec 13;3(2):456-460. doi: 10.1016/j.atssr.2024.12.004. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Understanding the precise anatomy of the upper thoracic sympathetic trunk is crucial for effectively treating palmar hyperhidrosis using the surgical technique of endoscopic thoracic sympathectomy (ETS). The variability in the location of T2 and T3 ganglia in relation to the ribs may contribute to inconsistent clinical outcomes after ETS.

METHODS: For the cadaver study, adult human cadaveric thoraces were dissected to map the locations of T2 and T3 ganglia by identifying their white rami communicantes. For the ETS group, T3 ganglionectomy ETS was performed. Surgical outcome and postoperative incidence of compensatory sweating were assessed.

RESULTS: A total of 74 pediatric patients underwent thoracoscopic T3 ganglionectomy. All patients were satisfied with the surgical outcomes. No patients complained of compensatory sweating. Forty cadavers were dissected: 25 adult female and 15 adult male. The findings showed that a high percentage of T2 ganglia are near the superior border of the third rib, while the T3 ganglion is near the fourth rib.

CONCLUSIONS: Because of the proximity of the T2 ganglion to the third rib, accidental thermal injury to the T2 ganglion may occur when third rib-oriented ETS is performed. A ganglion-oriented T3 ETS can be accomplished by using the white ramus communicans as a guide to accurately locate the T3 ganglion.

PMID:40525165 | PMC:PMC12167563 | DOI:10.1016/j.atssr.2024.12.004

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Primary Hyperhidrosis in Children: Current Perspectives and Therapeutic Options

Pediatr Ann. 2025 Jun;54(6):e196-e202. doi: 10.3928/19382359-20250321-03. Epub 2025 Jun 1.

ABSTRACT

Primary hyperhidrosis is a common condition that often begins before age 18 years and frequently presents to the pediatric primary care provider. It can have significant negative impacts on a child’s quality of life (QOL) and emotional well-being. There are a variety of treatment options available that have been shown to decrease symptoms, as well as improve QOL. These treatments include over-the-counter antiperspirants, prescription antiperspirants, topical anticholinergics, iontophoresis, systemic anticholinergics, injectable botulinum toxin, and surgical sympathectomy. Treatment of this condition is lifelong and often nuanced. It is imperative for the pediatric practitioner to be well versed in the risks and benefits, as well as proper usage, of these various therapeutic modalities. With this knowledge, effective treatment plans can be crafted to improve both the physical and mental health of affected children. [Pediatr Ann. 2025;54(6):e196-e202.].

PMID:40489364 | DOI:10.3928/19382359-20250321-03

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Achieving high patient satisfaction after sympathectomy through preoperative thoracoscopic sympathetic nerve block in primary hyperhidrosis

J Thorac Dis. 2025 Apr 30;17(4):2050-2055. doi: 10.21037/jtd-2024-2145. Epub 2025 Apr 21.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) is a frequent complication following sympathectomy, influencing patient satisfaction. This study was established to evaluate the impact of bilateral thoracoscopic sympathetic nerve block (TSNB) on patient satisfaction after sympathectomy in the treatment of primary hyperhidrosis.

METHODS: From March 2021 to August 2023, 52 patients with primary palmar and craniofacial hyperhidrosis underwent TSNB at T3 using a 2-mm thoracoscope under local anesthesia. One week later, they decided whether to proceed with sympathectomy. Satisfaction was assessed using a 100-point scale, and patients were divided into two groups based on CH occurrence after sympathectomy. The groups were compared in terms of sex, age, hyperhidrosis site, and satisfaction scores.

RESULTS: Among 52 patients who underwent TSNB, 35 (67.31%) proceeded to sympathectomy, and CH occurred in 18 (51.43%) of these patients, while the remaining 17 patients (48.57%) did not develop CH. No significant differences were observed between the CH and no-CH groups regarding age (26.61±9.02 vs. 25.41±10.09 years, P=0.66), sex (61.11% vs. 52.94% male, P=0.88), or primary hyperhidrosis site (palmar: 77.78% vs. 88.24%, P=0.66). Satisfaction scores were comparable between the CH group (92.50±7.33) and the no-CH group (96.18±4.52), with no statistically significant difference (P=0.15).

CONCLUSIONS: Sympathectomy is associated with a high incidence of CH. Through TSNB, patients could preoperatively experience potential effects, including CH, enabling informed surgical decisions. Patients who developed CH reported high satisfaction levels comparable to those without CH, underscoring the utility of TSNB in improving patient-centered outcomes.

PMID:40400983 | PMC:PMC12090137 | DOI:10.21037/jtd-2024-2145

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Global research trends and hotspots of hyperhidrosis: a bibliometric analysis (2008-2023)

Front Surg. 2025 Apr 22;12:1559951. doi: 10.3389/fsurg.2025.1559951. eCollection 2025.

ABSTRACT

BACKGROUND: Recent studies have demonstrated significant advancements in the treatment of hyperhidrosis. However, a bibliometric analysis of relevant studies in this field is notably lacking. This study aims to provide a detailed analysis of research trends and key areas of interest in hyperhidrosis over the last 16 years using bibliometric methods.

METHODS: We searched the Web of Science Core Collection (WoSCC) database for hyperhidrosis-related publications from 2008 to 2023 and conducted bibliometric analysis using VOS viewer and the R package “bibliometrix.”

RESULTS: The main research institutions involved in this study are the University of São Paulo, Hospital Israelita Albert Einstein, Yonsei University and Fujian Medical University, with a total of 728 articles included from 52 countries. Authors from these institutions have published in top journals, with Dermatologic Surgery being the most popular journal and the Journal of the American Academy of Dermatology being the most cited. A total of 2,830 authors have contributed to this field, with prominent researchers including Nelson Wolosker, Paulo Kauffman, Pedro Puech-Leão, Jose Ribas Milanez de Campos, and Dee Anna Glaser. Nelson Wolosker stands out as the most co-cited author. The primary focus of research in this area is on the treatment of hyperhidrosis and the prevention of post-operative complications. Emerging re-search hotspots include keywords such as “botulinum toxin,” “oxybutynin,” “sympathectomy,” “iontophoresis,” and “compensatory sweating”.

CONCLUSION: The most prevalent academic emphasis within this field remains the treatment of hyperhidrosis and the management of compensatory hyperhidrosis. Despite this academic preponderance, there is a compelling necessity to foster enhanced collaboration and exchange between disparate countries and institutions.

PMID:40330089 | PMC:PMC12052815 | DOI:10.3389/fsurg.2025.1559951

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Case Report: Single-port thoracoscopic surgery for severe primary palmar hyperhidrosis in a 9-year-old child

Front Med (Lausanne). 2025 Apr 15;12:1542064. doi: 10.3389/fmed.2025.1542064. eCollection 2025.

ABSTRACT

Primary palmar hyperhidrosis (PPH) is a somatic condition characterized by excessive sweating of the hands. It mainly affects adolescents and young adults and is rarely observed among children. This condition significantly impairs patients’ academic performance, daily activities, and social interactions and can even lead to insurmountable psychological burdens. Surgical intervention for PPH is typically reserved for individuals aged 16 years and older, as compensatory hyperhidrosis occurs at a high rate (65%) postoperatively among children younger than 14 years. Therefore, the decision for surgery is controversial and has been rarely documented in the literature. Here, we report a 9-year-old child with a 3-year history of bilateral palmar hyperhidrosis. Conservative treatment with medications for 6 months led to no improvement. The patient had signs of low self-esteem, social withdrawal, and aversion to school, alongside recurrent skin damage at the fingertips. Both the child and parents expressed a strong desire for effective treatment. Single-port endoscopic thoracic sympathectomy (ETS) was conducted after comprehensive risk disclosure and obtaining informed consent from the parents, achieving remarkable therapeutic outcomes. At the 12-month follow-up, the patient exhibited no recurrence of symptoms, no compensatory hyperhidrosis, and no complications, such as Horner’s syndrome. Both hands remained warm and dry, the lesions of fingertip skin healed, and the patient’s personality became noticeably more positive. Furthermore, the surgical incision was aesthetically pleasing.

PMID:40303365 | PMC:PMC12037579 | DOI:10.3389/fmed.2025.1542064

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Investigation and analysis of personality characteristics of primary palmar hyperhidrosis patients: a cross-sectional observational study

Eur J Med Res. 2025 Apr 23;30(1):323. doi: 10.1186/s40001-025-02575-7.

ABSTRACT

BACKGROUND: Patients with primary palmar hyperhidrosis (PPH) may exhibit distinct personality traits that influence their perception of the condition. These traits can manifest as heightened sensitivity to physical symptoms, as well as feelings of anxiety or depression, especially in social settings.

METHODS: This study is a retrospective cross-sectional observational study aimed to evaluate and analyze the personality characteristics of patients with primary palmar hyperhidrosis using the Personality Diagnostic Questionnaire-Version 4 (PDQ-4). This study explored the relationships between personality traits and various factors, including age, gender, body mass index (BMI), onset age, the age when symptoms began to impact daily life (Impact age), the choice of thoracic sympathectomy nerve segment, and postoperative satisfaction. The study enrolled primary palmar hyperhidrosis patients treated at the Thoracic Surgery Department of Beijing Haidian Hospital between 2016 and 2021, with a total of 791 patients meeting the inclusion criteria. Statistical analyses, such as the Chi-square test and Mann-Whitney U-test, were conducted using SPSS 26.0 to investigate associations between personality traits and various variables.

RESULTS: Primary palmar hyperhidrosis patients exhibited a higher prevalence of personality disorders at 16.18% compared to the general population, which ranges from 6.1 to 9.5%. Male patients exhibited a statistically significantly higher prevalence of schizoid, narcissistic, and antisocial personality disorders compared to female patients (P < 0.05). Furthermore, postoperative satisfaction among patients with primary palmar hyperhidrosis declined over time, with a statistically significant difference (P < 0.05). Notably, primary palmar hyperhidrosis patient comorbid personality disorders experienced a more pronounced decline in satisfaction.

CONCLUSIONS: Patients with primary palmar hyperhidrosis demonstrate a relatively high prevalence of personality disorders.

PMID:40269968 | DOI:10.1186/s40001-025-02575-7