Category: Treatment

Posted on

Radiofrequency Ablation for Refractory Palmar and Plantar Hyperhidrosis: A Case Report

Anesth Pain Med. 2026 Feb 28;16(1):e172975. doi: 10.5812/aapm-172975. eCollection 2026 Feb 28.

ABSTRACT

INTRODUCTION: Palmar and plantar hyperhidrosis (PH) is characterized by sweat production that far exceeds thermoregulatory needs and often has substantial effects on daily functioning, social interaction, and mental health. The condition results from sympathetically mediated overstimulation of the eccrine glands, which are innervated by unmyelinated cholinergic C-type fibers. Radiofrequency ablation (RFA) offers a minimally invasive approach to symptom control in refractory PH through heat-mediated disruption of these sympathetic fibers. Reports describing staged upper- and lower-limb RFA for combined palmar and plantar disease in a single patient remain uncommon; this is the primary reason for presenting this case.

CASE PRESENTATION: A 21-year-old man (American Society of Anesthesiologists physical status I) presented with a 10-year history of progressive palmar and plantar hyperhidrosis that had not shown durable responses to conservative or prior interventional treatment. He used topical aluminum chloride for 2 months without meaningful benefit and subsequently underwent 2 sessions of palmar botulinum toxin injections 5 months apart, which reduced palmar sweating by an estimated 50 – 60% for approximately 2 months per session; the lower limbs were not treated. Eighteen months before the current admission, he underwent RFA of the right thoracic sympathetic chain at another center. This produced approximately 80% improvement in palmar sweating, although sweating persisted along the ulnar nerve distribution; the benefit lasted only approximately 4 months, after which symptoms recurred to baseline. During the present admission, staged RFA was performed bilaterally at L3, with different lower-limb protocols selected in advance based on the prior treatment response and the greater severity of plantar sweating on the left. Seven days later, bilateral RFA was performed at T3. At the 2-week, 1-month, and 7-month follow-up visits, the patient reported no compensatory sweating or change in cutaneous sensation. By his own assessment, overall sweating of the palms and soles was reduced by approximately 90% from baseline, with a satisfaction score of 9/10 and subjectively improved quality of life.

CONCLUSIONS: Staged RFA targeting both the thoracic and lumbar sympathetic chains appears to be a reasonably safe palliative option for patients with refractory combined palmar and plantar hyperhidrosis, with a more favorable complication profile than surgical sympathectomy. This case is considered reportable because it involves combined, staged treatment of both the upper and lower limbs in a single patient.

PMID:42763681 | PMC:PMC13589454 | DOI:10.5812/aapm-172975

Posted on

A 1% glycopyrronium bromide cream for topical treatment of severe primary axillary hyperhidrosis in adolescents: safety, local tolerability, systemic exposure and efficacy from an open-label phase II study

J Dtsch Dermatol Ges. 2026 Sep 15. doi: 10.1111/ddg.70469. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Primary axillary hyperhidrosis (PAHH) results from dysregulation of the autonomic nervous system and typically begins during puberty. Treatment options for adolescents remain limited. This open-label phase II study evaluated the safety, local tolerability, systemic exposure, and efficacy of 1% GPB cream over 8 weeks in adolescents with severe PAHH.

PATIENTS AND METHODS: A total of 42 adolescents (23 male [55%] and 19 female [45%]; aged 12-17 years) applied the cream once daily for the first 4 weeks and thereafter as needed (at least twice weekly but no more than once daily). The primary endpoints assessed adverse drug reactions (ADRs), local tolerability, and systemic glycopyrronium exposure. Changes in sweat production, PAHH severity, and quality of life were assessed in all patients.

RESULTS: Two patients experienced mild ADRs (dry eye and increased conjugated bilirubin in one patient each); no serious adverse events occurred. All 40 evaluable patients had a skin reaction score of 0 throughout treatment. Total sweat production decreased significantly from baseline to day 29 (p < 0.001) and day 57 (p < 0.001). Patient-rated hyperhidrosis severity (PRHS) and quality of life, assessed using the Children’s Dermatology Life Quality Index (CDLQI), also improved significantly at both time points (all p < 0.001).

CONCLUSIONS: 1% GPB cream showed favorable safety and tolerability and improved clinical outcomes in adolescents with severe PAHH, consistent with findings in adults.

PMID:42745527 | DOI:10.1111/ddg.70469

Posted on

Primary Hyperhidrosis: A Review of Epidemiology, Pathophysiology and Management

Acta Derm Venereol. 2026 Sep 16;106. doi: 10.2340/actadv.v106.adv-2026-0770.

ABSTRACT

Primary hyperhidrosis is termed as excessive sweating exceeding the physiological needs of thermoregulation. This review provides an updated overview focusing on epidemiology, quality of life, pathophysiology, economic impacts, diagnostic approaches and current management strategies. A literature search was conducted in June 2026 across PubMed and the Cochrane Central Register of Controlled Trials. Additional references were identified through manual searches of relevant bibliographies. Reported prevalence of hyperhidrosis varied widely, likely reflecting differences in methodology and disease recognition. Primary hyperhidrosis is associated with autonomic dys-regulation involving sympathetic pathways. Emerging evidence suggests that molecular alterations in eccrine glands may represent secondary adap-tations to sustained cholinergic stimulation, while genetic variability in receptor expression may contribute to interindividual differences in disease severity. Hyperhidrosis has a strong negative impact on the economy and quality of life, adversely affecting both mental and physical health. Multiple treatment options are available, including topical therapies, systemic agents, device-based interventions, botulinum toxin injections, and surgery. Despite increasing recognition of the clinical burden, comprehensive economic evaluations remain limited, with indirect costs and long-term societal impact insufficiently characterized. In conclusion, primary hyperhidrosis imposes a substantial burden on affected individuals, requiring improved re-cognition, standardized diagnostic frameworks, and individualized management strategies supported by high-quality and longitudinal research.

PMID:42747166 | DOI:10.2340/actadv.v106.adv-2026-0770

Posted on

Persistent Hyperhidrosis in the Psychiatric Setting: A Case Report

Cureus. 2026 Aug 11;18(8):e114349. doi: 10.7759/cureus.114349. eCollection 2026 Aug.

ABSTRACT

Hyperhidrosis, defined as excessive sweating beyond what is required for thermoregulation, is a recognized adverse effect of numerous medications, including several classes of psychotropic agents acting through different mechanisms. We present the case of a 43-year-old male with a complex psychiatric and medication history who developed persistent, drenching night sweats that continued despite multiple psychotropic medication adjustments and discontinuations. Alternative metabolic, infectious, endocrine, and substance-related causes were considered without identification of a clear etiology. This case highlights the difficulty of attributing hyperhidrosis to a single agent in patients with complex medication histories and emphasizes the importance of balancing symptom management with the continuation of necessary psychiatric treatment.

PMID:42725212 | PMC:PMC13561136 | DOI:10.7759/cureus.114349

Posted on

Botulinum toxin A for primary axillary hyperhidrosis: a narrative review

J Med Life. 2026 Jun;19(6):420-425. doi: 10.25122/jml-2026-0005.

ABSTRACT

Primary axillary hyperhidrosis (PAH) markedly impairs psychosocial well-being and daily functioning. Botulinum toxin type A (BoNT-A) is widely used, both on- and off-label, to suppress eccrine sweating through presynaptic inhibition of acetylcholine release and temporary chemodenervation of cholinergic sympathetic fibers. This narrative review synthesizes published clinical evidence between 2000 and January 2025 regarding the efficacy, durability, safety, and quality-of-life outcomes of BoNT-A for PAH, with comparative consideration of toxin formulations, injection techniques, and device-based alternatives. Evidence from randomized trials, prospective cohorts, long-term observational studies, and meta-analyses consistently demonstrates that intradermal BoNT-A achieves substantial axillary sweat reduction, often exceeding 50-80%, with improvement of at least two grades on the Hyperhidrosis Disease Severity Scale and meaningful reductions in Dermatology Life Quality Index scores. Treatment effects typically persist for approximately 4-7 months per cycle and are associated with predominantly mild, localized adverse events. Comparative data indicate similar efficacy among onabotulinumtoxinA, incobotulinumtoxinA, and abobotulinumtoxinA when equivalent dosing and standardized mapping techniques are applied. Injection strategy, particularly multi-point intradermal delivery guided by starch-iodine mapping, influences coverage and durability. Energy-based modalities-including microwave thermolysis and fractional microneedle radiofrequency-reduce sweating via device-mediated thermal targeting of eccrine glands and show variable comparative outcomes versus intradermal BoNT-A in durability, downtime, and cost. Overall, BoNT-A remains a well-supported first-line injectable therapy for PAH refractory to topical treatment, while further head-to-head and cost-effectiveness studies remain warranted.

PMID:42602382 | PMC:PMC13474375 | DOI:10.25122/jml-2026-0005

Posted on

Real-World Outcomes of Microwave Treatment for Axillary Hyperhidrosis and Bromhidrosis: A 12-Month Study in a Southeast Asian Setting

Clin Cosmet Investig Dermatol. 2026 Jul 25;19:617844. doi: 10.2147/CCID.S617844. eCollection 2026.

ABSTRACT

BACKGROUND: Microwave therapy has emerged as a minimally invasive treatment option, but long-term real-world data, particularly from Southeast Asian populations, remain limited.

PURPOSE: To evaluate the effectiveness of microwave therapy and its impact on quality of life (QoL) in patients with axillary hyperhidrosis and bromhidrosis.

PATIENTS AND METHODS: A longitudinal ambispective case series study was conducted on 52 adult patients with axillary hyperhidrosis and bromhidrosis treated with microwave therapy. Treatment efficacy and QoL improvement were assessed at 1 week and at 3, 6, 9, and 12 months post-intervention using the Minor test, Hyperhidrosis Disease Severity Scale (HDSS), Visual Analog Scale (VAS), and Dermatology Life Quality Index (DLQI). Repeated measures were analyzed using mixed-effects models.

RESULTS: At 1 week, the mean area of discoloration decreased markedly from 49.1 cm2 to 0.3 cm2 in the left axilla, with similar improvement observed in the right axilla. At 12 months, compared with baseline, the model-predicted probability of HDSS grade 4 decreased from 68.2% to 5.7%, while the mean odor score and DLQI score decreased from 6.8 to 3.0 and from 19.5 to 6.5, respectively. Overall satisfaction at 12 months was 66.6%. Statistically significant improvements were observed across the majority of efficacy outcomes (p < 0.05). The most common adverse events were pain and swelling, which were mild and self-limiting, with no serious complications reported.

CONCLUSION: Microwave therapy demonstrated a favorable safety profile and sustained clinical benefits in patients with axillary hyperhidrosis and bromhidrosis over 12 months of follow-up. Although patient satisfaction declined modestly at 12 months, overall treatment outcomes remained favorable.

PMID:42529744 | PMC:PMC13418893 | DOI:10.2147/CCID.S617844

Posted on

A retrospective study comparing T3 ganglionectomy and R4 sympathicotomy for reducing compensatory hyperhidrosis in primary palmar hyperhidrosis

J Thorac Dis. 2026 Jun 30;18(6):592. doi: 10.21037/jtd-2026-0904. Epub 2026 Jun 26.

ABSTRACT

BACKGROUND: Despite the high surgical success rate, postoperative compensatory hyperhidrosis (CH) remains a persistent concern in the treatment of primary palmar hyperhidrosis using endoscopic thoracic sympathectomy (ETS). This study aims to compare the early clinical outcomes of two surgical techniques-T3 ganglionectomy and R4 sympathicotomy-to determine which approach minimizes CH occurrence and enhances patient satisfaction.

METHODS: A retrospective analysis of medical records was conducted on patients who underwent either T3 ganglionectomy or R4 sympathicotomy for primary palmar hyperhidrosis at Gangnam Severance Hospital from January 2023 to December 2023. Demographic data and postoperative outcomes were evaluated. CH and degree of satisfaction were assessed during outpatient visits at 3 weeks and 3 months after surgery.

RESULTS: In this study, 44 patients underwent T3 ganglionectomy and 225 patients underwent R4 sympathicotomy. There were no statistically significant differences in baseline characteristics (age, sex, body mass index, smoking history, and family history) or operative complications between the two groups. However, CH at 3 weeks and 3 months after surgery was significantly lower in T3 ganglionectomy group [4 (9.1%) vs. 143 (63.6%); P<0.001, 5 (11.4%) vs. 150 (66.7%); P<0.001]. Additionally, patient satisfaction was significantly higher in the T3 ganglionectomy group compared to the R4 sympathicotomy group (P<0.001).

CONCLUSIONS: T3 ganglionectomy exhibited superior surgical outcomes in terms of both CH and patient satisfaction for primary palmar hyperhidrosis when compared to R4 sympathicotomy. Nonetheless, a larger prospective study with long-term follow-up is necessary to validate these findings.

PMID:42444879 | PMC:PMC13358477 | DOI:10.21037/jtd-2026-0904

Posted on

Clinical Characteristics and Treatment Patterns of Hyperhidrosis in Northern Hokkaido: A Single-Center Retrospective Descriptive Study

J Dermatol. 2026 Jul 1. doi: 10.1111/1346-8138.70373. Online ahead of print.

ABSTRACT

Hyperhidrosis is a common condition associated with a substantial negative impact on the quality of life. Several studies have described the clinical characteristics and disease burden of patients with hyperhidrosis in Japan. However, comparable real-world clinical data on hyperhidrosis from Hokkaido remain limited. We therefore evaluated real-world clinical practice patterns at our institution before and after the establishment of a specialized outpatient clinic for hyperhidrosis. In this retrospective study, we analyzed the data of 144 patients who presented with hyperhidrosis between November 2013 and March 2025. Patient characteristics, pathways to care, treatment modalities, and treatment continuation were evaluated using data from electronic medical records. The sex distribution, age at presentation, and subtype distribution of hyperhidrosis in our cohort were largely consistent with those reported in a prior nationwide survey. Primary axillary and/or palmar hyperhidrosis accounted for 87.5% of all cases. After launching a specialized clinic in April 2023, we observed a substantial increase in the number of patients who consulted for hyperhidrosis during visits for other dermatologic conditions; this finding may suggest the presence of previously unrecognized patients. However, changes in hospital access policies may also have influenced consultation patterns. The treatment continuation rates for axillary and palmar hyperhidrosis were both approximately 40%. Among the treatments for axillary hyperhidrosis, sofpironium bromide gel was prescribed most frequently, whereas glycopyrronium tosylate hydrate wipes showed a higher treatment continuation rate. In conclusion, the presence of a specialized outpatient clinic may improve access to care for patients with primary focal hyperhidrosis and facilitate the identification of previously unrecognized patients. However, treatment continuation remained suboptimal, highlighting the importance of improving continuity of care in hyperhidrosis management at our institution.

PMID:42385158 | DOI:10.1111/1346-8138.70373