Category: Treatment

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Management of Craniofacial Hyperhidrosis with Botulinum Toxin: A Systematic Review

Skin Appendage Disord. 2026 Sep 25. doi: 10.1159/sad/aesag012. Online ahead of print.

ABSTRACT

INTRODUCTION: Treatment of craniofacial hyperhidrosis (CFH) is challenging because of the anatomical characteristics of the head and face. Although topical anticholinergics are generally considered first-line therapy, botulinum toxin has emerged as an effective option, while evidence remains more limited than for axillary hyperhidrosis. The objective of this study is to systematically review current evidence on the efficacy and safety of botulinum toxin in the treatment of CFH.

METHODS: Clinical studies evaluating different types of botulinum toxin type A (BoNT-A) and type B (BoNT-B) for CFH were reviewed, focusing on treatment efficacy, onset of response, anatomical sites and safety.

RESULTS: BoNT-A was the most consistently studied formulation and demonstrated substantial improvement of CFH. The duration of response generally ranged from 4 to 9 months, with more recent cohorts reporting efficacy lasting up to 12 months. Onset of action typically occurred within 1-2 weeks. The forehead and scalp were the most frequently treated sites, followed by gustatory and occipital regions. BoNT-B also produced significant reductions in sweating and improvements in quality of life.

CONCLUSION: Botulinum toxin appears to be an effective and safe treatment for CFH. Long-term studies are needed to establish the optimal toxin type, administration technique and retreatment interval.

PMID:42923985 | PMC:PMC13688397 | DOI:10.1159/sad/aesag012

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Treatment Satisfaction and Patterns Among Primary Hyperhidrosis Patients

J Dermatol. 2026 Oct 19. doi: 10.1111/1346-8138.70539. Online ahead of print.

ABSTRACT

Primary hyperhidrosis can substantially impair daily activities and psychosocial well-being. This single-center cross-sectional questionnaire study examined treatment use and factors associated with treatment satisfaction among 92 patients with primary hyperhidrosis recruited by treating physicians at a single clinic between 2024 and 2025. Treatment use was analyzed at the patient-treatment level using logistic regression with patient-level clustering. Factors associated with treatment satisfaction were evaluated using generalized estimating equation logistic regression, and sensitivity analyses applied alternative satisfaction thresholds. Patient-reported sweat reduction was the factor most consistently associated with treatment satisfaction. This association remained evident in adjusted models and sensitivity analyses. In contrast, time to treatment effect, hyperhidrosis disease severity scale score, sex, age group, treatment-related adverse events, treatment modality, and affected site showed no statistically significant or consistent associations with satisfaction. Sweat reduction and satisfaction wasn’t completely concordant; some observations indicated satisfaction despite poor sweat reduction, whereas dissatisfaction despite favorable sweat reduction was rare. Treatment frequency showed no consistent association with satisfaction, and treatment duration differed only under one strict definition of satisfaction. Although affected site was not independently associated with satisfaction in the regression models, descriptive satisfaction rates varied across body-site and treatment-modality combinations. Patient-reported sweat reduction did not fully explain treatment satisfaction. Treatment benefit should therefore be assessed comprehensively by considering perceived sweat reduction, treatment burden, and broader clinical context.

PMID:42897084 | DOI:10.1111/1346-8138.70539

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Topical oxybutynin antiperspirant for axillary hyperhidrosis: a phase IIb PROBE design clinical trial (TODAY trial)

J Vasc Bras. 2026 Sep 14;25:e20250065. doi: 10.1590/1677-5449.20250065. eCollection 2026.

ABSTRACT

BACKGROUND: Primary hyperhidrosis is a chronic condition with limited therapeutic options.

OBJECTIVES: To evaluate the impact of 10% oxybutynin spray on axillary hyperhidrosis, considering both its local and systemic effects, in terms of Hyperhidrosis Disease Severity Scale (HDSS) outcomes for hyperhidrosis of the axilla and eight additional sites.

METHODS: Prospective phase II PROBE design trial. Adult patients with axillary hyperhidrosis were randomized to receive a 10% oxybutynin topical spray, oral oxybutynin, or placebo spray for 35 days. Efficacy was evaluated on day 35 using the HDSS and a hyperhidrosis-specific quality-of-life (QoL) assessment questionnaire.

RESULTS: 17 patients were randomized. No significant differences were observed in HDSS outcomes from baseline to day 35 in any of the three groups (2.5 [2 – 4], 4 [3 – 4], 3.5 [3 – 4], p= 0.207), although a trend to improvement was noted in both treatment groups. Significant improvement in the QoL questionnaire was observed from baseline to day 35 in the oxybutynin spray group (pre-intervention QoL: 78.5 [70 – 96] and post-intervention QoL: 38.5 [32 – 67], p = 0.031).

CONCLUSIONS: No differences were observed in the primary outcome. A significant improvement from baseline to day 35 was observed in the QoL questionnaire score for the oxybutynin spray group.

PMID:42890128 | PMC:PMC13671017 | DOI:10.1590/1677-5449.20250065

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Efficacy of Radiofrequency Combined with Chemical Sympatholysis in the Treatment of Primary Palmar Hyperhidrosis: A Retrospective Cohort Study

J Vasc Interv Radiol. 2026 Oct 14:109135. doi: 10.1016/j.jvir.2026.109135. Online ahead of print.

ABSTRACT

PURPOSE: To investigate and compare the efficacy and safety of radiofrequency thermocoagulation (RFT) and combined with chemical sympatholysis (RFT-CS) for the treatment of primary palmar hyperhidrosis (PPH) (Hyperhidrosis Disease Severity Scale [HDSS] grade III or IV).

MATERIALS AND METHODS: Patients who underwent computed tomography-guided percutaneous thoracic sympathetic neurolysis (TSN) for PPH were retrospectively analyzed and divided into two treatment regimens: RFT (group RFT, N = 60, 120 sides) and RFT combined with CS (group RFT-CS, N = 58, 116 sides).

RESULTS: At 1, 3, 6, 12, and 24 months, the number of sides with HDSS III/IV in the RFT group was 29, 32, 41, 47, and 56, respectively; in the RFT-CS group, 25, 31, 36, 40, and 45, with no statistically significant intergroup differences at any time point (all P ≥ .05). Overall recurrence rates rose from 3.0% at 1 month to 19.5% at 24 months, with no significant differences between groups at any time point (all P ≥ .05). The RFT-CS group had significantly higher compensatory hyperhidrosis (CH) rates at 12 months (62.1% vs. 56.7%; P = .012) and 24 months (58.6% vs. 50.0%; P = .014), and a higher incidence of thoracic neuralgia at 1 month (P = .023) and 3 months (P = .011).

CONCLUSION: Both of the TSN treatment modes are effective for the treatment of severe PPH. Compared with RFT alone, RFT combined with CS does not seem to show better efficacy but increases the occurrence of CH and thoracic neuralgia.

PMID:42874704 | DOI:10.1016/j.jvir.2026.109135

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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

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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

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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

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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

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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