Category: Treatment

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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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Botulinum Toxin Type A in the Treatment of Primary Axillary Hyperhidrosis:A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of Efficacy and Safety in Chinese Patients

Aesthet Surg J. 2026 Jan 19:sjaf260. doi: 10.1093/asj/sjaf260. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy and safety of botulinum toxin type A (BoNTA) treatment for primary axillary hyperhidrosis (PAH) have not been explored in the Chinese population.

OBJECTIVES: The objective was to evaluate efficacy and safety of 1 intradermal BoNTA injection in Chinese PAH cases.

METHODS: This was a Phase 3, multicenter, randomized, double-blind, placebo-controlled study. Patients were randomized to an experimental group or the control group at a ratio of 3:1 and received either BoNTA or a placebo once. The primary efficacy endpoint was the proportion of patients who experienced an over 50% reduction in axillary sweat weight at Week 4 posttreatment compared to baseline. The key secondary efficacy endpoints were the percentage changes in axillary sweat weight at Weeks 1, 4, 8, and 16 posttreatment.

RESULTS: A total of 344 patients were randomized to the experimental group (n = 258) or the control group (n = 86). The proportions of patients who experienced an over 50% reduction in axillary sweat weight at Week 4 posttreatment were 83.72% (216/258) in the experimental group and 55.81% (48/86) in the control group, respectively. The between-group difference was 27.91% (P < .001). BoNTA treatment yielded a significant reduction in axillary sweat weight, hyperhidrotic area, hyperhidrosis disease severity scale (HDSS) scores, and grade of bromhidrosis. The patients in the experimental group reported significantly higher satisfaction scores than those in the control group. BoNTA treatment was well tolerated. Neither group experienced suspected unexpected serious adverse reactions, or adverse events or adverse drug reactions leading to withdrawal or death.

CONCLUSIONS: One intradermal 50-U BoNTA treatment led to a significant reduction in axillary sweat weight, axillary hyperhidrotic area, HDSS scores, and axillary bromhidrosis grades in Chinese PAH patients. The therapeutic effect was maintained for 16 weeks posttreatment, with a favorable safety profile.

PMID:41553927 | DOI:10.1093/asj/sjaf260

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Beyond the Axilla: The Evolving Role of Botulinum Toxin in the Treatment of Facial, Scalp, and Focal Hyperhidrosis

Clin Dermatol. 2025 Dec 27:S0738-081X(25)00336-0. doi: 10.1016/j.clindermatol.2025.12.003. Online ahead of print.

ABSTRACT

Botulinum toxin type A (BoNTA) is an established treatment for focal hyperhidrosis of the axillae and palms, but its use has recently expanded to include craniofacial, facial, and scalp hyperhidrosis. This systematic review with narrative synthesis evaluates the clinical use of BoNTA for focal hyperhidrosis across multiple anatomical sites. A structured search of PubMed/MEDLINE, Embase, and Scopus was conducted for English-language human studies published between 2000 and 2025. Original clinical studies reporting outcomes related to sweat reduction, disease severity, quality of life, duration of effect, or adverse events were included, while reviews and non-original publications were used only for background and citation tracking. A total of 33 original clinical studies met inclusion criteria. Evidence was strongest for axillary hyperhidrosis, where randomized controlled trials consistently demonstrated substantial reductions in sweating and sustained patient-reported benefit. Palmar hyperhidrosis showed reliable efficacy, although treatment was limited by injection discomfort and transient weakness. Evidence for craniofacial, facial, and scalp hyperhidrosis consisted primarily of small cohorts and case series, which nevertheless reported meaningful symptom improvement and acceptable safety profiles despite heterogeneity in dosing and injection techniques. Overall, BoNTA remains a cornerstone therapy for focal hyperhidrosis, and while evidence beyond the axillae is less robust, available data support its use in selected patients and underscore the need for larger, standardized studies in craniofacial and scalp hyperhidrosis.

PMID:41461243 | DOI:10.1016/j.clindermatol.2025.12.003

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Botulinum Toxin as a Tool to Reduce Hyperhidrosis in Amputees

Cutis. 2025 Oct;116(4):131-132. doi: 10.12788/cutis.1274.

ABSTRACT

Botulinum toxin (BTX) is an effective treatment for improving prosthetic discomfort and reducing limb pain in amputees, particularly those experiencing hyperhidrosis of the residual limb. We describe a technique for administering BTX injections by dividing the residual limb into targeted areas and delivering the treatment in stages. This approach demonstrated an excellent outcome in our patient, enhancing comfort and managing hyperhidrosis. Our case underscores the importance of personalized treatment plans that are tailored to each patient’s needs while also addressing factors that may affect their access to effective therapies.

PMID:41363962 | DOI:10.12788/cutis.1274

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Three-Year Results Following Microwave Therapy in Patients with Severe Primary Axillary Hyperhidrosis

Aesthetic Plast Surg. 2025 Dec 1. doi: 10.1007/s00266-025-05469-5. Online ahead of print.

ABSTRACT

Microwave therapy (Miradry®) is an approved treatment for axillary hyperhidrosis (AH). There are several studies in the literature that show favourable safety and efficacy profile, although a few follow up patients under longer period and on larger cohort patients. In the present study, we report three-year results after microwave therapy for AH. At dermatology clinic in Östergötland 103 patients with severe AH received one or two Miradry® treatments, between 2020 and 2022. Patients were examined at several intervals during study period. Between March 2024 and June 2025, 87 patients were contacted by post and asked to complete HDSS (Hyperhidrosis Disease Severity Scale) and Hyperhidrosis Quality of Life (HidroQoL©); 45 patients have responded to our survey (response rate 51.7%). Statistically significant improvement was observed in both HDSS (from medians 3 at the study inclusion to medians 2 at 3 year) and HidroQoL© (medians 26 at baseline and medians 6 at 3 year). As a conclusion, our data demonstrate that microwave therapy is a promising long-term efficient treatment for AH and significantly improves quality of life in patients suffering from severe AH.Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:41326743 | DOI:10.1007/s00266-025-05469-5

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Altered Th17/Treg balance and therapeutic targeting of RORgamma in primary focal hyperhidrosis

Front Immunol. 2025 Oct 17;16:1656632. doi: 10.3389/fimmu.2025.1656632. eCollection 2025.

ABSTRACT

BACKGROUND: Primary focal hyperhidrosis (PFH) significantly impacts patients’ physical and mental health, yet its underlying mechanisms remain unclear.

METHODS: This study involved 80 healthy controls and 60 patients each with primary palmar (PPH), craniofacial (PCH), or axillary hyperhidrosis (PAH). Peripheral blood mononuclear cells (PBMCs) were analyzed via flow cytometry to assess Th17 and Treg cell populations. Cytokine levels were measured in patient serum using ELISA, while sweat gland tissue from PAH patients underwent gene expression analysis. A pilocarpine-induced mouse model of hyperhidrosis was used to test SR2211, a RORγ inverse agonist.

RESULTS: PFH patients exhibited a disrupted Th17/Treg balance, with increased Th17 and decreased Treg cells across all subtypes compared to controls. Elevated IL-17 and IL-6 and reduced IL-10 and TGF-β1 levels were observed in PFH serum. Sweat glands showed increased RORγt and decreased FOXP3 expression. In mice, SR2211 treatment reduced sweat secretion, secretory granules, and serum acetylcholine. It also lowered Th17 infiltration, serum IL-17/IL-6, and IL-17A expression in sweat glands.

DISCUSSION: PFH is associated with a Th17/Treg immune imbalance. SR2211 alleviated hyperhidrosis and Th17-related inflammation in mice, highlighting the potential of targeting the RORγ-Th17 axis as a therapeutic strategy for PFH.

PMID:41181099 | PMC:PMC12575253 | DOI:10.3389/fimmu.2025.1656632

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Development and validation of a model for predicting depression risk in primary palmar hyperhidrosis: a cross-sectional retrospective observational study

BMJ Open. 2025 Oct 10;15(10):e101212. doi: 10.1136/bmjopen-2025-101212.

ABSTRACT

OBJECTIVE: Primary palmar hyperhidrosis (PPH), characterised by excessive palm sweating, significantly impacts patients’ physiology, psychology, self-esteem, work, life and social interactions. The incidence of depression is higher among PPH patients. Timely detection of key predictive factors and the development of risk prediction models are crucial for effective intervention and treatment in this patient group.

DESIGN: We conducted an in-depth analysis of clinical data from 926 PPH patients treated at the Thoracic Surgery Department of Beijing Haidian Hospital between 2016 and 2021. We used the Boruta algorithm alongside the Backward Elimination strategy to select predictive factors and constructed five machine-learning models. By evaluating these models’ performance, we determined the optimal one. Additionally, we introduced the Shapley Additive exPlanations method to enhance the interpretability of this optimal model.

RESULTS: The Personality Diagnostic Questionnaire-4 score, Self-Rating Anxiety Scale score, family history, quality of life excluding PPH, onset age and the age when PPH begins to impact life (Impact age) are six predictive factors for depression in PPH patients. The support vector machine (SVM) model performs more comprehensively through model validation. In the validation set, the area under the curve is 0.798 (95% CI: 0.737 to 0.859), with a Brier score of 0.1451 (95% CI: 0.1233 to 0.1716), accuracy of 0.7184, sensitivity of 0.775, specificity of 0.699 and F1 score of 0.585.

CONCLUSIONS: These findings can enhance our understanding of depression in PPH patients, and the SVM model is a valuable screening tool for assessing the risk of depression in PPH patients.

PMID:41073115 | DOI:10.1136/bmjopen-2025-101212

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Hyperhidrosis: Diagnosis and management strategies

Nurse Pract. 2025 Oct 1;50(10):31-36. doi: 10.1097/01.NPR.0000000000000354. Epub 2025 Sep 25.

ABSTRACT

Hyperhidrosis, a condition characterized by an overactive cooling system that produces four to five times the normal amount of sweat, can profoundly impact a person’s physical, psychological, and social well-being. It can be classified as primary or secondary, and the location and severity determine treatment options. These options include topical agents, systemic agents, and nonsurgical and surgical procedures. Nurse practitioners play a crucial role in managing this condition, and their awareness and understanding are vital in designing effective treatment options for their patients. This article aims to enhance knowledge by discussing hyperhidrosis, its impact on a patient’s physical and psychological well-being, and recommended treatment modalities.

PMID:40996843 | DOI:10.1097/01.NPR.0000000000000354

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Unilateral versus Bilateral T3 Ganglionectomy in Primary Palmar Hyperhidrosis Patients

Thorac Cardiovasc Surg. 2025 Sep 11. doi: 10.1055/a-2699-8163. Online ahead of print.

ABSTRACT

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a distressing condition that significantly impairs quality of life. Endoscopic thoracic sympathectomy (ETS) is an effective treatment, but compensatory hyperhidrosis (CH) remains a common and problematic complication. The optimal extent of surgical interruption, particularly the choice between unilateral and bilateral ganglionectomy, remains uncertain.

METHODS: We conducted a retrospective analysis of 118 patients who underwent unilateral (n=41) or bilateral (n=77) T3 ganglionectomy via video-assisted thoracoscopic surgery (VATS) between November 2023 and January 2025. Patient-reported outcomes, including CH and postoperative satisfaction, were assessed three months postoperatively using standardized questionnaires. Comparisons between the two groups were performed using t-tests and chi-square tests.

RESULTS: Baseline demographics were comparable between groups. The unilateral group reported significantly higher satisfaction, with 93% “very satisfied” compared to 61% in the bilateral group (p<0.001). CH was less prevalent in the unilateral group (20% vs. 48%, p=0.007), and when present, was generally mild and limited to a single body region. In contrast, bilateral ganglionectomy was associated with more frequent and multi-regional CH. Among unilateral ETS patients, only 22% later underwent contralateral surgery, indicating that unilateral intervention was sufficient in most cases.

CONCLUSIONS: Unilateral T3 ganglionectomy offers a favorable balance of efficacy and safety, yielding higher satisfaction and significantly reduced CH compared to bilateral procedures. These findings support the use of unilateral ETS as a first-line surgical strategy for PPH, particularly in patients sensitive to CH. A tailored, staged approach may enhance long-term outcomes and patient satisfaction.

PMID:40935159 | DOI:10.1055/a-2699-8163

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Imbalance of NKCC1/KCC2 contributes to the pathogenesis of primary focal hyperhidrosis

Neurochem Int. 2025 Aug 27:106043. doi: 10.1016/j.neuint.2025.106043. Online ahead of print.

ABSTRACT

BACKGROUND: Primary focal hyperhidrosis (PFH) is characterized by excessive sweating in localized regions, significantly impacting patients’ quality of life. The imbalance between sodium-potassium-chloride cotransporter 1 (NKCC1) and potassium-chloride cotransporter 2 (KCC2) disrupts chloride ion homeostasis, potentially contributing to the pathogenesis of PFH.

METHODS: Sweat gland tissues from 76 healthy controls and 76 PFH patients were collected. Expression levels of NKCC1 and KCC2 were assessed using quantitative real-time PCR and Western blotting. Primary sweat gland cells isolated from PFH patients (PFH-SG) and controls (NPFH-SG) were subjected to NKCC1 knockdown via lentiviral shRNA transfection. A hyperhidrosis mouse model was induced by intraperitoneal injection of pilocarpine hydrochloride, and mice were pretreated with the NKCC1 inhibitor bumetanide for one week. Sweat secretion, serum acetylcholine, and chloride ion concentrations were measured. Expression levels of aquaporin 5 (AQP5), brain-derived neurotrophic factor (BDNF), and neuregulin-1 (NRG-1) proteins were analyzed.

RESULTS: PFH tissues showed significantly elevated NKCC1 and decreased KCC2 expression compared to controls, correlating with lower sweat chloride levels. NKCC1 knockdown in PFH-SG cells reduced elevated AQP5 expression. In vivo, bumetanide treatment markedly reduced sweat secretion, lowered serum acetylcholine, and restored chloride ion concentrations in hyperhidrosis mice. Furthermore, bumetanide treatment significantly decreased expressions of BDNF and NRG-1 in sympathetic ganglia axons, indicating attenuation of sympathetic hyperactivity associated with hyperhidrosis. NKCC1/KCC2 imbalance contributes significantly to PFH pathology.

CONCLUSIONS: Bumetanide effectively improves this imbalance, reducing excessive sweating and modulating related neurotransmitter signaling, offering potential therapeutic avenues for PFH.

PMID:40882919 | DOI:10.1016/j.neuint.2025.106043