Category: Treatment

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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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Influence of sex on the outcomes of uniportal video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis

Wideochir Inne Tech Maloinwazyjne. 2025 Feb 10;20(1):55-60. doi: 10.20452/wiitm.2025.17934. eCollection 2025 Apr 9.

ABSTRACT

INTRODUCTION: Primary palmar hyperhidrosis (PPH) impairs the quality of life. Video‑assisted thoracoscopic sympathicotomy is an effective treatment method; however, the impact of sex on surgical outcomes accord‑ ing to the denervation level (T3 vs T3-T4 sympathicotomy) remains unclear.AIM This study investigated the efficacy, complications, and symptom relief rates of isolated T3 vs combined T3-T4 sympathicotomy for PPH, focusing on sex differences.

MATERIALS AND METHODS: A retrospective analysis of 327 patients undergoing bilateral uniportal video‑assisted thoracoscopic sympathicotomy for PPH between 2012 and 2022 was performed. The patients were divided into 2 groups depending on the procedure type (isolated T3 sympathicotomy [n = 167] vs T3-T4 combined sympathicotomy [n = 160]). Demographic data, procedure outcomes, and complications were compared.

RESULTS: Success rates were 95.8% in the T3 sympathicotomy group and 93.8% in the T3-T4 sympathicotomy group, with no significant difference. The most common complication was dryness of the hands. The overall complication rate was lower in the T3 than in the T3-T4 sympathicotomy group (9.6% vs 14.4%; P = 0.04). Compensatory sweating occurred in 2.4% and 3.1% of the participants in the T3 and T3-T4 sympathicotomy groups, respectively (P = 0.52). The frequency of compensatory sweating, chest pain, and dryness of the hands was significantly higher in men. Age, sex, and duration of surgery had no independent influence on the occurrence of complications.

CONCLUSIONS: Isolated T3 sympathicotomy is an effective and safe option for the treatment of PPH, and is associated with fewer complications than combined T3-T4 sympathicotomy. Higher complication rates in men emphasize the need for sex‑specific surgical planning and patient counseling.

PMID:40547836 | PMC:PMC12177343 | DOI:10.20452/wiitm.2025.17934

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Hyperhidrosis Clinical Trial Disparities: Enrollment and Reporting Trends

Skin Appendage Disord. 2025 May 14:1-5. doi: 10.1159/000546318. Online ahead of print.

ABSTRACT

INTRODUCTION: Hyperhidrosis is a chronic condition of excessive sweating with a significant impact on quality of life. Although recent therapeutic advances have expanded treatment options, clinical trial data may lack generalizability due to underrepresentation of diverse populations. This study examined geographic distribution, racial/ethnic representation, and demographic reporting trends in randomized controlled trials (RCTs) for hyperhidrosis.

METHODS: A search of ClinicalTrials.gov in November 2024 identified completed phase 2 and 3 interventional RCTs for hyperhidrosis from 2005 to 2024. Demographics were extracted from trial registries and associated PubMed publications. Race and ethnicity were categorized per US Census definitions, and geographic representation was analyzed by continent.

RESULTS: Thirty-two RCTs with 4,904 participants were included. Most were US-based (62.5%) and only 53.1% reported race/ethnicity. Among reported participants, 55.1% were White, 10.3% Black, 4.1% Asian, and 13% Hispanic/Latino. Race/ethnicity was unknown or unreported for 28.5% of participants. Reporting improved over time (race: 30-63.6%; ethnicity: 20-50%), while geographic diversity declined.

CONCLUSION: Nearly half of hyperhidrosis RCTs failed to report race/ethnicity, and participant diversity remains limited despite improvements. Limited racial/ethnic and geographic diversity undermines the generalizability of trial findings and highlights the need for more inclusive study designs.

PMID:40539206 | PMC:PMC12176401 | DOI:10.1159/000546318

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Seasonal Variation and Meteorological Correlates of Botulinum Toxin Injections for Axillary Hyperhidrosis in Japan: A Retrospective Analysis

Cureus. 2025 May 12;17(5):e83996. doi: 10.7759/cureus.83996. eCollection 2025 May.

ABSTRACT

BACKGROUND: Primary axillary hyperhidrosis, characterized by excessive underarm sweating without an underlying medical condition, significantly impairs quality of life. While various treatments exist, botulinum toxin type A injections are widely used in Japan, especially for severe cases. Although increased sweating is commonly observed during warmer months, the relationship between treatment demand and meteorological factors remains unclear. This study aims to determine whether there are seasonal differences in the number of axillary hyperhidrosis injections in Japan and to investigate their relationship with meteorological conditions.

METHODS: A retrospective, descriptive analysis was conducted using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from fiscal years 2019 to 2022. Monthly injection data were correlated with meteorological variables (temperature, precipitation, solar radiation, wind speed, relative humidity, atmospheric pressure) obtained from the Japan Meteorological Agency. Seasonal differences were assessed using the Steel-Dwass test, and partial correlation analysis examined associations between meteorological factors and injection numbers.

RESULTS: The number of axillary hyperhidrosis injections peaked consistently in May and June each year, with significantly higher volumes in spring and summer compared to fall and winter (p<0.001). Partial correlation analysis revealed a strong positive correlation between all-day solar radiation and injection numbers (r=0.7193; p<0.0001), while temperature (r=-0.6052; p<0.0001) and wind speed (r=-0.441; p=0.0031) were negatively correlated. Relative humidity showed a moderate positive correlation (r=0.3626; p=0.0169). The seasonal peak preceded the hottest months, suggesting proactive treatment-seeking behavior.

CONCLUSIONS: Botulinum toxin injections for axillary hyperhidrosis in Japan display a reproducible seasonal pattern, with demand peaking in late spring and early summer. Solar radiation, rather than temperature alone, is most closely associated with treatment frequency, indicating that patients may seek care in anticipation of increased symptoms. These findings can inform healthcare resource planning and patient education to optimize the management of axillary hyperhidrosis.

PMID:40519391 | PMC:PMC12162388 | DOI:10.7759/cureus.83996

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PAI1 regulating CHRNA1 contributes to primary focal hyperhidrosis: Clinical and experimental studies

Mol Ther Nucleic Acids. 2025 May 16;36(2):102566. doi: 10.1016/j.omtn.2025.102566. eCollection 2025 Jun 10.

ABSTRACT

Primary focal hyperhidrosis (PFH) is a debilitating condition characterized by localized excessive sweating, yet its underlying mechanisms remain poorly understood. In this study, sweat gland tissues from PFH patients (n = 204) and healthy controls (n = 60) were analyzed to assess the mRNA and protein levels of plasminogen activator inhibitor 1 (PAI-1) and nicotinic acetylcholine receptor alpha 1 subunit (CHRNA1) using RT-qPCR and western blotting. Primary sweat gland cells were isolated for in vitro experiments, and a pilocarpine-induced hyperhidrosis mouse model was established to evaluate the therapeutic effect of recombinant human PAI-1 (rhPAI-1). PFH patients showed significantly reduced PAI-1 expression and elevated CHRNA1 expression compared to controls (p < 0.01). Treatment with rhPAI-1 downregulated CHRNA1 and aquaporin 5 (AQP5) expression in sweat gland cells and decreased sweat secretion and serum acetylcholine levels in vivo. These results suggest that PAI-1 negatively regulates CHRNA1 and AQP5 expression, offering new insights into the molecular pathology of PFH and identifying PAI-1 as a potential therapeutic target for hyperhidrosis.

PMID:40503176 | PMC:PMC12155562 | DOI:10.1016/j.omtn.2025.102566

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Efficacy and Safety of Botulinum Toxin Type A in Primary Axillary Hyperhidrosis: A Meta-analysis and Systematic Review

Aesthetic Plast Surg. 2025 Jun 11. doi: 10.1007/s00266-025-04909-6. Online ahead of print.

ABSTRACT

BACKGROUND: The clinical efficacy of botulinum toxin type A (BTX-A) injections for the treatment in primary axillary hyperhidrosis is a subject of ongoing debate. This study aims to consolidate and analyze the available evidence regarding the use of BTX-A as a therapeutic intervention for this conclusion.

METHOD: This study was conducted in accordance with PRISMA guidelines and registered with PROSPERO. We included RCTs on BTX-A injections for PAH, comparing it to placebo or other treatments. A comprehensive literature search was conducted in multiple databases up to May 2024. Out of identified articles, some underwent full-text review and were included in the qualitative and quantitative synthesis. Statistical analyses were done using RevMan5.4, and study quality was assessed with the Cochrane risk of bias tool. Subgroup and sensitivity analyses were also conducted.

RESULT: Twelve studies met our inclusion criteria (n = 904). BTX-A injection showed greater sweat reduction compared to placebo by gravimetric measurement (116.12 [92.68-139.57]; P < 0.05). BTX-A injection showed comparable sweat reduction to other treatments by gravimetric measurement (26.14 [- 26.8, 79.07]; P = 0.333) and HDSS (- 0.85 [- 1.20, 0.50], P = 0.413). The pain score of BTX-A injection is comparable to other treatments (- 0.41 [- 1.11, 0.29], P = 0.456). BTX-A injection exhibited fewer side effects compared to other treatments (0.18 [0.07, 0.43], P < 0.05).

CONCLUSION: In primary axillary hyperhidrosis, BTX-A injection significantly reduces sweat production compared with placebo, and there is no statistically significant difference compared with other treatments. BTX-A injection had less fewer side effects compared with other treatments.

LEVEL OF EVIDENCE I: 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:40500510 | DOI:10.1007/s00266-025-04909-6

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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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A Comparative Study of Aluminum Chloride, Oxybutynin Chloride, and Botulinum Toxin in the Treatment of Primary Focal Hyperhidrosis

J Cutan Med Surg. 2025 May 21:12034754251336233. doi: 10.1177/12034754251336233. Online ahead of print.

ABSTRACT

BACKGROUND: Primary hyperhidrosis (HH) is a common challenging problem. Different treatment modalities are present with no clear evidence favoring one modality over the others.

OBJECTIVES: To assess and compare the efficacy of aluminum chloride hexahydrate (ACH), oxybutynin chloride, and botulinum toxin type-A (BTX-A) in treating primary focal HH.

PATIENTS AND METHODS: Sixty-six patients of both sexes, with primary HH, were equally and randomly divided into 3 groups. Group (A) received a single session of intradermal (BTX-A), Group (B) received topical application of ACH lotion 25% once daily, and Group (C) received oral oxybutynin chloride 10 mg daily for 3 months. The clinical response was assessed using the Hyperhidrosis Severity Scale (HDSS) and the patients were followed up for 6 months.

RESULTS: The 3 modalities were effective and safe in the treatment of primary HH, but the clinical response was significantly higher in the BTX-A group (81.8% excellent response) compared to the other 2 modalities. The reduction of hyperhidrosis was also maintained for a longer period in the BTX-A group.

CONCLUSION: Among the 3 modalities, BTX-A was associated with a higher reduction of HDSS scores. A single session was sufficient; however, pain and high cost are limiting factors.

PMID:40396355 | DOI:10.1177/12034754251336233