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Thoracoscopic Sympathectomy for Primary Hyperhidrosis: A 3 mm Two-Port Approach

J Laparoendosc Adv Surg Tech A. 2025 Dec 12. doi: 10.1177/10926429251405812. Online ahead of print.

ABSTRACT

Background: Primary hyperhidrosis is a debilitating condition characterized by excessive focal sweating, most commonly affecting the axillae, palms, and soles, for which surgical intervention provides a durable solution in patients refractory to medical management. Methods: We present our outpatient surgical technique for video-assisted thoracoscopic sympathectomy (VATS) using a two-port, 3-mm incision approach and evaluate its efficacy and outcomes. A case series of 33 consecutive patients undergoing outpatient VATS sympathectomy between 2016 and 2023 was reviewed, with 9 patients excluded for lack of postoperative follow-up. All procedures were performed with electrocautery at the third and fourth ribs posteriorly (T3 and T4). Results: The technique demonstrated consistent efficacy in symptom resolution with short operative times, low postoperative pain, and rapid recovery. Mean operative time was 22.0 ± 3.7 minutes, with same-day discharge achieved in all patients. The average pain score at discharge was 2.0 ± 2.6, and no intraoperative or immediate postoperative complications occurred. Symptom severity scores improved across all regions, most notably in the palms (8.8 ± 2.1 to 1.3 ± 2.1, P < .001) and axillae (7.1 ± 2.9 to 2.2 ± 2.3, P < .001), with improvement also observed in plantar sweating (8.6 ± 2.0 to 4.8 ± 3.0, P < .001), while facial sweating showed a modest, nonsignificant change (2.3 ± 2.8 to 1.5 ± 2.2, P = .21). At 2-4 weeks, complication rates, including compensatory hyperhidrosis and pneumothorax, were comparable to conventional methods. Conclusion: This minimally invasive two-port VATS sympathectomy with 3-mm incisions appears safe, effective, and patient-centered, supporting its use as a surgical approach for primary hyperhidrosis.

PMID:41467293 | DOI:10.1177/10926429251405812

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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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Primary focal hyperhidrosis and autonomic symptom burden: a case-control study using the COMPASS-31 questionnaire

Clin Auton Res. 2025 Dec 13. doi: 10.1007/s10286-025-01178-w. Online ahead of print.

ABSTRACT

PURPOSE: To explore the relationship between primary focal hyperhidrosis (PFH) and generalized autonomic dysfunction, we assessed autonomic symptom burden using a comprehensive and validated measure of autonomic symptoms.

METHODS: In this case-control study, we compared 132 patients with PFH with 74 matched healthy controls. Autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire. Propensity score matching minimized confounding. Mann-Whitney U tests compared COMPASS-31 scores between groups. A sensitivity analysis using multivariate linear regression accounted for specific hyperhidrosis sites and demographic factors.

RESULTS: PFH cases demonstrated significantly higher median COMPASS-31 scores compared to controls (18.7 [IQR 7.7-34.8] vs. 11.2 [IQR 3.5-19.3], p < 0.001). Significant differences were observed in orthostatic (2.0 [0-20] vs. 0 [0-12], p = 0.028), vasomotor (0 [0-0] vs. 0 [0-0], p = 0.005; 24.2% vs. 9.5% non-zero scores, respectively), secretomotor (3.2 [2.1-8.6] vs. 0 [0-3.8], p < 0.001), and gastrointestinal (5.4 [1.8-8] vs. 1.8 [0.9-5.4], p = 0.004) domains. Sensitivity analysis confirmed PFH status as a significant predictor of higher COMPASS-31 scores (additional 7.5 points on average, 95% CI 1.6-13.4, p = 0.012) after adjusting for demographic factors and hyperhidrosis sites. Craniofacial and truncal hyperhidrosis were associated with higher autonomic symptom burden.

CONCLUSION: PFH is associated with a broader spectrum of autonomic symptoms beyond localized sweating, establishing a link to more generalized autonomic dysfunction. These findings underscore the need for a comprehensive approach to evaluating and managing patients with PFH.

PMID:41388201 | DOI:10.1007/s10286-025-01178-w

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Development and Validation of the Japanese Version of the Hyperhidrosis Quality of Life Index

J Dermatol. 2025 Dec 10. doi: 10.1111/1346-8138.70101. Online ahead of print.

ABSTRACT

Hyperhidrosis decreases an individual’s quality of life (QOL). The Hyperhidrosis Quality of Life Index (HidroQoL) measures the impact of hyperhidrosis on QOL and has established reliability and validity. However, a Japanese version does not exist. Hence, this study aimed to develop the Japanese version of the HidroQoL (HidroQoL-J) and verify its reliability and validity. The first survey included 528 participants (272 males, 256 females, mean age ± standard deviation 41.89 ± 15.24 years) who met the criteria for hyperhidrosis and scored ≥ 2 on the Hyperhidrosis Disease Severity Scale (HDSS). The second survey was conducted for reliability and included 210 participants (105 males, 105 females, mean age ± standard deviation 43.56 ± 14.60 years). The main survey items were (1) HidroQoL-J, (2) Dermatology Life Quality Index (DLQI), (3) Skindex-16, and (4) Anxiety Scale Specific to Hyperhidrosis Symptoms (ASSHS). Confirmatory factor analysis revealed the HidroQoL-J had a two-factor structure: a “daily life activities domain” with six items and a “psychosocial life domain” with 12 items, as in the original English version of the instrument. Cronbach’s alphas (α) for the HidroQoL-J were 0.93, 0.85, and 0.91 for overall, daily life activities, and psychosocial life, respectively. Test-retest reliability was r = 0.70, 0.67, and 0.69 for overall, daily life activities, and psychosocial life (all p < 0.001), respectively. Furthermore, the intraclass correlation coefficients were 0.70, 0.67, and 0.69, respectively. Moderate positive correlations were observed between the overall HidroQoL-J score and the DLQI (r = 0.56) and Skindex-16 (r = 0.43) scores (all p < 0.001). There was also a moderate positive correlation between the overall score of the HidroQoL-J and HDSS (r = 0.42) and a weak positive correlation with ASSHS (r = 0.39) (all p < 0.001). Therefore, the HidroQoL-J exhibited sufficient reliability and validity to measure the impact of hyperhidrosis symptoms on QOL.

PMID:41376248 | DOI:10.1111/1346-8138.70101

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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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Compensatory hyperhidrosis following endoscopic thoracic sympathectomy: a 5-year follow-up study of risk factors and symptom progression

J Cardiothorac Surg. 2025 Dec 8. doi: 10.1186/s13019-025-03720-3. Online ahead of print.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) is a common complication after endoscopic thoracic sympathectomy (ETS) for hyperhidrosis. Despite its prevalence, long-term data on CH progression and associated risk factors are scarce. This study aimed to evaluate the risk factors and progression of CH during a 5-year follow-up period.

METHODS: This study retrospectively analyzed 138 patients with primary palmar hyperhidrosis (PPH) who underwent endoscopic thoracic sympathectomy between January 2014 and December 2019. All patients received bilateral single-port thoracoscopic sympathectomy and were followed up at 1, 3, and 5 years postoperatively. The severity of postoperative sweating was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with the development and progression of CH.

RESULTS: A total of 138 patients were included in the study, with 78.9% reporting the occurrence of CH after surgery and 23.8% of them experiencing severe CH. HDSS scores gradually increased over the 5-year postoperative period, indicating symptom worsening. Further analysis revealed that bilateral R4-level sympathectomy significantly increased the risk of CH progression (OR = 4.28, 95% CI: 1.27-15.60, P = 0.021) while having three or more affected areas was identified as a protective factor (OR = 0.19, 95% CI: 0.05-0.63, P = 0.008).

CONCLUSION: This study found that compensatory hyperhidrosis is relatively common in patients undergoing ETS, and symptoms may progressively worsen over time. The level of sympathetic nerve resection and the number of affected areas are key predictive factors for symptom progression.

PMID:41361439 | DOI:10.1186/s13019-025-03720-3

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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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Is There a Risk of Recurrence That Would Discourage Sympathicotomy for Hyperhidrosis in Minors?

J Clin Med. 2025 Nov 19;14(22):8194. doi: 10.3390/jcm14228194.

ABSTRACT

Background/Objectives: Primary palmar hyperhidrosis (PPH) is a socially debilitating condition that often begins in adolescence. Although sympathicotomy is a low-risk procedure, there are conflicting opinions about the optimal time for surgery: some recommend it at onset in adolescence, while others are cautious because of the risk of recurrence associated with juvenile neuroplasticity. The primary objective was to assess the recurrence rate; secondary objectives included the management of hyperhidrosis, compensatory sweating onset, and satisfaction. Methods: This retrospective cohort study included sympathicotomy procedures for palmar hyperhidrosis performed between 2004 and 2024 in patients younger than 18 years with a preoperative Hyperhidrosis Disease Severity Scale (HDSS) class of 4. Quantitative data are presented as medians and interquartile ranges, while categorical data are presented as numbers and percentages. Results: 28 patients were included, of whom 4 underwent single-stage surgery and 24 two-stage surgery. The median age was 17.30 years, with no gender predominance. At a median follow-up of 75 months, the recurrence rate was 10.71%. Twenty-two patients experienced compensatory sweating, with the majority (60.7%) reporting mild symptoms and the remainder reporting moderate. The median patient satisfaction score was 9.34 (range 9-10). Conclusions: Even though PPH typically begins during adolescence, there is no consensus on the appropriateness of sympathicotomy for younger patients, primarily due to concerns about recurrence. Our data, characterized by long-term follow-up and large numbers of minors, are consistent with those observed in adults’ cohorts in terms of hyperhidrosis management, compensatory sweating rates, and, particularly, recurrence rates, supporting the surgical approach even at a young age.

PMID:41303230 | DOI:10.3390/jcm14228194

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Can large language models respond health education questions for patients with palmar hyperhidrosis? A comparative study of ChatGPT and DeepSeek

Digit Health. 2025 Nov 13;11:20552076251396576. doi: 10.1177/20552076251396576. eCollection 2025 Jan-Dec.

ABSTRACT

OBJECTIVE: To compare the adaptability of two large language models: ChatGPT and DeepSeek in responding to health education questions related to patients with palmar hyperhidrosis.

METHODS: Based on clinical guidelines and expert experience, 17 health education questions relevant to palmar hyperhidrosis were developed and posed separately to ChatGPT and DeepSeek. Twelve experienced thoracic surgery experts independently evaluated the adaptability of the responses generated by both models. Each response was rated using a five-point Likert scale to quantitatively analyze the adaptability of the information provided.

RESULTS: Both language models demonstrated good adaptability in addressing health education questions related to palmar hyperhidrosis. In the English context, 10 responses of ChatGPT received a full score (5 points) from more than 50% of experts, while DeepSeek did so for 8. In the Chinese context, both ChatGPT and DeepSeek receive 10 responses a full score (5 points) from more than 50% of experts. ChatGPT outperformed DeepSeek in the English-language setting, whereas DeepSeek showed superior overall performance in the Chinese context.

CONCLUSION: This preliminary study demonstrates that both ChatGPT and DeepSeek are capable of effectively addressing health education questions for patients with palmar hyperhidrosis. ChatGPT performs better in English-language setting, while DeepSeek shows greater adaptability in Chinese-language context. However, human review remains essential to ensure the accuracy and reliability of the provided information in practical applications.

PMID:41246197 | PMC:PMC12615908 | DOI:10.1177/20552076251396576