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Scar-concealed 2 + 3 mm dual-port thoracoscopic sympathectomy for palmar hyperhidrosis: single-center outcomes

Front Surg. 2025 Oct 24;12:1664901. doi: 10.3389/fsurg.2025.1664901. eCollection 2025.

ABSTRACT

OBJECTIVE: To minimize the trauma and incision of the operation for primary palmar hyperhidrosis (PPH), we have designed a inconspicuous scar thoracoscopic bilateral thoracic sympathetic chain transection via “2 + 3 mm” two-pinhole incisions (ISTTST). This study mainly retrospectively compares and analyzes the pros and cons of this surgical method vs. the conventional single-port thoracoscopic sympathetic nerve transection (CSTTST).

METHODS: Data of patients with moderate or severe PPH and underwent thoracic sympathetic chain transection were collected. Patients undergoing ISTTST and those receiving CSTTST were included in the two-pinhole group and the single-port group respectively. The baseline characteristics, intraoperative and postoperative conditions of the two groups were compared.

RESULTS: A total of 265 patients were enrolled, including 162 in the single-port group and 103 in the two-pinhole group. There were no statistically significant differences in baseline conditions such as gender, age, BMI, age of onset of PPH, hyperhidrosis sites, hyperhidrosis degree, and transection level of thoracic sympathetic chain between the two groups (P > 0.05). The two-pinhole group had shorter operation time (19.809 ± 3.356 min vs. 22.534 ± 4.541 min), lower postoperative incision pain score (1.563 ± 0.518 vs. 2.012 ± 0.788), and better incision satisfaction (9.437 ± 0.498 vs. 8.068 ± 1.424) (all P < 0.001). There were no statistically significant differences in postoperative conditions such as surgical effect, 24-h postoperative discharge rate, postoperative complication rate, postoperative compensatory hyperhidrosis, postoperative recurrence rate of PPH, and postoperative follow-up time between the two groups (P > 0.05).

CONCLUSION: The ISTTST is a more concealed-scar, minimally invasive, and convenient procedure, meeting the aesthetic needs. Compared with the CSTTST, it has certain advantages and deserves more attention and attempts.

PMID:41209064 | PMC:PMC12592174 | DOI:10.3389/fsurg.2025.1664901

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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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Food and Beverage Habits Among Individuals with Primary Hyperhidrosis: A Case-Control Survey in Sweden

Clin Cosmet Investig Dermatol. 2025 Oct 24;18:2769-2776. doi: 10.2147/CCID.S547497. eCollection 2025.

ABSTRACT

AIM: Excessive sweat production in primary hyperhidrosis (PH) can lead to water and mineral loss, yet data on patients’ dietary habits are limited.

PURPOSE: To explore associations between food and beverage consumption and severe PH.

PATIENTS AND METHODS: Participants with primary palmar and axillary hyperhidrosis (n=171) and without hyperhidrosis (n=165) completed a validated questionnaire on food and beverage habits at two hospitals in northern Sweden. Frequency and quantity of specific foods and beverages were compared between groups.

RESULTS: A total of 336 individuals participated in this study (men, n=109; women, n=218; unspecified sex, n=9). Individuals with PH were younger (18-29 years, n=104 vs n=66; p<0.001) and more frequently female compared to controls (n=75 vs 58; p<0.001). Total caffeine consumption was higher in PH (median score: 186.6 vs.151.0; p<0.001), and 57% of individuals with PH consumed energy drinks weekly compared with 39.5% of controls (p<0.001). Spicy foods, fatty foods, fast foods, and sweets were reported to trigger sweating. Women with PH more often reported difficulties replenishing water loss, and increased thirst was the most reported symptom in both men and women.

CONCLUSION: PH was associated with higher caffeine intake, distinct beverage consumption patterns, and self-reported fluid loss symptoms. These findings indicate potential associations between diet and PH and may inform patient education and future research, although causality cannot be inferred from this study.

PMID:41164747 | PMC:PMC12560645 | DOI:10.2147/CCID.S547497

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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 increases the risk of postoperative infections after shoulder arthroplasty and rotator cuff repair

JSES Int. 2025 May 26;9(5):1623-1629. doi: 10.1016/j.jseint.2025.04.034. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Hyperhidrosis (HH), or excessive sweating, has been associated with higher rates of infections. Despite being a relatively common condition, its impact on postoperative outcomes following orthopedic procedures in proximity to the axilla, such as rotator cuff repair (RCR) and shoulder arthroplasty (SA), remains unknown.

METHODS: A retrospective cohort study was conducted using the TriNetX globally federated database. Patients with and without HH who underwent either RCR or SA were matched based on patient demographics and comorbidities. A standard difference of <0.1 was used to assess success of propensity score matching. Primary outcomes were 90-day postoperative superficial soft tissue infections (SSTIs), deep infections, and wound complications. Tests of significance and risk ratios (RR) with 95% confidence intervals were calculated.

RESULTS: After matching, 2,941 patients who underwent RCR and 2,066 patients who underwent SA were identified in each cohort. HH patients undergoing RCR demonstrated a higher risk of SSTIs (RR = 1.81; P = .007), urinary tract infection (UTI; RR = 2.09; P < .001), and emergency services usage (RR = 1.69; P < .001). Similarly, HH patients undergoing SA were also at higher risk of SSTIs (RR = 1.87; P = .004), UTI (RR = 1.65; P = .003), and emergency services usage (RR = 1.54; P < .001). There was no significant difference in the rates of deep soft tissue infections between the HH and non-HH groups for both RCR and SA.

DISCUSSION: HH is associated with an increased risk for 90-day complications including SSTIs, UTIs, and emergency services usage following both RCR and SA. Additional strategies for optimizing surgical care of these patients should be investigated.

PMID:41049663 | PMC:PMC12490586 | DOI:10.1016/j.jseint.2025.04.034

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Pleural effusion following thoracoscopic sympathectomy in a patient with palmar hyperhidrosis

BMC Pulm Med. 2025 Oct 2;25(1):446. doi: 10.1186/s12890-025-03933-1.

ABSTRACT

Thoracoscopic sympathectomy can be used to treat primary hyperhidrosis (PH). Nonetheless, there is a paucity of literature addressing the postoperative complications associated with this procedure. We report a case of a 21-year-old male patient who developed prolonged bilateral pleural effusion after undergoing thoracoscopic sympathectomy for PH. This case aims to raise awareness of this rare complication and discuss effective management strategies for it.

PMID:41039538 | DOI:10.1186/s12890-025-03933-1

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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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Development of a Nomogram Model for Predicting Anxiety Risk in Patients With Hyperhidrosis: A Study Involving 234 Patients

J Dermatol. 2025 Sep 18. doi: 10.1111/1346-8138.17965. Online ahead of print.

ABSTRACT

Primary focal hyperhidrosis (HH) carries a substantial psychosocial burden, and anxiety is a common but underrecognized comorbidity. We developed and internally validated a nomogram to estimate individualized anxiety risk in primary HH and examined robustness in prespecified sensitivity analyses. We retrospectively analyzed 234 consecutive patients with primary HH at a single center (June 2020-August 2023). Eligibility followed Hornberger criteria; secondary causes were excluded by history/physical examination, medication review, and targeted laboratory tests when indicated. Anxiety was diagnosed clinically according to CCMD-3. After LASSO prescreening with a priori clinical inclusion, the final multivariable logistic model retained 10 readily available predictors: diabetes, intolerance to cold, intolerance to heat, male sex, fatigue, and sweating at the head, hand, foot, chest, and neck. Internal validation used 1000-bootstrap optimism correction to assess discrimination and calibration; clinical utility was quantified with decision-curve analysis (DCA) across threshold probabilities of 0.02-0.36. The nomogram showed good discrimination (optimism-corrected C-index 0.826) and good calibration (bootstrap-corrected MAE 0.033, Brier 0.219). Three prespecified sensitivity analyses yielded consistent conclusions: SA1 (no diabetes) C-index 0.827, Brier 0.221, MAE 0.043; SA2 (craniofacial involvement + number of involved sites) C-index 0.839, Brier 0.220, MAE 0.028; and SA3 (stricter exclusion) C-index 0.811, Brier 0.211, MAE 0.045. Across thresholds of 0.02-0.36, all models demonstrated positive net benefit versus treat-none with largely overlapping curves. This transparent, internally validated tool may help identify HH patients at high risk of anxiety and support timely psychological intervention; external multicenter validation is warranted.

PMID:40964789 | DOI:10.1111/1346-8138.17965