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20-Year Efficacy of Endoscopic Thoracic Sympathectomy for Primary Hyperhidrosis: A Cohort Study

J Clin Med. 2025 Jul 8;14(14):4831. doi: 10.3390/jcm14144831.

ABSTRACT

Background: Primary focal hyperhidrosis, characterized by excessive sweating primarily affecting the hands and axillae, can significantly impact quality of life. Bilateral thoracic sympathectomy is the gold standard treatment, providing permanent resolution of palmar hyperhidrosis. Most studies evaluating outcomes and patient satisfaction after sympathectomy focus on short- to medium-term follow-up, typically up to 5 years. This study aimed to assess anxiety, satisfaction, and sweat redistribution 20 years after bilateral endoscopic thoracic sympathectomy. Methods: Between January 2002 and December 2003, 106 patients with primary hyperhidrosis underwent bilateral endoscopic thoracic sympathectomy targeting ganglia T2-T3 at our center. The patients were contacted via telephone in 2023 and asked to complete the same survey they had filled out preoperatively and 12 months postoperatively. The survey evaluated sweat redistribution, anxiety, hyperhidrosis-related symptoms, and satisfaction. Anxiety, satisfaction, and perceived sweating were rated using a 5-point visual analog scale (VAS) ranging from 0 (unsatisfied/no symptoms) to 4 (very satisfied/severe symptoms). Results: Of the 106 eligible patients, 24 (22.6%) completed the survey. Most reported persistent anhidrosis (palmar or palmar-axillary) 20 years post-surgery. The survey results remained consistent with those at the 1-year follow-up. Significant sweat redistribution to the abdomen and back was observed. Patient satisfaction remained high, with no significant differences between the 1-year and 20-year assessments. Anxiety significantly decreased compared to preoperative levels (p < 0.001). Conclusions: Bilateral endoscopic thoracic sympathectomy is an effective long-term treatment for reducing excessive sweating. Patient satisfaction remains high over time, despite the persistence of compensatory sweating.

PMID:40725520 | DOI:10.3390/jcm14144831

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[[Translated article]]Hyperhidrosis, Anticholinergics, and Dementia

Actas Dermosifiliogr. 2025 Jul 19:S0001-7310(25)00502-2. doi: 10.1016/j.ad.2025.07.007. Online ahead of print.

ABSTRACT

In recent decades, the use of certain oral anticholinergics for the treatment of hyperhidrosis has become widespread, often off-label but supported by multiple studies, including clinical trials, demonstrating their effectiveness and an apparently good safety profile. Similarly, various studies published in recent years have associated the use of anticholinergics to the development of dementia, particularly in elderly patients. Additionally, other studies have suggested that hyperhidrosis itself may be an early symptom of developing dementia. However, to date, no research has specifically linked the use of oral anticholinergics for hyperhidrosis treatment with the development of dementia. We present the currently available data on this controversial topic.

PMID:40691936 | DOI:10.1016/j.ad.2025.07.007

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Autonomic seizures and hyperhidrosis due to glioblastoma in a middle-aged man: a case report

J Med Case Rep. 2025 Jul 1;19(1):296. doi: 10.1186/s13256-025-05375-z.

ABSTRACT

BACKGROUND: Hyperhidrosis is common. History, physical examination, and simple investigations are often sufficient to confirm the diagnosis. However, hyperhidrosis can result from focal autonomic seizures. Diagnosing focal autonomic seizures is challenging, and there is a high rate of misdiagnosis.

CASE PRESENTATION: A 59-year-old Emirati man presented with intermittent sweating episodes and fatigue of 3 weeks duration. Initial differential diagnoses included poorly controlled diabetes, hyperthyroidism, and cardiac arrhythmia. A focal autonomic seizure was suspected after visits to five different specialities. A diagnosis of temporal glioblastoma was confirmed on an magnetic resonance imaging scan. The patient had surgical removal of the tumor, and his symptoms resolved after treatment with levetiracetam and dexamethasone.

CONCLUSION: Hyperhidrosis is common and can be easy to treat. However, hyperhidrosis may be a manifestation of focal autonomic seizure resulting from life-threatening conditions such as glioblastoma. Clinicians need to have a high index of suspicion when managing patients with excessive recurrent sweating.

PMID:40598620 | DOI:10.1186/s13256-025-05375-z

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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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T3 Endoscopic Thoracic Ganglionectomy Using Cutting Mode Cautery for Palmar Hyperhidrosis

Ann Thorac Surg Short Rep. 2024 Dec 13;3(2):456-460. doi: 10.1016/j.atssr.2024.12.004. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Understanding the precise anatomy of the upper thoracic sympathetic trunk is crucial for effectively treating palmar hyperhidrosis using the surgical technique of endoscopic thoracic sympathectomy (ETS). The variability in the location of T2 and T3 ganglia in relation to the ribs may contribute to inconsistent clinical outcomes after ETS.

METHODS: For the cadaver study, adult human cadaveric thoraces were dissected to map the locations of T2 and T3 ganglia by identifying their white rami communicantes. For the ETS group, T3 ganglionectomy ETS was performed. Surgical outcome and postoperative incidence of compensatory sweating were assessed.

RESULTS: A total of 74 pediatric patients underwent thoracoscopic T3 ganglionectomy. All patients were satisfied with the surgical outcomes. No patients complained of compensatory sweating. Forty cadavers were dissected: 25 adult female and 15 adult male. The findings showed that a high percentage of T2 ganglia are near the superior border of the third rib, while the T3 ganglion is near the fourth rib.

CONCLUSIONS: Because of the proximity of the T2 ganglion to the third rib, accidental thermal injury to the T2 ganglion may occur when third rib-oriented ETS is performed. A ganglion-oriented T3 ETS can be accomplished by using the white ramus communicans as a guide to accurately locate the T3 ganglion.

PMID:40525165 | PMC:PMC12167563 | DOI:10.1016/j.atssr.2024.12.004

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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