Compensatory hyperhidrosis remains the most significant complication after endoscopic thoracic sympathectomy (ETS) for primary palmar hyperhidrosis. However, its temporal evolution and long-term predictors are not fully elucidated.This multicenter retrospective study included 226 patients who underwent bilateral clip-based ETS between 2009 and 2023. Patients were stratified by surgical level: R3 (n = 60), R4 (n = 72), R2-R4 (n = 81), and asymmetric interruption (n = 13). Compensatory hyperhidrosis severity was assessed at 6 and 12 months, and final follow-up (mean 98 months). Logistic regression identified independent predictors of compensatory hyperhidrosis, recurrence, and patient satisfaction.Complete palmar dryness was achieved in 84.5% of patients. Compensatory hyperhidrosis occurred in 48.7%, exclusively within the first 6 postoperative months, with no late-onset cases. During long-term follow-up, spontaneous regression of compensatory hyperhidrosis was observed in 28.2% of affected patients. Compensatory hyperhidrosis incidence differed significantly across surgical levels (p = 0.011): 38.3% (R3), 55.6% (R4), 63.0% (R2-R4), and 30.8% (asymmetric). Multivariate analysis confirmed multi-level R2-R4 sympathectomy as an independent predictor of compensatory hyperhidrosis (OR = 2.18, p = 0.042), while single-level R4 interruption provided the lowest persistent compensatory hyperhidrosis burden. Overall satisfaction was 79.6%, and recurrence-not compensatory hyperhidrosis-was the main determinant of dissatisfaction (OR = 2.48, p < 0.001). Smoking history independently predicted recurrence (OR = 2.09, p = 0.042).Compensatory hyperhidrosis develops exclusively during the early postoperative period and shows partial spontaneous improvement over time. Multi-level interruption significantly increases compensatory hyperhidrosis risk without improving efficacy, supporting limited single-level approaches (preferably R4). These findings emphasize the importance of surgical level selection, smoking cessation, and realistic postoperative counseling.

Ramicotomy is a surgical approach that focuses on dividing the rami communicantes of the sympathetic chain and has been introduced as a treatment for palmar and axillary hyperhidrosis with the goal of reducing the incidence of compensatory sweating. Evidence from recent randomized controlled studies and meta-analyses suggests that this technique effectively reduces localized excessive sweating while resulting in lower rates of compensatory hyperhidrosis and less postoperative hand dryness compared with traditional sympathetic chain interruption. Despite these advantages, ramicotomy has been linked to a greater likelihood of symptom recurrence, underscoring the importance of thorough patient selection and detailed preoperative counseling about potential long-term outcomes. Overall quality of life improvements and patient satisfaction appear similar between ramicotomy and conventional sympathicotomy, although ramicotomy may provide benefits in decreasing the severity or extent of compensatory sweating. In cases of axillary hyperhidrosis, combining ramicotomy with endoscopic sympathetic blockade does not seem to significantly change patient satisfaction or overall rates of compensatory sweating compared with blockade alone, though it may influence the pattern or distribution of compensatory symptoms. In summary, ramicotomy is a reasonable surgical option for carefully selected patients who prioritize a lower risk of compensatory hyperhidrosis, accepting the trade-off of a potentially higher recurrence rate.

ABSTRACT Excessive sweating is a common side effect of antidepressants, affecting approximately 22% of patients. Antidepressant‐induced excessive sweating (ADIES) can significantly impair quality of life and medication adherence. This case report explores the use of Vitamin E as a novel adjunct treatment for ADIES. A woman in her 30s with major depressive disorder experienced significant improvement in depressive symptoms with venlafaxine but developed distressing night sweats at higher doses. Given the patient's reluctance to switch to a different antidepressant and to reduce polypharmacy, a trial of over‐the‐counter Vitamin E was initiated based on its prior evidence in managing hot flashes in postmenopausal women. After 3 months, the patient reported a significant reduction in sweating, as measured by validated symptom severity scales (CGI‐S and HDSS). The case highlights Vitamin E as a potentially effective, low‐risk, and accessible option for ADIES, especially for patients at risk for polypharmacy. While larger studies are needed, Vitamin E may offer a simple strategy for improving quality of life and medication adherence.

BackgroundCompensatory hyperhidrosis (CH) remains the most prevalent postoperative adverse event following endoscopic thoracic sympathectomy (ETS) for primary hyperhidrosis (PH). Current predictive models lack reliability in estimating CH severity. This study introduces a novel predictive framework utilizing rough set theory to establish decision rules for CH stratification.MethodsIn this single‑center retrospective cohort study, clinical data from 225 PH patients undergoing ETS were analyzed, including 37 predictive indicators. These variables were subjected to correlation analysis, regression analysis, and rough set analysis with CH severity.ResultsThere were 93.3% (210/225) of patients exhibiting CH following ETS, with 33.3% classified as grade III CH, and no grade IV CH was noted. Body mass index (BMI), the level of sympathectomy, and the temperature difference of the right hand after surgery and before anaesthesia were shown to be significantly correlated with CH on correlation analysis. However, no valid regression model was established with significant correlations involving indicators for further regression analysis. By switching to rough set analysis, four predictive rules for grade III CH were derived: (I) BMI >22 kg/m2 + initial onset age of PH >11 years, 84% accuracy; (II) BMI 19.5–22 kg/m2 + surgical age >28.5 years, 82% accuracy; (III) BMI 18.5–19.4 kg/m2 + postoperative right-hand temperature >36.6 ℃, 77% accuracy; (IV) BMI <18.5 kg/m2 + postoperative right-hand temperature <37.0 ℃ + initial PH onset age <10 years, 71% accuracy.ConclusionsRough set analysis provides a promising approach for exploring the patterns of CH severity following ETS in patients with PH, and thus which merits further investigation through multicenter, large-sample studies. The four preliminary decision rules for predicting grade III CH derived from rough set analysis show potential clinical relevance but remain tentative, as their utility requires validation in prospective cohorts prior to widespread clinical application.

Occupational heat stress is a growing concern, especially among outdoor, physically demanding workers in tropical regions like Tamil Nadu. A total of 1,027 participants in different sectors were surveyed in this cross-sectional study (2024) to determine the effect of low-cost Cooling Foods (CFs) on occupational heat stress. The temperature was measured using the Wet Bulb Globe Temperature (WBGT), with a mean of 29.6 °C ± 3.2 °C; approximately 60% of workers were exposed to levels exceeding the Threshold Limit Value (TLVs). The CF consumers experienced much less heat-related illness (HRI), such as excessive sweating and nausea/vomiting. The non-consumers were more likely to be dehydrated (AOR = 1.5; 95% CI: 1.1-1.9) and had a higher core body temperature (AOR = 1.4; 95% CI: 1.1-1.9). CFs are an affordable and available solution to occupational heat stress; additional research is needed to build robust evidence.

Hyperhidrosis, defined as excessive sweating beyond physiological needs. It impairs the quality of life (QOL) of patients. While there are many studies on the relationship between sweating and skin diseases, however few studies have been conducted from epidemiological perspective of hyperhidrosis on coexisting skin diseases. This study aimed to investigate the prevalence, severity, affected areas, and treatment history of hyperhidrosis among patients with skin diseases. An anonymous, self-report questionnaire was administered to 1,000 patients at the department of dermatology, Gunma University Hospital between June and August 2022, yielding 885 responses (88.5%). Hyperhidrosis was defined using the Hornberger’s diagnostic criteria, and severity was assessed by the Hyperhidrosis Disease Severity Scale (HDSS). The overall prevalence of hyperhidrosis among this skin disease patient cohort was 22.4% (n = 198), which was higher than the rate previously reported in Japan (10%–12.8%). Patients with hyperhidrosis were significantly younger (mean age 51.3 years) than those without (mean age 57.2 years; p &amp;lt; 0.01). Over half (54.3%) of affected patients reported severe or very severe symptoms (HDSS 3 or 4). The most common affected sites were the head/face (15.1%), followed by the axillary (8.7%). The prevalence was high in inflammatory skin diseases, with 29.2% of Atopic Dermatitis (AD) patients, 17.7% of psoriasis patients, and 7.1% of Alopecia Areata (AA) patients also having hyperhidrosis. Despite the high prevalence and severity, only a small fraction of hyperhidrosis patients (7.9%) reported a history of treatment. These findings suggest that hyperhidrosis is a common complication in skin disease. This high prevalence may be attributable to compensatory sweating caused by primary skin diseases. To improve patient’s QOL, dermatologists should actively screen for hyperhidrosis and combine sweat management with skin disease treatment.

M.H. has received equipment support and speaker honoraria for symposia on microwave thermolysis. G.G. has received an educational travel grant for lectures on microwave thermolysis.

The role of acupuncture in managing hyperhidrosis and vasomotor sweating: Evidence, mechanisms, and gaps.

Abstract Endoscopic thoracic sympathectomy, while effective for palmar hyperhidrosis, results in devastating compensatory sweating and autonomic dysfunction affecting &gt;80% of patients. We present our institutional evolution of robotic-assisted sympathetic trunk reconstruction (STR) for post-sympathectomy complications. Our prospective series of 23 patients underwent robotic STR with free nerve grafting (mean follow-up: 2 years). Six-month outcomes demonstrated significant improvement: Chest severity 9.4 ± 0.9 to 6.0 ± 2.4 (p &lt; 0.001), back severity 9.3 ± 0.8 to 6.1 ± 2.6 (p &lt; 0.001), with sustained gains at 2 years. To minimize donor site morbidity, we progressively transitioned to free intercostal nerve autografts, followed by vascularized intercostal nerve (vICN) grafting beginning January 2025. Vascularized grafts maintained immediate perfusion, enabling continuous Schwann cell proliferation and accelerated recovery. A propensity score-matched analysis of vICN versus free intercostal grafts achieved 100% technical success with no vascular complications. Six-month vICN recipients demonstrated continuous improvement without temporary worsening observed in controls. Recently, single-port robotic systems substantially reduced postoperative chest wall morbidity. These innovations demonstrate that precisely executed microsurgical technique, enabled by robotic precision and interdisciplinary expertise, offers viable treatment for carefully selected patients with intolerable post-sympathectomy complications.

Botulinum toxin typeA (BTX-A) is an established component of dermatological practice and is primarily used for the treatment of facial expression lines as well as axillary hyperhidrosis, and also for off-label dermatological conditions. Worldwide, BTX‑A preparations are available that differ in composition, activity, dosage, and approved indications. An identical BTX‑A active substance may be marketed under different brand names with a similar formulation but different approved indications.

Assessing Meda Dhatu Dushti (fat tissue imbalance) in Ayurveda involves examining subjective symptoms like excessive sweating, sweet taste, laziness, and body odor, alongside objective signs such as obesity, abdominal fat, tumors, and skin issues, correlating classical signs with modern metrics like BMI, lipids (triglycerides), and leptin levels, recognizing it as the root of disorders like obesity, diabetes, and PCOD, linking it to Medovaha Srotas Dushti (channel obstruction) and Agni Mandya (weak digestion).Serum insulin refers to the amount of the hormone insulin in your bloodstream, measured via a blood test, crucial for regulating blood sugar by helping cells absorb glucose for energy; it's used to diagnose diabetes, insulin resistance (often with prediabetes/metabolic syndrome), hypoglycemia, and pancreatic tumors (insulinomas), usually requiring a fast before the blood draw for accurate fasting levels. Levels help assess pancreas function and how effectively your body uses insulin, working alongside glucose tests for a complete picture of metabolic health. Also levels of serum Insulin is closely related to obesity which we can compare it to meda dhatu dushti and meda dhatvagnimandya. The assessment of Meda Dhatu Dushti (vitiation of fat tissue) and serum insulin levels involves an integrated approach bridging Ayurvedic diagnostics with modern metabolic markers, particularly in cases of obesity (Sthaulya), Metabolic Syndrome, and Diabetes (Madhumeha).This Research paper indicates a strong correlation between Medovaha Srotas Dushti (dysfunction of fat channels) and insulin resistance.

The efficacy and safety of botulinum toxin type A (BoNTA) treatment for primary axillary hyperhidrosis (PAH) have not been explored in the Chinese population. The objective was to evaluate efficacy and safety of 1 intradermal BoNTA injection in Chinese PAH cases. 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. 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. 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.

Cimicifuga racemosa extracts, particularly the ethanolic extract Ze 450, are widely used to alleviate menopausal symptoms, such as hot flushes and excessive sweating. While their clinical efficacy is well established, the effects of these interventions on systemic energy metabolism remain unclear. This pilot study investigated the impact of Ze 450 on body composition, metabolic markers, and voluntary physical activity in non-ovariectomized female Wistar rats. Animals (N = 36) received Ze 450 at either 30 mg/kg or 130 mg/kg body weight, with or without access to voluntary wheel running over four weeks. Neither treatment influenced body weight gain or final body weight, indicating normal growth across all groups. Post-mortem analyses included visceral fat mass, serum cholesterol, and leptin levels. Both Ze 450 and running reduced visceral fat mass, adipocyte size, and circulating leptin levels, suggesting that they share overlapping mechanisms. Serum cholesterol was significantly lowered by running but remained unaffected by Ze 450, while liver weight and alanine aminotransferase activity were unchanged, confirming hepatic safety. Collectively, Ze 450 improved key metabolic parameters related to adiposity and appetite without affecting hepatic integrity, highlighting its potential as a safe, non-hormonal metabolic modulator complementary to physical activity.

Introduction: The traditional Indian medical system, offers a holistic approach that could complement standard treatments. Abnormal skin colour, pain, itching, excess sweating, swollen part comes under kushtha roga. This presents an overview of Ayurvedic management strategies for Shvitra having Sapta Dravya i.e., Vata, Pitta, Kapha, Rasa, Rakta, Mamsa and Meda. Conventional treatments often focus on managing symptoms and slowing disease Progression primitively based on Doshik predominance. Case: A 43-years-old Male, complaining of white discoloured patches over bilateral hands. Vitals and all systemic examinations were normal. Methodology: Vitiligo was assessed by vitiligo area severity index score (VASI). Arogyavardhani Vati, Haridra Khand, Amalaki, Bakuchi, Triphala, Vidanga Churna, Bactimo- PSOR tab for oral medication and Bakuchi Taila and Psorolin ointment for local application with dietary modifications along with (PUVA) therapy. Results: White coloured patches turned to Reddish, size of patches diminished, and number of patches decreases and before treatment VASI score was 2 but after taking 6 months medication it reduces to 0.5 Discussion: Shvitra is a Santarpana Janya Vyadhi and treatment provided Ushna, Tikshna, Tridosha Shamaka, and Phototherapy. All procedure maintained the Dosha Samyavastha status. Conclusion: In Shvitra, Kapha Dosha (Prithvi and Aapya Pradhan) diminishes by using Ushna Aushadhi and Pathya Aahara.

Background: Tap water iontophoresis (TWI) is a well-established second-line treatment for primary focal hyperhidrosis. While its efficacy is proven, data regarding the correlation between session frequency and clinical response, as well as long-term adherence in hospital-based settings, remain limited. Objective: We aimed to evaluate the efficacy and safety of hospital-based TWI and to analyze the relationship between the number of treatment sessions and clinical outcomes. Methods: This retrospective study included 92 patients with primary focal hyperhidrosis treated with TWI. Disease severity was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Clinical response was categorized as “Excellent” (≥2-point HDSS reduction), “Good” (1-point reduction), or “No Response.” Relapse rates and reasons for treatment discontinuation were analyzed over a 6-month follow-up period. Results: The overall objective response rate was 65.2% (46.7% Excellent, 18.5% Good). A significant positive correlation was found between the total number of treatment sessions and the degree of clinical response (r = 0.401, p < 0.001). Patients achieving an “Excellent” response completed a significantly higher median number of sessions compared to non-responders (p = 0.001). However, among responders, the relapse rate was 85% within six months. Logistical difficulties were the most common reason for treatment discontinuation (17.5%). No compensatory hyperhidrosis or severe adverse events were observed. Conclusions: Hospital-based TWI is a safe and highly effective induction therapy, with success rates closely linked to the number of completed sessions. However, the high relapse rate and logistical barriers to adherence suggest that hospital-based protocols should serve primarily as a bridge to home-based maintenance therapy to ensure sustained long-term remission.

BackgroundPalmar hyperhidrosis, characterized by excessive sweating primarily affecting the hands, significantly impairs quality of life and psychological well-being. Although topical agents, iontophoresis, microwave therapy, and sympathectomy are established interventions, real-world treatment patterns and pharmacotherapeutic adequacy among Chinese patients remain poorly delineated.MethodsAn anonymous, questionnaire-based survey was conducted among consecutive patients at a tertiary thoracic surgery clinic in China between March 2023 and October 2024. A total of 363 valid responses were collected and analyzed using SPSS 27.0. Descriptive statistics and multivariable logistic regression were used to evaluate treatment patterns, patient preference, and predictors of treatment selection.ResultsThe study cohort was composed predominantly of individuals with severe disease (87.3% HDSS grade 3–4), and nearly all participants (97.8%) presented with palmar hyperhidrosis. Regarding treatment history, only 38.1% had previously received pharmacotherapy, while 32.6% had utilized Traditional Chinese Medicine (TCM) therapeutic approaches, including TCM, acupuncture, massage and manipulation therapies. Antiperspirants (28.6%) and TCM (25.0%) were the most frequently used prior pharmacotherapies, yet both were associated with limited therapeutic efficacy. According to our survey, owing to high symptom severity, 52.9% had a general knowledge of surgical intervention before the outpatient visit. Primary concerns regarding previous pharmacotherapy included insufficient efficacy and localized adverse effects, particularly skin irritation. Notably, 50.0% of participants remained receptive to future pharmacotherapy, showing a preference for topical formulations (29.3%) and reduced dosing frequency (31.6%). Gender and disease severity were identified as significant determinants of treatment choice. Importantly, prior negative experiences - such as inefficacy and side effects - did not significantly diminish willingness to consider future pharmacologic treatment.ConclusionInadequate management and suboptimal treatment outcomes represent considerable challenges in the care of palmar hyperhidrosis in China. Existing pharmacotherapeutic options are constrained by limited availability, inadequate efficacy, and a narrow range of approved agents - a reality that highlights a critical disconnect with substantial patient demand. These findings underscore an urgent need to accelerate drug development and clinical translation in this field.

Relieving botulinum toxin type A (BoNT-A) injection-related pain is important for hyperhidrosis treatment. Till now, there is no report on the comparison of BoNT-A intradermal injection (BontAintra) and BoNT-A mesotherapy (BontAmeso). The purpose of this study was to investigate the effect, duration of efficacy, pain, and patients' satisfaction of BontAintra and BontAmeso. This preliminary, prospective, randomized, self-controlled study recruited subjects expecting to reduce axillary sweat. The subjects were randomized to receive a 50 U BontAintra on the left axillae and a 50, 60, or 70U BontAmeso on the right axillae, respectively. The axillary sweat weight and hyperhidrosis severity scale (HDSS) on 2 weeks, 1 months, 4 months, and 6 months post-treatment were measured. The pain, satisfaction, and adverse events (AEs) were compared. Thirty-one subjects were enrolled. According to the axillary sweat weight and HDSS, the 70 U BontAmeso generated statistically comparable axillary sweat reduction and duration of efficacy with the 50 U BontAintra. The efficacy of 50 and 60U BontAmeso was comparable with the 50 U BontAintra on the 2week follow-up, and the duration of efficacy was significantly shorter. The pain ratings with three dosages of BontAmeso were significantly lower than those with BontAintra. The subjects' satisfaction ratings with BontAmeso were significantly higher than those with BontAintra. No serious AEs occurred. Compared with the 50 U BontAintra, the 70 U BontAmeso generated statistically comparable axillary sweat reduction and duration of efficacy, with significantly lower treatment-associated pain and higher satisfaction. 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 .

Hyperhidrosis (HH) is a dermatological disorder characterized by excessive sweating beyond thermoregulatory needs. It is classified into primary and secondary forms, and often interferes with daily activities, causing embarrassment along with social anxiety. The condition affects approximately 2–5% population worldwide. A large percentage of the adult population typically uses deodorant and antiperspirant products, as well as certain surgical techniques for sweat gland removal. Thus, an effort to provide Ayurveda management options, including Ayurveda antiperspirant formulations, should be made to substitute the adoption of chemical, artificial deodorant talc, or any surgical procedure. In the present cases, two patients who visited the Ayurveda Outpatient department, with complaints of axillary and palmar HH, were managed through Pragharshana (~therapeutic coarse powder massage) with Shirishadi churna, a compound formulation mentioned in the Aragvadhiya adhyaya of Charaka Samhita, for a duration of 60 days. The intervention provided marked improvement in Gravimetric measurements, Minor starch-iodine test, Axillary Osmidrosis assessment, HH Disease Severity Scale, and Dermatology Life Quality Index parameters. No recurrence of excessive sweating or malodor was observed during follow-up. The results suggest that Shirishadi churna offers a noninvasive, affordable, and self-applicable Ayurvedic option for managing primary palmar and axillary HH, providing a practical and safe approach suitable for routine self-care in resource-limited settings.

Primary focal hyperhidrosis (PFH) is defined as a condition characterized by excessive sweating in localized areas, which causes patients to experience difficulties in daily life, regardless of temperature or psychological stress. Previous surveys in Japan have revealed that the majority of patients with PFH may not visit medical institutions. Identifying the factors potentially associated with PFH is useful for detecting unmedicated patients and providing appropriate medical interventions. In this study, we explored factors associated with PFH in a multi-center, cross-sectional questionnaire survey (KOBE study). This study enrolled patients aged 5-64 years who visited 1 of the 24 dermatological institutions in Japan between April and July 2024 and completed a questionnaire (registered at the Japan Registry of Clinical Trials: jRCT1050250083). A combination of univariate and multivariate logistic regression analyses was performed to explore the associated factors. A total of 3,617 participants were included in the analysis. The prevalence of PFH was 15.0% (544 of 3,617 participants). Among the potential associated factors, the odds ratios (ORs) were higher in order of axillary osmidrosis (OR = 5.440), psoriasis (OR = 1.830), wet earwax (OR = 1.780), a definite Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score (OR = 1.780), a doubtful HADS-A score (OR = 1.460), and smoking (OR = 1.450). Receiver operating characteristic (ROC) curve analysis indicated that a HADS-A score of 6 was the optimal cutoff value for suspecting PFH. These findings may aid in detecting unmedicated potential patients in routine clinical practice and promoting active intervention for the disease, ultimately improving the quality of life and well-being of patients with PFH.

Real-time monitoring of hand tremor and palmar hyperhidrosis with a self-powered touch-free image sensor fabricated with semiconductor nanowires