Primary Hyperhidrosis: A Review of Epidemiology, Pathophysiology and Management
DOI:
https://doi.org/10.2340/actadv.v106.adv-2026-0770Keywords:
primary hyperhidrosis, quality of life, cholinergic dysregulation, treatment strategies, economic burden, diagnosis and managementAbstract
Primary hyperhidrosis is termed as excessive sweating exceeding the physiological needs of thermoregulation. This review provides an updated overview focusing on epidemiology, quality of life, pathophysiology, economic impacts, diagnostic approaches and current management strategies. A literature search was conducted in June 2026 across PubMed and the Cochrane Central Register of Controlled Trials. Additional references were identified through manual searches of relevant bibliographies. Reported prevalence of hyperhidrosis varied widely, likely reflecting differences in methodology and disease recognition. Primary hyperhidrosis is associated with autonomic dys-regulation involving sympathetic pathways. Emerging evidence suggests that molecular alterations in eccrine glands may represent secondary adap-tations to sustained cholinergic stimulation, while genetic variability in receptor expression may contribute to interindividual differences in disease severity. Hyperhidrosis has a strong negative impact on the economy and quality of life, adversely affecting both mental and physical health. Multiple treatment options are available, including topical therapies, systemic agents, device-based interventions, botulinum toxin injections, and surgery. Despite increasing recognition of the clinical burden, comprehensive economic evaluations remain limited, with indirect costs and long-term societal impact insufficiently characterized. In conclusion, primary hyperhidrosis imposes a substantial burden on affected individuals, requiring improved re-cognition, standardized diagnostic frameworks, and individualized management strategies supported by high-quality and longitudinal research.
Downloads
References
Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up. J Am Acad Dermatol 2019; 81: 657–666. DOI: https://doi.org/10.1016/j.jaad.2018.12.071
Glaser DA, Ballard AM, Hunt NL, Pieretti LJ, Pariser DM. Prevalence of multifocal primary hyperhidrosis and symptom severity over Time: Results of a targeted surTargeted Survey. Dermatol Surg 2016; 42: 1347–1353. DOI: https://doi.org/10.1097/DSS.0000000000000949
McConaghy JR, Fosselman D. Hyperhidrosis: Management options. Am Fam Physician 2018; 97: 729–734.
Henning MAS, Al-Rahimi HI, Ibler KS, Jemec GBE, Pedersen OB. Validation of new items for diagnosing primary hyperhidrosis, and estimation of the prevalence of primary hyperhidrosis. Clin Exp Dermatol 2025; 50: 1583–1589. DOI: https://doi.org/10.1093/ced/llaf013
Hagenström K, Müller K, Ohm F, Augustin M. Epidemiology and health care of hyperhidrosis in Germany: Claims data analysis. BMJ Open 2024; 14: e085862. DOI: https://doi.org/10.1136/bmjopen-2024-085862
Fujimoto T, Inose Y, Nakamura H, Kikukawa Y. Questionnaire-based epidemiological survey of primary focal hyperhidrosis and survey on current medical management of primary axillary hyperhidrosis in Japan. Arch Dermatol Res 2023; 315: 409–417. DOI: https://doi.org/10.1007/s00403-022-02365-9
Abusailik MA, Mustafa SMB, Alzboun HM, Al-Issa HA, Oweis SW, Alshudeifat AY, et al. Primary hyperhidrosis: Prevalence, severity, and impact on quality of life among Jordanian patients. Indian J Dermatol 2021; 66: 573. DOI: https://doi.org/10.4103/ijd.ijd_812_20
Ribeiro Santos Morard M, Betanho Martins R, Lopes Ribeiro AC, Guimarães Rocha Lima P, Dos Santos Carvalho B, Junior J. Primary hyperhidrosis prevalence and characteristics among medical students in Rio de Janeiro. PLoS ONE 2019; 14: e0220664. DOI: https://doi.org/10.1371/journal.pone.0220664
Wadhawa S, Agrawal S, Chaudhary M, Sharma S. Hyperhidrosis prevalence: A disease underreported by patients and underdiagnosed by physicians. Indian Dermatol Online J 2019; 10: 676–681. DOI: https://doi.org/10.4103/idoj.IDOJ_55_19
Hasimoto EN, Cataneo DC, Reis TAD, Cataneo AJM. Hyperhidrosis: Prevalence and impact on quality of life. J Bras Pneumol 2018; 44: 292–298. DOI: https://doi.org/10.1590/s1806-37562017000000379
Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: An update on prevalence and severity in the United States. Arch Dermatol Res 2016; 308: 743–749. DOI: https://doi.org/10.1007/s00403-016-1697-9
Shayesteh A, Janlert U, Brulin C, Boman J, Nylander E. Prevalence and characteristics of Hyperhidrosis in Sweden: A cross-sectional study in the general Population. Dermatology 2016; 232: 586–591. DOI: https://doi.org/10.1159/000448032
Liu Y, Bahar R, Kalia S, Huang RY, Phillips A, Su M, et al. Hyperhidrosis prevalence and demographical characteristics in dermatology outpatients in Shanghai and Vancouver. PLoS ONE 2016; 11: e0153719. DOI: https://doi.org/10.1371/journal.pone.0153719
Lima SO, Aragão JFB, Machado Neto J, Almeida KBS de, Menezes LMS, Santana VR. Research of primary hyperhidrosis in students of medicine of the State of Sergipe, Brazil. An Bras Dermatol 2015; 90: 661–665. DOI: https://doi.org/10.1590/abd1806-4841.20153859
Augustin M, Radtke MA, Herberger K, Kornek T, Heigel H, Schaefer I. Prevalence and disease burden of hyperhidrosis in the adult Population. Dermatology 2013; 227: 10–13. DOI: https://doi.org/10.1159/000351292
Fujimoto T, Kawahara K, Yokozeki H. Epidemiological study and considerations of primary focal hyperhidrosis in Japan: From questionnaire analysis. J Dermatol 2013; 40: 886–890. DOI: https://doi.org/10.1111/1346-8138.12258
Stefaniak T, Tomaszewski KA, Proczko-Markuszewska M, Idestal A, Royton A, Abi-Khalil C. Is subjective hyperhidrosis assessment sufficient enough? Prevalence of hyperhidrosis among young Polish adults. J Dermatol 2013; 40: 819–823. DOI: https://doi.org/10.1111/1346-8138.12238
Westphal FL, de Carvalho MAN, Lima LC, de Carvalho BCN, Padilla R, Araújo KKL. Prevalence of hyperhidrosis among medical students. Rev Col Bras Cir 2011; 38: 392–397. DOI: https://doi.org/10.1590/S0100-69912011000600005
Felini R, Demarchi AR, Fistarol ED, Matiello M, Delorenze LM. Prevalence of hyperhidrosis in the adult population of Blumenau-SC, Brazil. An Bras Dermatol 2009; 84: 361–366. DOI: https://doi.org/10.1590/S0365-05962009000400007
Li X, Chen R, Tu Y rong, Lin M, Lai F cai, Li Y ping, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescents. Chin Med J 2007; 120: 2215–2217. DOI: https://doi.org/10.1097/00029330-200712020-00011
Tu YR, Li X, Lin M, Lai FC, Li YP, Chen JF, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People’s Republic of China. Eur J Cardiothorac Surg 2007; 31: 737–739. DOI: https://doi.org/10.1016/j.ejcts.2007.01.020
Iwase S, Ikeda T, Kitazawa H, Hakusui S, Sugenoya J, Mano T. Altered response in cutaneous sympathetic outflow to mental and thermal stimuli in primary palmoplantar hyperhidrosis. J Auton Nerv Syst 1997; 64: 65–73. DOI: https://doi.org/10.1016/S0165-1838(97)00014-3
Niwa ASM, Gregório ML, Leão LEV, de Godoy MF. Heart rate variability assessment and its application for autonomic function evaluation in patients with hyperhidrosis. Eur Neurol 2020; 83: 293–300. DOI: https://doi.org/10.1159/000507810
Swartling C, Naver H, Pihl-Lundin I, Hagforsen E, Vahlquist A. Sweat gland morphology and periglandular innervation in essential palmar hyperhidrosis before and after treatment with intradermal botulinum toxin. J Am Acad Dermatol 2004; 51: 739–745. DOI: https://doi.org/10.1016/j.jaad.2004.07.030
Parveen A, Abbas S, Mehmood N, Patafi MAM, Wajid U, Luqman M, et al. Primary hyperhidrosis: From a genetics point of view. J Family Med Prim Care 2023; 12: 3028–3032. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1568_22
Lin JB, Kang MQ, Huang LP, Zhuo Y, Li X, Lai FC. CHRNA1 promotes the pathogenesis of primary focal hyperhidrosis. Mol Cell Neurosci 2021; 111: 103598. DOI: https://doi.org/10.1016/j.mcn.2021.103598
Chen JF, Lin M, Li X, Lin JB. PAI1 inhibits the pathogenesis of primary focal hyperhidrosis by targeting CHRNA1. Orphanet J Rare Dis 2023; 18: 205. DOI: https://doi.org/10.1186/s13023-023-02808-0
Schneier FR, Heimberg RG, Liebowitz MR, Blanco C, Gorenstein LA. Social anxiety and functional impairment in patients seeking surgical evaluation for hyperhidrosis. Compr Psychiatry 2012; 53: 1181–1186. DOI: https://doi.org/10.1016/j.comppsych.2012.04.009
Kristensen JK, Vestergaard DG, Swartling C, Bygum A. Association of primary hyperhidrosis with depression and anxiety: A systematic review. Acta Derm Venereol 2020; 100: adv00044. DOI: https://doi.org/10.2340/00015555-3598
Heiskanen SL, Niskala J, Jokelainen J, Tasanen K, Huilaja L, Sinikumpu SP. Hyperhidrosis comorbidities and treatments: A register-based study among 511 subjects. Acta Derm Venereol 2022; 102: adv00656. DOI: https://doi.org/10.2340/actadv.v102.1061
Shayesteh A, Boman J, Nylander E. Impostor phenomenon is a common feature among individuals with primary hyperhidrosis. SAGE Open Med 2024; 12: 20503121231220828. DOI: https://doi.org/10.1177/20503121231220828
Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, et al. Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multicentre study among dermatological outpatients in 17 European countries. Br J Dermatol 2022; 187: 115–125. DOI: https://doi.org/10.1111/bjd.21021
Kaplan T, Gunduz O, Oznur B, Han S. Could thoracoscopic sympathicotomy for hyperhidrosis also improve acne vulgaris? Kardiochir Torakochirurgia Pol 2014; 11: 264–267. DOI: https://doi.org/10.5114/kitp.2014.45674
Nastase F, Verenca MC, Niculet E, Radaschin DS, Busila C, Vasile CI, et al. Primary hyperhidrosis in children-A retrospective study and a short review. Life (Basel) 2024; 14: 645. DOI: https://doi.org/10.3390/life14050645
Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: A case-control study of 387 patients. J Am Acad Dermatol 2009; 61: 242–246. DOI: https://doi.org/10.1016/j.jaad.2009.02.038
Henning MAS, Reguant R, Jørgensen IF, Andersen RK, Ibler KS, Pedersen OB, et al. The temporal association of hyperhidrosis and its comorbidities - A nationwide hospital-based cohort study. J Eur Acad Dermatol Venereol 2022; 36: 2504–2511. DOI: https://doi.org/10.1111/jdv.18351
Kjeldstrup Kristensen J, Grejsen D, Swartling C, Bygum A. In hyperhidrosis quality of life is even worse than in acne, eczema, or psoriasis. A comparison of Skindex-16 and Dermatology Life Quality Index (DLQI). Int J Dermatol 2020; 59: e392–e393. DOI: https://doi.org/10.1111/ijd.15164
Trettin B, Hansen J, Bygum A. The impact of adolescents’ everyday life experiences on their primary hyperhidrosis treatment - A qualitative study. J Dermatolog Treat 2022; 33: 928–934. DOI: https://doi.org/10.1080/09546634.2020.1789541
Shayesteh A, Persson M, Brulin C, Nylander E. “Excessive sweating is not a feminine thing”: A qualitative study of women’s experiences suffering from primary hyperhidrosis. PLoS One 2021; 16: e0254689. DOI: https://doi.org/10.1371/journal.pone.0254689
Shayesteh A, Brulin C, Nylander E. The meaning of living for men suffering from primary hyperhidrosis. Am J Mens Health 2019; 13: 1557988319892725. DOI: https://doi.org/10.1177/1557988319892725
Kamudoni P, Mueller B, Halford J, Schouveller A, Stacey B, Salek MS. The impact of hyperhidrosis on patients’ daily life and quality of life: A qualitative investigation. Health Qual Life Outcomes 2017; 15: 121. DOI: https://doi.org/10.1186/s12955-017-0693-x
Shayesteh A, Boman J, Janlert U, Brulin C, Nylander E. Primary hyperhidrosis: Implications on symptoms, daily life, health and alcohol consumption when treated with botulinum toxin. J Dermatol 2016; 43: 928–933. DOI: https://doi.org/10.1111/1346-8138.13291
Muthusamy A. A study on the impact of hyperhidrosis on the quality of life among college students. JCDR 2016; 10: CC08–CC10. DOI: https://doi.org/10.7860/JCDR/2016/19495.8061
Glaser DA, Pariser DM, Hebert AA, Landells I, Somogyi C, Weng E, et al. A prospective, nonrandomized, open-label study of the efficacy and safety of onabotulinumtoxinA in adolescents with primary axillary hyperhidrosis. Pediatr Dermatol 2015; 32: 609–617. DOI: https://doi.org/10.1111/pde.12620
Rieger R, Pedevilla S, Lausecker J. Quality of life after endoscopic lumbar sympathectomy for primary plantar hyperhidrosis. World J Surg 2015; 39: 905–911. DOI: https://doi.org/10.1007/s00268-014-2885-4
Kouris A, Armyra K, Stefanaki C, Christodoulou C, Karimali P, Kontochristopoulos G. Quality of life and social isolation in Greek adolescents with primary focal hyperhidrosis treated with botulinum toxin type A: A case series. Pediatr Dermatol 2015; 32: 226–230. DOI: https://doi.org/10.1111/pde.12480
Wu Y, Li C, Tian S, Xing Q, Chen G, Zhang W. Computed tomography-guided percutaneous t4 thoracic sympathetic radiofrequency thermocoagulation for primary palmar hyperhidrosis: Aa retrospective observational trial. Cardiovasc Intervent Radiol 2023; 46: 80–88. DOI: https://doi.org/10.1007/s00270-022-03305-w
Zhang D, Zhuang W, Lan Z, Huang S, Gao Z, Chen Q, et al. Long-term follow-up in quality of life before and after endoscopic thoracic sympathicotomy in 367 patients with palmar hyperhidrosis. Ann Palliat Med 2022; 11: 1961–1968. DOI: https://doi.org/10.21037/apm-21-2860
Alkosha HM, Abuelnasr T, Mohammed M. Efficacy and outcome prediction of unilateral video-assisted thoracoscopic sympathectomy in primary palmar hyperhidrosis: Aa comparative study with bilateral sympathectomy. World Neurosurg 2022; 161: e308–e318. DOI: https://doi.org/10.1016/j.wneu.2022.02.005
Dogru MV, Sezen CB, Girgin O, Cansever L, Kocaturk CI, Metin M, et al. Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience. Gen Thorac Cardiovasc Surg 2020; 68: 273–279. DOI: https://doi.org/10.1007/s11748-019-01210-7
Wolosker N, Faustino CB, de Campos JRM, Kauffman P, Yazbek G, Fernandes PP, et al. Comparative analysis of the results of videothoracoscopic sympathectomy in the treatment of hyperhidrosis in adolescent patients. J Pediatr Surg 2020; 55: 418–424. DOI: https://doi.org/10.1016/j.jpedsurg.2019.11.004
Hajjar WM, Al-Nassar SA, Al-Sharif HM, Al-Olayet DM, Al-Otiebi WS, Al-Huqayl AA, et al. The quality of life and satisfaction rate of patients with upper limb hyperhidrosis before and after bilateral endoscopic thoracic sympathectomy. Saudi J Anaesth 2019; 13: 16–22. DOI: https://doi.org/10.4103/sja.SJA_335_18
Elalfy K, Emile S, Elfeki H, Elmetwally A, Farag M, Gado W. Sequential extended thoracoscopic sympathicotomy for palmo-axillo-plantar hyperhidrosis. Ann Thorac Surg 2017; 104: 1200–1207. DOI: https://doi.org/10.1016/j.athoracsur.2017.04.035
Kuijpers M, Klinkenberg TJ, Bouma W, DeJongste MJ, Mariani MA. Single-port one-stage bilateral thoracoscopic sympathicotomy for severe hyperhidrosis: Pprospective analysis of a standardized approach. J Cardiothorac Surg 2013; 8: 216. DOI: https://doi.org/10.1186/1749-8090-8-216
Mostafa TAH, Hamed AA, Mohammed BM, El Sheikh NA, Shama AAA. C-arm guided percutaneous radiofrequency thoracic sympathectomy for treatment of primary palmar hyperhidrosis in comparison with local botulinum toxin type a injection, randomized trial. Pain Physician 2019; 22: 591–599. DOI: https://doi.org/10.36076/ppj/2019.22.591
Elshabory O, Mohamed HAK, Zaky M, Elsaie ML. Comparative study between fractional laser assisted drug delivery of botulinum toxin versus botulinum toxin injection in primary palmar and axillary hyperhidrosis. Arch Dermatol Res 2025; 317: 241. DOI: https://doi.org/10.1007/s00403-024-03715-5
Elsayed M, Ghonemy S, Sheneeb N, Elradi M. Fractional CO2 laser-assisted delivery of botulinum toxin-A versus aluminum chloride in treatment of primary palmar hyperhidrosis. Photodermatol Photoimmunol Photomed 2024; 40: e13006. DOI: https://doi.org/10.1111/phpp.13006
Prodan-Barbulescu C, Castiglione L, Burtic SR, Murariu M, Reddy S, Rosca O, et al. Longitudinal assessment of facial hyperhidrosis management: Evaluating the utility and quality of life improvements following botulinum toxin injection. Toxins (Basel) 2024; 16: 59. DOI: https://doi.org/10.3390/toxins16010059
Nofal E, Salem S, Khashaba SA. Intradermal botulinum toxin A injection versus topical 2% glycopyrrolate for the treatment of primary facial hyperhidrosis: A pilot study and review of literature. Dermatol Surg 2022; 48: 843–848. DOI: https://doi.org/10.1097/DSS.0000000000003490
Ando Y, Ohshima Y, Yanagishita T, Watanabe H, Tamada Y, Akiyama M, et al. Clinical utility of botulinum toxin type A local injection therapy for head and forehead hyperhidrosis. J Dermatol 2022; 49: 719–723 DOI: https://doi.org/10.1111/1346-8138.16368
Campanati A, Gregoriou S, Consales V, Rizzetto G, Bobyr I, Diotallevi F, et al. Combined treatment of palmar hyperhidrosis with botulinum toxin type A and oxybutynin chloride: Results of a clinical, multicenter, prospective study. Dermatol Ther 2020; 33: e14039. DOI: https://doi.org/10.1111/dth.14039
Mirkovic SE, Rystedt A, Balling M, Swartling C. Hyperhidrosis substantially reduces quality of life in children: A retrospective study describing symptoms, consequences and treatment with botulinum toxin. Acta Derm Venereol 2018; 98: 103–107. DOI: https://doi.org/10.2340/00015555-2755
Jog M, Wein T, Bhogal M, Dhani S, Miller R, Ismail F, et al. Real-world, long-term quality of life following therapeutic onabotulinumtoxinA treatment. Can J Neurol Sci 2016; 43: 687–696. DOI: https://doi.org/10.1017/cjn.2016.262
Kouris A, Armyra K, Christodoulou C, Karimali P, Karypidis D, Kontochristopoulos G. Quality of life in patients with focal hyperhidrosis before and after treatment with botulinum toxin A. ISRN Dermatol 2014; 2014: 308650. DOI: https://doi.org/10.1155/2014/308650
Solish N, Benohanian A, Kowalski JW. Canadian dermatology study group on health-related quality of life in primary axillary hyperhidrosis. prospective open-label study of botulinum toxin type A in patients with axillary hyperhidrosis: Effects on functional impairment and quality of life. Dermatol Surg 2005; 31: 405–413. DOI: https://doi.org/10.1097/00042728-200504000-00006
Baumann L, Slezinger A, Halem M, Vujevich J, Martin LK, Black L, et al. Pilot study of the safety and efficacy of Myobloc (botulinum toxin type B) for treatment of axillary hyperhidrosis. Int J Dermatol 2005; 44: 418–424. DOI: https://doi.org/10.1111/j.1365-4632.2004.02531.x
Pissa M, Hashem R, Shayesteh A, Wrisley S, Micu E. Evaluation of quality of life, anxiety, and depression in patients with primary axillary hyperhidrosis undergoing treatment with a microwave device: One-year fFollow-up. Acta Derm Venereol 2024; 104: adv40543. DOI: https://doi.org/10.2340/actadv.v104.40543
Smith S, Glaser DA, Green LJ, Kaminer MS, Tims E, Pariser DM. A pivotal study on the safety and effectiveness of a targeted alkali thermolysis patch for treatment of primary axillary hyperhidrosis or excessive axillary sweating. Dermatol Surg 2024; 50: 1182–1187. DOI: https://doi.org/10.1097/DSS.0000000000004472
Kaufman J, Green JB, Cazzaniga A, Canty DJ, Tims E, Waugh J. A pilot study of the safety and effectiveness of a novel device in subjects with axillary hyperhidrosis. Dermatol Surg 2022; 48: 1220–1225. DOI: https://doi.org/10.1097/DSS.0000000000003598
Zhang Y, Gong YY, Tang YL, Bai YS, Yang K, Chen HY, et al. Clinical efficacy of microwave in the treatment of axillary osmidrosis and primary hyperhidrosis. Dermatol Ther 2022; 35: e15657. DOI: https://doi.org/10.1111/dth.15657
Rummaneethorn P, Chalermchai T. A comparative study between intradermal botulinum toxin A and fractional microneedle radiofrequency (FMR) for the treatment of primary axillary hyperhidrosis. Lasers Med Sci 2020; 35: 1179–1184. DOI: https://doi.org/10.1007/s10103-020-02958-8
Cohen SR, Goodacre AK, Leong TS, Southwell L, Nomachi T. Short-term clinical outcomes and safety associated with percutaneous radiofrequency treatment for excessive sweating. Aesthet Surg J 2019; 39: 1390–1399. DOI: https://doi.org/10.1093/asj/sjy277
Schick CH, Grallath T, Schick KS, Hashmonai M. Radiofrequency thermotherapy for treating axillary hyperhidrosis. Dermatol Surg 2016; 42: 624–630. DOI: https://doi.org/10.1097/DSS.0000000000000703
Abtahi-Naeini B, Naeini FF, Adibi N, Pourazizi M. Quality of life in patients with primary axillary hyperhidrosis before and after treatment with fractionated microneedle radiofrequency. J Res Med Sci 2015; 20: 631. DOI: https://doi.org/10.4103/1735-1995.166196
Hong CHH, Lupin M, O’Shaughnessy KF. Clinical evaluation of a microwave device for treating axillary hyperhidrosis. Dermatol Surg 2012; 38: 728–735. DOI: https://doi.org/10.1111/j.1524-4725.2012.02375.x
Saki N, Shakouri N, Rastaghi F, Hosseini SA, Alipour S, Ahramiyanpour N. Oxybutynin gel versus nanoemulgel for treating primary palmar hyperhidrosis: A pilot double‐blind randomized controlled trial. J Cosmetic Dermatol 2023; 22: 2268–2272. DOI: https://doi.org/10.1111/jocd.15715
Szeimies RM, Abels C, Kilic A, Reich H, Berger B, Schulze Zur Wiesche E, et al. Long-term efficacy and safety of 1% glycopyrronium bromide cream in patients with severe primary axillary hyperhidrosis: Results from a Phase 3b trial. J Eur Acad Dermatol Venereol 2023; 37: 823–830. DOI: https://doi.org/10.1111/jdv.18843
Abels C, Soeberdt M, Kilic A, Reich H, Knie U, Jourdan C, et al. A glycopyrronium bromide 1% cream for topical treatment of primary axillary hyperhidrosis: efficacy and safety results from a phase IIIa randomized controlled trial. Br J Dermatol 2021; 185: 315–322. DOI: https://doi.org/10.1111/bjd.19810
Hebert AA, Glaser DA, Green L, Hull C, Cather J, Drew J, et al. Long-term efficacy and safety of topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Post hoc pediatric subgroup analysis from a 44-week open-label extension study. Pediatr Dermatol 2020; 37: 490–497. DOI: https://doi.org/10.1111/pde.14135
Wolosker N, Kauffman P, de Campos JRM, Faustino CB, da Silva MFA, Teivelis MP, et al. Long-term results of the treatment of primary hyperhidrosis with oxybutynin: Follow-up of 1,658 cases. Int J Dermatol 2020; 59: 709–715. DOI: https://doi.org/10.1111/ijd.14872
Almeida ART, Ferrari F, Restrepo MVS, Rocha VB. Oxybutynin in primary hyperhidrosis: A long-term real-life study. Dermatol Ther 2020; 33: e14344. DOI: https://doi.org/10.1111/dth.14344
Glaser DA, Hebert AA, Nast A, Werschler WP, Green L, Mamelok RD, et al. A 44-week open-label study evaluating safety and efficacy of topical glycopyrronium tosylate in patients with primary axillary hyperhidrosis. Am J Clin Dermatol 2019; 20: 593–604. DOI: https://doi.org/10.1007/s40257-019-00446-6
Hebert AA, Glaser DA, Green L, Werschler WP, Forsha DW, Drew J, et al. Glycopyrronium tosylate in pediatric primary axillary hyperhidrosis: Post hoc analysis of efficacy and safety findings by age from two phase three randomized controlled trials. Pediatr Dermatol 2019; 36: 89–99. DOI: https://doi.org/10.1111/pde.13723
Pariser DM, Hebert AA, Drew J, Quiring J, Gopalan R, Glaser DA. Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Patient-reported outcomes from the ATMOS-1 and ATMOS-2 pPhase III randomized controlled trials. Am J Clin Dermatol 2019; 20: 135–145. DOI: https://doi.org/10.1007/s40257-018-0395-0
Artzi O, Loizides C, Zur E, Sprecher E. Topical oxybutynin 10% gel for the treatment of primary focal hyperhidrosis: A randomized double-blind placebo-controlled split area study. Acta Derm Venereol 2017; 97: 1120–1124. DOI: https://doi.org/10.2340/00015555-2731
Şener S, Karakoç Y. Effects of direct current administration on hyperhidrosis disease severity scale in patients with axillary hyperhidrosis. Biomed Res Int 2019; 2019: 3232015. DOI: https://doi.org/10.1155/2019/3232015
Henning MAS, Ibler KS, Loft I, Ostrowski SR, Erikstrup C, Nielsen KR, et al. The health-related quality of life in hyperhidrosis and co-morbidities. Qual Life Res 2022; 31: 2331–2340. DOI: https://doi.org/10.1007/s11136-022-03108-z
Shayesteh A, Janlert U, Nylander E. Hyperhidrosis – sweating sites matter: Quality of life in primary hyperhidrosis according to the sweating sites measured by SF-36. Dermatology 2018; 233: 441–445. DOI: https://doi.org/10.1159/000486713
Oshima Y, Fujimoto T, Nomoto M, Fukui J, Ikoma A. Hyperhidrosis: A targeted literature review of the disease burden. J Dermatol 2023; 50: 1227–1236. DOI: https://doi.org/10.1111/1346-8138.16908
Murota H, Fujimoto T, Oshima Y, Tamada Y, Yanagishita T, Murayama N, et al. Cost‐of‐illness study for axillary hyperhidrosis in Japan. J Dermatol 2021; 48: 1482–1490. DOI: https://doi.org/10.1111/1346-8138.16050
Kristensen JK, Nielsen C. Decreased work productivity due to primary palmar hyperhidrosis. What is the cost? Skin Health Dis 2021; 1: e24. DOI: https://doi.org/10.1002/ski2.24
Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Multi-specialty working group on the recognition, diagnosis, and treatment of primary focal hyperhidrosis. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51: 274–286. DOI: https://doi.org/10.1016/j.jaad.2003.12.029
Kowalski JW, Eadie N, Dagget S, Lai PY. Validity and reliability of the hyperhidrosis disease severity scale (HDSS). J Am Acad Dermatol 2004; 50: P51. DOI: https://doi.org/10.1016/j.jaad.2003.10.202
Kamudoni P, Mueller B, Salek MS. The development and validation of a disease-specific quality of life measure in hyperhidrosis: The Hyperhidrosis Quality of Life Index (HidroQOL©). Qual Life Res 2015; 24: 1017–1027. DOI: https://doi.org/10.1007/s11136-014-0825-2
Stefaniak TJ, Proczko M. Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals. Clin Auton Res 2013; 23: 197–200. DOI: https://doi.org/10.1007/s10286-013-0201-2
Thorlacius L, Gyldenløve M, Zachariae C, Carlsen BC. Distinguishing hyperhidrosis and normal physiological sweat production: New data and review of hyperhidrosis data for 1980-2013. Int J Dermatol 2015; 54: e409–15. DOI: https://doi.org/10.1111/ijd.12822
Thianboonsong T, Kanokrungsee S, Paichitrojjana A, Udompataikul M, Kamanamool N, Rojhirunsakool S. Efficacy and tolerability of 20% aluminum sesquichlorohydrate vs 20% aluminum chloride for the treatment of axillary hyperhidrosis: A randomized controlled trial. Dermatol Ther 2020; 33: e14354. DOI: https://doi.org/10.1111/dth.14354
ElKholy BM, Ali Ebrahim S, Othman Sobh MA, Alakad R, Mohamed Hoseiny HA. A comparative study of aluminum chloride, oxybutynin chloride, and botulinum toxin in the treatment of primary focal hyperhidrosis. J Cutan Med Surg 2025; 29: 581–586. DOI: https://doi.org/10.1177/12034754251336233
Flanagan KH, King R, Glaser DA. Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis. J Drugs Dermatol 2008; 7: 221–227.
Kirsch B, Smith S, Cohen J, DuBois J, Green L, Baumann L, et al. Efficacy and safety of topical sofpironium bromide gel for the treatment of axillary hyperhidrosis: A phase II, randomized, controlled, double-blinded trial. J Am Acad Dermatol 2020; 82: 1321–1327. DOI: https://doi.org/10.1016/j.jaad.2020.02.016
Fujimoto T, Abe Y, Igarashi M, Ishikoh A, Omi T, Kanda H, et al. A phase III, 52-week, open-label study to evaluate the safety and efficacy of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis. J Dermatol 2021; 48: 1149–1161. DOI: https://doi.org/10.1111/1346-8138.15927
Fujimoto T, Terahara T, Okawa K, Inakura H, Hirayama Y, Yokozeki H. Long-term evaluation of the safety and efficacy of a novel 20% oxybutynin hydrochloride lotion for primary palmar hyperhidrosis: An open-label extension study. J Dermatol 2023; 50: 1459–1472. DOI: https://doi.org/10.1111/1346-8138.16922
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898. DOI: https://doi.org/10.1136/bmj.l4898
Glaser DA. Oral medications. Dermatol Clin 2014; 32: 527–532. DOI: https://doi.org/10.1016/j.det.2014.06.002
Bajaj V, Langtry JAA. Use of oral glycopyrronium bromide in hyperhidrosis. Br J Dermatol 2007; 157: 118–121. DOI: https://doi.org/10.1111/j.1365-2133.2007.07884.x
Wolosker N, de Campos JRM, Kauffman P, Puech-Leão P. A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis. J Vasc Surg 2012; 55: 1696–1700. DOI: https://doi.org/10.1016/j.jvs.2011.12.039
Wolosker N, Teivelis MP, Krutman M, de Paula RP, Schvartsman C, Kauffman P, et al. Long-term efficacy of oxybutynin for palmar and plantar hyperhidrosis in children younger than 14 years. Pediatr Dermatol 2015; 32: 663–667. DOI: https://doi.org/10.1111/pde.12385
Cruddas L, Baker DM. Treatment of primary hyperhidrosis with oral anticholinergic medications: A systematic review. Acad Dermatol Venereol 2017; 31: 952–963. DOI: https://doi.org/10.1111/jdv.14081
Schollhammer M, Brenaut E, Menard-Andivot N, Pillette-Delarue M, Zagnoli A, Chassain-Le Lay M, et al. Oxybutynin as a treatment for generalized hyperhidrosis: A randomized, placebo-controlled trial. Br J Dermatol 2015; 173: 1163–1168. DOI: https://doi.org/10.1111/bjd.13973
Müller C, Berensmeier A, Hamm H, Dirschka T, Reich K, Fischer T, et al. Efficacy and safety of methantheline bromide (Vagantin®) in axillary and palmar hyperhidrosis: results from a multicenter, randomized, placebo‐controlled trial . Acad Dermatol Venereol 2013; 27: 1278–1284. DOI: https://doi.org/10.1111/j.1468-3083.2012.04708.x
Solish N, Bertucci V, Dansereau A, Hong HCH, Lynde C, Lupin M, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33: 908–923. DOI: https://doi.org/10.1111/j.1524-4725.2007.33192.x
Dagash H, McCaffrey S, Mellor K, Roycroft A, Helbling I. Tap water iontophoresis in the treatment of pediatric hyperhidrosis. J Pediatr Surg 2017; 52: 309–312. DOI: https://doi.org/10.1016/j.jpedsurg.2016.11.026
Hoorens I, Ongenae K. Primary focal hyperhidrosis: Current treatment options and a step-by-step approach. J Eur Acad Dermatol Venereol 2012; 26: 1–8. DOI: https://doi.org/10.1111/j.1468-3083.2011.04173.x
Albucker SJ, Lipner SR. Microwave energy devices for hyperhidrosis are associated with infections, neurologic symptoms, and burns in a retrospective analysis of the Manufacturer and User Facility Device Experience database 2013-2022. J Am Acad Dermatol 2023; 89: 820–822. DOI: https://doi.org/10.1016/j.jaad.2023.06.005
Choi YH, Lee SJ, Kim DW, Lee WJ, Na GY. Open clinical trial for evaluation of efficacy and safety of a portable “dry-type” iontophoretic device in treatment of palmar hyperhidrosis. Dermatol Surg 2013; 39: 578–583. DOI: https://doi.org/10.1111/dsu.12099
Wimmer F, Ramic A, Nolte JP, Djedovic G, Dietl M. Correction: Evaluation of efficacy and safetEfficacy and Safety of miraDry® procedure in the treatment of primary axillary hyperhidrosis. Aesthetic Plast Surg 2025; 49: 2545–2551. DOI: https://doi.org/10.1007/s00266-024-04558-1
.Micu E, Fragkou Dragka M, Shayesteh A. Three-year results following microwave therapy in patients with severe primary axillary hyperhidrosis. Aesthetic Plast Surg 2026; 50: 2006–2011. DOI: https://doi.org/10.1007/s00266-025-05469-5
Lee FG, Mansour AM, Wallace SJ, Miller NF. Conservative management of median nerve brachial plexopathy after microwave-based MiraDry treatment for axillary hyperhidrosis. Plast Reconstr Surg Glob Open 2021; 9: e3992. DOI: https://doi.org/10.1097/GOX.0000000000003992
Glaser DA, Galperin TA. Local procedural approaches for axillary hyperhidrosis. Dermatol Clin 2014; 32: 533–540. DOI: https://doi.org/10.1016/j.det.2014.06.014
Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, et al. Interventions for hyperhidrosis in secondary care: A systematic review and value-of-information analysis. Health Technol Assess 2017; 21: 1–280. DOI: https://doi.org/10.3310/hta21800
Remington C, Ruth J, Hebert AA. Primary hyperhidrosis in children: A review of therapeutics. Pediatr Dermatol 2021; 38: 561–567. DOI: https://doi.org/10.1111/pde.14551
de Almeida ART, Montagner S. Botulinum toxin for axillary hyperhidrosis. Dermatol Clin 2014; 32: 495–504. DOI: https://doi.org/10.1016/j.det.2014.06.013
Weinberg T, Solish N, Murray C. Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis. Dermatol Clin 2014; 32: 505–515 DOI: https://doi.org/10.1016/j.det.2014.06.012
Shayesteh A, Nylander E. Botulinumtoxin hjälper mot primär fokal hyperhidros. Bra effekt--få biverkningar, visar litteraturgenomgång [Botulinum toxin helps against primary local hyperhidrosis. Good effect--few adverse effects according to a literature review]. Lakartidningen 2011; 108: 2433–2435.
Yamauchi PS, Lowe NJ. Botulinum toxin types A and B: Comparison of efficacy, duration, and dose-ranging studies for the treatment of facial rhytides and hyperhidrosis. Clin Dermatol 2004; 22: 34–39. DOI: https://doi.org/10.1016/j.clindermatol.2003.11.005
Gee S, Yamauchi PS. Nonsurgical management of hyperhidrosis. Thorac Surg Clin 2008; 18: 141–155. DOI: https://doi.org/10.1016/j.thorsurg.2008.01.003
Hoverson K, Kandula P. Hyperhidrosis: A review and treatment options. Adv Cosmet Surg 2020; 3: 155–163. DOI: https://doi.org/10.1016/j.yacs.2020.01.014
Campanati A, Gregoriou S, Milia-Argyti A, Kontochristopoulos G, Radi G, Diotallevi F, et al. The pharmacological treatment and management of hyperhidrosis. Expert Opin Pharmacother 2022; 23: 1217–1231. DOI: https://doi.org/10.1080/14656566.2022.2083499
Lin TS, Fang HY. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis—with emphasis on perioperative management (1,360 case analyses). Surg Neurol 1999; 52: 453–457. DOI: https://doi.org/10.1016/S0090-3019(99)00111-1
Doolabh N, Horswell S, Williams M, Huber L, Prince S, Meyer DM, et al. Thoracoscopic sympathectomy for hyperhidrosis: Indications and results. Ann Thorac Surg 2004; 77: 410–414. DOI: https://doi.org/10.1016/j.athoracsur.2003.06.003
Additional Files
Published
How to Cite
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
