Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; a Narrative Review

Background: Primary hyperhidrosis (PH) refers to excessive sweating, beyond normal physiological levels, in specific sites of the body for unknown reasons. It is usually bilateral and is most prominent in the palms, axillae, feet, and face. PH prevalence is estimated to be 0%-6.1% in different populations. It usually begins in childhood and is more frequent in women. In 57% of cases, there is a positive family history. It is an autosomal dominant disorder with variable penetration in chromosomes 5, 14, or both. Objective: The aim of this study was to illustrate current treatments of PH while focusing on surgical therapies through a narrative review. Methods: A complete search of online articles from 2007 to 2014 in PubMed, Scopus, and the Cochrane Library was performed. A free search and a search in the MeSH database for the study’s keywords were also done. More than 600 relevant articles were found, of which 51 were chosen for this study. This article is based on those articles. Results: Surgery is the best and more permanent therapy for PH. The most common consequences of surgery are compensatory sweating and gustatory sweating. There is controversy concerning whether lowering the level and limiting the number of ganglia on which surgery is performed reduces compensatory sweating. Conclusion: It seems that ramicotomy (selective division of the sympathetic postganglionic fibers) reduces compensatory sweating, but this theory should be confirmed with more studies.