Twenty-site HDSS mapping after thoracoscopic sympathectomy for primary palmar hyperhidrosis: a secondary complete-case analysis of a multicenter randomized trial

  1. Nelson Wolosker
  2. Niura Noro Hamilton
  3. Miguel Lia Tedde
  4. Marina Borri Wolosker
  5. Wolfgang W Schmidt Aguiar
  6. Hylas Paiva da Costa Ferreira
  7. Fernando Luiz Westphal
  8. Alexandre M Rodrigues Lima
  9. Humberto A de Oliveira
  10. Sergio Tadeu L F Pereira
  11. Fabio de Oliviera Riuto
  12. Guilherme C Resende
  13. Marina Maria Krum Brenner
  14. Daniel de Oliveira Bonomi
  15. Caroline E Brero Valero
  16. Paulo M Pego-Fernandes
Read the full article See related articles

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

This article is not in any list yet, why not save it to one of your lists.
Log in to save this article

Abstract

Objective

To map, using the Hyperhidrosis Disease Severity Scale (HDSS), the preoperative distribution and six-month regional evolution of sweating severity across 20 anatomical sites after dominant-side unilateral versus one-stage bilateral R4 video-assisted thoracoscopic sympathectomy for primary palmar hyperhidrosis.

Methods

This was a secondary complete-case, site-level analysis of a prospective multicenter randomized trial. Adults undergoing one-stage bilateral thoracic sympathectomy (BTS) or dominant-side unilateral sympathectomy (UniS) were eligible when baseline and six-month HDSS data were complete for all 20 prespecified sites. HDSS was grouped as 1, 2, or 3-4. Regional outcomes were classified as improvement, stability, or worsening and were stratified by baseline HDSS.

Results

Ninety-two patients were included: 36 BTS and 56 UniS. Before surgery, severe sweating was present in 182 of 184 hand-site observations, 168 of 184 foot-site observations, and 75 of 184 axillary-site observations. At six months, improvement was more frequent after BTS than UniS in the hands (88.9% vs 52.7%) and axillae (72.2% vs 29.5%). Worsening was concentrated mainly in abdominal, hemidorsal, and thoracic sites. Among observations that were normal at baseline, progression to HDSS 3-4 occurred in 10.8% after BTS and 7.7% after UniS. Among observations with baseline HDSS 3-4, complete resolution to HDSS 1 occurred in 47.2% after BTS and 21.8% after UniS.

Conclusion

Baseline-stratified 20-site HDSS mapping may improve preoperative counseling and postoperative outcome assessment by distinguishing true new-onset compensatory hyperhidrosis from worsening or persistence of pre-existing sweating.

Trial registration

ClinicalTrials.gov NCT03921320

Article activity feed

  1. Version published to 10.64898/2026.08.02.26359508 on medRxiv