Primary Palmoplantar Hyperhidrosis and Thoracoscopic Sympathectomy: A New Objective Assessment Method

Background: This study was conducted to establish an objective approach to evaluate symptoms and sweat production in patients with primary palmoplantar hyperhidrosis (PPH) and assess their response to bilateral thoracoscopic sympathectomy (BTS). Methods: We conducted two institutional review board-approved studies. We performed a one-time evaluation of healthy volunteers (controls) with three questionnaires (Hyperhidrosis Disease Severity Scale, Dermatology Life Quality Index, and Short Form-36) and measurement of transepidermal water loss (TEWL; g/m²/h). We evaluated PPH patients with these same tools before and 1 month after BTS and compared them with controls. Results: We evaluated 35 controls (mean age, 23.0 ± 3.3 years) and 45 PPH patients (mean age, 26.5 ± 12.3 years); 18 PPH patients underwent BTS and the 1-month postoperative evaluation. Hyperhidrosis Disease Severity Scale and Dermatology Life Quality Index scores were higher in PPH patients than in controls (p < 0.0001), but normalized after BTS. Short Form-36 scale scores were lower in PPH patients than in controls (p < 0.05), but improved significantly after BTS. Compared with controls, preoperative TEWL values were significantly higher in PPH patients (palmar: 142.7 ± 43.6 PPH vs 115.8 ± 48.7 controls, p = 0.011; plantar: 87.5 ± 28.8 PPH vs 57.7 ± 24.7 controls, p < 0.0001). After BTS, palmar TEWL values were significantly lower (49.1 ± 29.8, p < 0.0001). Plantar TEWL did not change significantly (77.6 ± 46.6, p = 0.52). Conclusions: PPH patients should be objectively evaluated with standardized quality of life measures and TEWL measurements before and after treatment. We believe that this objective practical approach provides a benchmark for clinical practice and research.