Primary hyperhidrosis: an invalidating disease—patients management and surgical recommendations

Hyperhidrosis is a pathological condition consisting in extreme perspiration exceeding organism thermoregulation within a physiological range. Primary hyperhidrosis (PH) is idiopathic; usually affects palms, axillae, face and soles, singularly (focal hyperhidrosis) or together (generalized hyperhidrosis). Medical treatments are several, ranging from topic to systemic approach, with different characteristics. All medical treatments are unfortunately characterized by a common undesired feature: the expiration of their effects. Surgery for hyperhidrosis is mainly represented by ETS (endoscopic thoracic sympathectomy). ETS consists of single or multiple surgical interruptions of sympathetic chain. This operation is usually called sympathectomy or sympathicotomy. Compensatory hyperhidrosis (CH) is an undesirable effect of sympathectomy. CH sometimes greatly affects patient’s quality of life (QoL). ETS outcomes, in terms of both sweating remission and CH onset are determined by nerve interruption level (or levels). Therefore, surgical strategy is based on the statements that high level and multiple nerve trunk interruption more likely determine dry skin whereas low interruption avoid CH onset. Therefore, target level and numbers of interruption should be always decided weighting benefits and side effects in accordance with patient will.