Living Through Sweat: A Qualitative Study of the Pre-Surgical Decision-Making Trajectory in Patients with Palmar Hyperhidrosis

Purpose: This study aimed to explore the dynamic and ambivalent pre-surgical decision-making process of patients with palmar hyperhidrosis (PH), focusing on the "anxiety-sweating" feedback loop and the psychological factors influencing their treatment choices, particularly the interplay between psychological distress and the decision to pursue surgery. Patients and Methods: We conducted a qualitative descriptive phenomenological study in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Semi-structured in-depth interviews were conducted with 19 adults who had lived with PH for more than 10 years and were considering surgical treatment. All interviews were conducted before surgery. Data were analyzed using NVivo 11 software and Colaizzi's seven-step phenomenological method. Results: Analysis revealed a four-stage pre-surgical journey. First, patients initially normalized excessive hand sweating as a personal difference or familial trait, but gradually developed disease awareness as symptoms persisted and intensified. Second, PH imposed a substantial psychosocial burden, including functional limitations in study, work, and daily life, as well as reduced self-confidence, anticipatory anxiety, and social avoidance. Many participants described a self-reinforcing "anxiety-sweating" vicious cycle. Third, dissatisfaction with conservative treatments and increasing access to treatment-related information prompted patients to move from temporary coping strategies toward consideration of more durable interventions. Fourth, surgical deliberation was characterized by ambivalence: patients hoped surgery would relieve symptoms and restore social confidence, while also expressing concerns regarding compensatory sweating, postoperative discomfort, and recovery. Conclusion: The pathway toward surgical consideration in patients with palmar hyperhidrosis was a dynamic and ambivalent process shaped by symptom normalization, psychosocial burden, prior treatment experiences, and concerns about surgical risks. These findings highlight the importance of addressing psychological and social experiences alongside technical counseling and support the value of shared decision-making in pre-surgical care.