Primary palmar hyperhidrosis: a comprehensive review and novel therapeutic advances

Primary palmar hyperhidrosis is an autonomic disorder characterized by excessive and uncontrollable sweating of the palms, significantly impairing daily functioning. Endoscopic thoracic sympathectomy remains the most effective treatment for severe primary palmar hyperhidrosis, yet its clinical use is limited by the high incidence of compensatory hyperhidrosis, which may even offset therapeutic benefits. In recent years, significant advances have been made in refining surgical techniques, identifying risk factors and predictors of compensatory hyperhidrosis, and developing alternative nonsurgical therapies, such as iontophoresis and topical or systemic anticholinergics. This review provides a comprehensive overview of the pathophysiology, diagnosis, and management of primary palmar hyperhidrosis, emphasizing advances in surgical techniques, emerging nonsurgical therapies, and strategies to predict and prevent compensatory hyperhidrosis. These developments highlight the importance of individualized treatment strategies aimed at improving symptom control, minimizing complications, and enhancing patient quality of life.