New sympathicotomy for prevention of severe compensatory hyperhidrosis in patients with primary hyperhidrosis

Primary hyperhidrosis (PH) is characterized by excessive and uncontrollable secretion in the eccrine sweat glands of the craniofacial region, armpits, hands, and feet (1,2). PH is generally considered to be associated with sympathetic nervous dysfunction; however, its etiology remains unclear (1-3). PH leads despairing impacts on quality of life (1,2). The treatment modality for PH includes a range of topical or systemic medications, psychotherapy, and surgical or non-surgical approaches (3-5). Many studies have been conducted to manage PH and sympathicotomy is the most effective for PH when conservative treatment has failed (6-9). However, in spite of advances in surgical techniques for sympathicotomy, compensatory hyperhidrosis (CH) remains the most important postoperative complication, which occasionally causes patients to regret receiving sympathicotomy and surgeons to hesitate to use a prompt sympathicotomy as the first treatment modality for PH, especially for craniofacial hyperhidrosis (4,10-12). The pathogenesis of CH is hypothesized to be caused by a dysfunctional reflex arc from the sympathetic nervous system to hypothalamus, which causes uncontrollable and excessive sweat in other parts of the body (13,14). Many studies have been performed, and some risk factors for CH and the extent of sympathicotomy have been suggested (6,7,11,15-18). However, many questions remain. The purpose of the present study was to suggest a new sympathicotomy method for PH to prevent severe CH