Efficacy and safety of rib-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation at two different targets for primary palmar hyperhidrosis: a randomized controlled trial.

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Original abstract

<h4>Objectives</h4>To compare the efficacy and safety of computed tomography-guided percutaneous thoracic sympathetic radiofrequency thermocoagulation (RFT) targeting the upper versus lateral margin of the fourth rib head for severe primary palmar hyperhidrosis (PPH).<h4>Methods</h4>Patients with severe PPH were randomly divided into Group U (upper margin target) and Group L (lateral margin target). Outcome measures included 1-year recurrence rate, Hyperhidrosis Disease Severity Scale (HDSS), Dermatology Life Quality Index (DLQI), palm skin temperature, finger perfusion index (PI), compensatory hyperhidrosis and patient satisfaction.<h4>Results</h4>Both groups (<i>n</i> = 55 each, 110 sides) successfully underwent RFT. No preprocedural PI differences were found (<i>p</i> > 0.05). Immediately post-RFT, PI in Group L was significantly higher than in Group U (left <i>p</i> = 0.025, right <i>p</i> = 0.013). No significant differences in HDSS grades were observed between groups before and at 1 day, 2 weeks, 1 month and 3 months post-procedure. However, at 6 and 12 months, Group L showed significantly lower HDSS grades (left <i>p</i> = 0.033 and 0.016; right <i>p</i> = 0.039 and 0.025) and lower DLQI scores (<i>p</i> = 0.037 and 0.024) than Group U. Patient satisfaction did not differ within 6 months, but Group L had significantly higher satisfaction at 12 months (<i>p</i> = 0.036).<h4>Conclusions</h4>Targeting the lateral margin of the fourth rib head for RFT achieved greater efficacy, better quality of life and higher patient satisfaction compared to the upper margin target.

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