DOI: https://doi.org/10.36347/sjmcr.2025.v13i12.035

Pages: 3037-3041

Primary hyperhidrosis is a chronic, benign, yet socially disabling disorder, most commonly affecting the palms, axillae, and soles. It is believed to result from sympathetic overactivity and shows strong familial clustering, with autosomal dominant inheritance and variable penetrance. Despite being non-life-threatening, it significantly impacts quality of life, limiting interpersonal interactions, academic performance, occupational productivity, and psychological well-being. Video-assisted thoracoscopic sympathectomy (VATS) is the gold-standard treatment for severe cases refractory to conservative management, providing immediate symptom resolution and high long-term success rates. However, reports documenting familial patterns across different ethnicities over extended periods remain limited. Materials and Methods: We present a combined institutional experience spanning 15 years involving two sibling pairs. Historical cohort (2010): Two Chinese siblings (15 and 17 years) with disabling palmar and plantar hyperhidrosis underwent bilateral VATS sympathectomy (T2–T4). Both achieved immediate and sustained symptom resolution at 12 months, with no compensatory hyperhidrosis or major complications. Contemporary cohort (2025): Two Malay brothers (21 and 23 years) presented with lifelong severe palmar and plantar hyperhidrosis (Hyperhidrosis Disease Severity Scale (HDSS) 4/4), unresponsive to topical therapy and lifestyle measures. Both underwent bilateral VATS sympathectomy (T2–T4, with nerve of Kuntz division when present), achieving immediate dryness, early discharge, and marked improvement in quality of life. Neither developed Horner’s syndrome, pneumothorax, or early compensatory hyperhidrosis. Results/Discussion: This series highlights the familial and likely genetic nature of hyperhidrosis across ethnicities. Prevalence estimates range from 0.6–5%, with 30–65% of patients reporting a positive family history. Beyond physical discomfort, hyperhidrosis contributes to so