The role of acupuncture in managing hyperhidrosis and vasomotor sweating: evidence, mechanisms, and gaps

Hyperhidrosis and thermoregulatory disorders, including menopausal and treatment-induced hot flushes, can significantly impair quality of life. While acupuncture has been proposed as a potential non-pharmacological treatment for these conditions, the quality and consistency of available evidence remain unclear. This review aims to critically assess the current literature on acupuncture for various kinds of hyperhidrosis, evaluating its clinical efficacy, mechanisms of action, and limitations. A narrative review was conducted based on English-language, PubMed-indexed published clinical studies, randomised controlled trials (RCTs), and meta-analyses investigating acupuncture as a treatment for primary hyperhidrosis, emotional sweating, paraneoplastic sweating, and hot flushes in both menopausal and breast cancer populations. Particular attention was paid to study quality, intervention protocols, and outcome durability. Evidence for the use of acupuncture in primary, emotional, and paraneoplastic hyperhidrosis is limited to small, often uncontrolled studies with significant methodological shortcomings. In contrast, acupuncture for menopausal and breast cancer-related hot flushes is supported by multiple RCTs and meta-analyses involving over 1,000 participants, demonstrating short-term improvements in frequency and severity of symptoms. However, effects on hot flushes generally diminish after three months post-treatment. Mechanistically, acupuncture is thought to act via modulation of the autonomic nervous system and neuropeptide regulation, though precise pathways remain to be fully elucidated. Acupuncture may offer short-term benefits for hot flushes in menopausal and breast cancer populations, but current evidence for its effectiveness in other kinds of hyperhidrosis remains weak and inconclusive. High-quality, standardised clinical trials with long-term follow-up are needed to better define its role in the integrative management of thermoregulatory disorders. • Evidence for primary, emotional, and paraneoplastic hyperhidrosis is limited • RCTs show acupuncture reduces menopausal and cancer-related hot flushes • Benefits often wane within three months after treatment cessation • Mechanisms include autonomic modulation and neuropeptide changes • Heterogeneous protocols limit comparability; standardized long-term RCTs needed