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Background Botulinum toxin type A (BTX-A) injection and thoracic sympathectomy are presently the most conventional treatment for palmar hyperhidrosis.However, few studies have compared the effect and side effect of these two therapies.Objective To assess and compare the efficacy of both BTX-A injection and thoracic sympathectomy.Methods 51 patients suffering palmar hyperhidrosiswere treated by either BTX-Ainjection or thoracic sympathectomy.The severity of hyperhidrosis was qualitatively measured by the Hyperhidrosis Disease Severity Scale (HDSS);a questionnaire (included time effect;local or systemic side effects;and severity of hyperhidrosis) was completed by all patients.The efficacy and the side effect between groups were compared and analyzed.Results: Hyperhidrosis quality of life improved quickly and significantly in both groups.In comparison, the score of the HDSS reduced significantly in both group after treatment (P<0.05);Especially in the sympathectomy group, all patients had a cessation of sweating in their hands after the treatment, and its curative effect last much longer than in the BTX-Agroup.Moreover more complications were observed in the sympathectomy group.Conclusion: The efficacy of thoracic sympathectomy is much greater and longer than BTX-A injection in treating the palmarhyperhidrosis, but with more complications.