Hyperhidrosis, or the condition of sweating in excess of that required to maintain normal thermoregulation, is divided into 2 categories: primary focal hyperhidrosis and secondary generalized hyperhidrosis. Primary focal hyperhidrosis, which often begins in childhood or adolescence, is usually idiopathic, excessive, bilateral, symmetrical sweating involving the axillae, palms, soles, and/or face.1 The condition also is associated with environmental and emotional triggers, such as anxiety or stress, heat, exercise, tobacco, alcohol, and hot spices.2
Axillary hyperhidrosis is the most common type of primary hyperhidrosis, followed by hyperhidrosis of the hands, feet, scalp, and groin. Axillary hyperhidrosis is more common after the onset of puberty and is linked to the development of apocrine glands.3 It may be associated with bromhidrosis or unpleasant odor from bacteria that colonize the axilla and breakdown the apocrine gland secretions.2
Secondary generalized hyperhidrosis is excessive sweating caused by an underlying condition or pharmacologic effect and it usually starts in adulthood. Unlike with primary focal hyperhidrosis, individuals with secondary generalized hyperhidrosis experience sweating on larger or other areas of the body. These individuals may often experience their sweating symptoms during sleep.1
The diagnostic criteria for primary focal hyperhidrosis includes focal, visible, excessive sweating of at least 6 months’ duration without apparent cause and at least 2 of the following characteristics: sweat is bilateral and relatively symmetric; excess sweat impairs daily activities; frequency of at least 1 episode a week; age of onset younger than 25 years; positive family history; and cessation of focal sweating during sleep.4,5
In addition, the impact of hyperhidrosis is significant and it can result in occupational, psychological and physical impairment, and potential social stigmatization.6,7 Excessive sweating can be a burden to affected individuals, interfering with daily activities and causing social embarrassment.
Prevalence
The prevalence of hyperhidrosis is thought to be substantially higher now than previously reported in the United States, according to a study by Doolittle and colleagues.8 Current results estimate hyperhidrosis prevalence across the United States has increased to 4.8%, or about 15.3 million people with highest prevalence among 18 to 39 year olds and lowest among adults 65 and older, as well as children and adolescents. A commonly referenced study of the prevalence of hyperhidrosis is based on the results of survey data from 2004. According to prior data, 2.8% to 3.1% of the US population has primary hyperhidrosis.7,8
Doolittle and colleagues based their current findings on a survey administered across the United States that was sent to 275,904 participants as a self-administered online survey. A total of 12,363 entered the survey with 8160 participants providing information regarding if they experience hyperhidrosis. Survey results showed that 85% of participants reported that hyperhidrosis negatively impacts their social life, sense of well-being, emotional, and mental health. Approximately 85% of respondents agreed that excessive sweating is embarrassing, 71% reported that hyperhidrosis has increased anxiety, and 35% said they have had to sacrifice many important things in life due to the condition. In addition, the study showed that 49% of people with hyperhidrosis have not discussed their condition with a health care professional as many respondents felt their condition was not treatable.8
Treatment Options
Numerous options are available for managing axillary hyperhidrosis, including noninvasive, minimally invasive, and surgical treatment.
According to Sammon and Khachemoune7, the management goal in axillary hyperhidrosis is to provide patients with pain-free, low cost, and effective treatments. However, finding one treatment that meets this goal is challenging, they said.
Topical antiperspirant treatments are the recommended first-line treatment and are the least expensive option. However, they are not as effective as the other treatments in the long-term and can cause skin irritations. Botulinum toxin A injections are the recommended second-line treatment for patients who fail topical treatments. Results last on average between 4 and 9 months, but can be painful and costly. Other treatments include anticholinergic agents, a-adrenergic antagonists, botulinum toxin type B (Myoblock), microwave thermolysis (miraDry), and iontophoresis.7
Surgery is an option for those who fail all other methods or who want a more permanent solution. Surgical options include suction-curettage, thoracic sympathectomy, and local excision. However, surgery is not always a viable option for some patients due to costs and potential side effects.
Newer treatments, such as lasers, microwave thermolysis, ultrasound, and fractional microneedle radiofrequency, may provide options for pain-free and effective treatments, noted Sammon and Khachemoune. However, further studies comparing the cost-effectiveness, and studies to determine the number of treatment sessions are needed.
Story continues on page 2
Psychosocial Effects
Hyperhidrosis often impacts a person psychosocially as well.4,7,9 At this year’s American Academy of Dermatology meeting in Orlando, FL, Adelaide A. Herbert, MD, discussed novel approaches to treating hyperhidrosis and the wide-ranging effects of the condition. She reviewed a study by Bragança and colleagues10 that evaluated anxiety and depression prevalence in patients with primary severe hyperhidrosis. The questionnaire Hospital Anxiety and Depression Scale was used for 197 individuals, in addition to the chi square test and Fisher exact test, P <.05.
“Primary hyperhidrosis can lead to mood changes due to the inconvenience caused by the disorder,” she said. “There was an increased prevalence of anxiety (49.6%) but not of depression (11.2%) among patients with primary hyperhidrosis, with no link to gender, age, or amount of affected areas. Palmar and plantar primary hyperhidrosis were the most frequent but when associated with the presence of anxiety, the most frequent were the axillary and craniofacial forms. There was an association between patients with depression and anxiety.”
Other Considerations
Hyperhidrosis also can have an economic impact on those with the condition. Some people miss work due to embarrassment caused from excessive sweating, or they choose careers in which they do not have to interact with people, shake hands, or give presentations, according to the International Hyperhidrosis Society. In addition to psychological stress, excessive sweating can also cause skin problems, such as bacterial or fungal overgrowth, infections, and maceration of the skin.1
The cost associated with clothes (undershirts, dress shirts) and other items (antiperspirants, wipes) needed after sweat events can also be significant, noted Dr Herbert. These items need to be replaced repeatedly and the costs equal about $1000 or more a year, she added.
References
1. Two types of hyperhidrosis. International Hyperhidrosis Society website. https://www.sweathelp.org/home/types-of-hyperhidrosis.html. Accessed May 11, 2017.
2. Keaney T. Hyperhidrosis treatment options. The Dermatologist. 2014;22(7):24-28.
3. Sato K, Leidal R, Sato F. Morphology and development of an apocrine sweat gland in human axillae. Am J Physiol. 1987;252(1 Pt 2):R166-R180.
4. Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51(2):274-286.
5. Pariser DM. Novel approaches to treating hyperhidrosis. Presented at: The 34th Anniversary Fall Clinical Dermatology Conference; October 1-4, 2015; Las Vegas: NV.
6. Centindag IB, Boley TM, Webb KN, Hazelrigg SR. Long-term results and quality-of-life measures in the management of hyperhidrosis. Thorac Surg Clin. 2008;18(2):217-222.
7. Sammons JE, Khachemoune A. Axillary hyperhidrosis: a focused review [published online April 6, 2017]. J Dermatolog Treat. doi:10.1080/09546634.2017.1309347
8. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Arch Dermatol Res. 2016;308(10):743-749.
9. Herbert AA. Novel approaches to treating hyperhidrosis. Presented at: The American Academy of Dermatology Meeting; March 3-7, 2017; Orlando, FL.
10. Bragança GM, Lima SO, Pinto Neto AF, Marques LM, Melo EV, Reis FP. Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis. An Bras Dermatol. 2014;89(2):230-235.
Hyperhidrosis, or the condition of sweating in excess of that required to maintain normal thermoregulation, is divided into 2 categories: primary focal hyperhidrosis and secondary generalized hyperhidrosis. Primary focal hyperhidrosis, which often begins in childhood or adolescence, is usually idiopathic, excessive, bilateral, symmetrical sweating involving the axillae, palms, soles, and/or face.1 The condition also is associated with environmental and emotional triggers, such as anxiety or stress, heat, exercise, tobacco, alcohol, and hot spices.2
Axillary hyperhidrosis is the most common type of primary hyperhidrosis, followed by hyperhidrosis of the hands, feet, scalp, and groin. Axillary hyperhidrosis is more common after the onset of puberty and is linked to the development of apocrine glands.3 It may be associated with bromhidrosis or unpleasant odor from bacteria that colonize the axilla and breakdown the apocrine gland secretions.2
Secondary generalized hyperhidrosis is excessive sweating caused by an underlying condition or pharmacologic effect and it usually starts in adulthood. Unlike with primary focal hyperhidrosis, individuals with secondary generalized hyperhidrosis experience sweating on larger or other areas of the body. These individuals may often experience their sweating symptoms during sleep.1
The diagnostic criteria for primary focal hyperhidrosis includes focal, visible, excessive sweating of at least 6 months’ duration without apparent cause and at least 2 of the following characteristics: sweat is bilateral and relatively symmetric; excess sweat impairs daily activities; frequency of at least 1 episode a week; age of onset younger than 25 years; positive family history; and cessation of focal sweating during sleep.4,5
In addition, the impact of hyperhidrosis is significant and it can result in occupational, psychological and physical impairment, and potential social stigmatization.6,7 Excessive sweating can be a burden to affected individuals, interfering with daily activities and causing social embarrassment.
Prevalence
The prevalence of hyperhidrosis is thought to be substantially higher now than previously reported in the United States, according to a study by Doolittle and colleagues.8 Current results estimate hyperhidrosis prevalence across the United States has increased to 4.8%, or about 15.3 million people with highest prevalence among 18 to 39 year olds and lowest among adults 65 and older, as well as children and adolescents. A commonly referenced study of the prevalence of hyperhidrosis is based on the results of survey data from 2004. According to prior data, 2.8% to 3.1% of the US population has primary hyperhidrosis.7,8
Doolittle and colleagues based their current findings on a survey administered across the United States that was sent to 275,904 participants as a self-administered online survey. A total of 12,363 entered the survey with 8160 participants providing information regarding if they experience hyperhidrosis. Survey results showed that 85% of participants reported that hyperhidrosis negatively impacts their social life, sense of well-being, emotional, and mental health. Approximately 85% of respondents agreed that excessive sweating is embarrassing, 71% reported that hyperhidrosis has increased anxiety, and 35% said they have had to sacrifice many important things in life due to the condition. In addition, the study showed that 49% of people with hyperhidrosis have not discussed their condition with a health care professional as many respondents felt their condition was not treatable.8
Treatment Options
Numerous options are available for managing axillary hyperhidrosis, including noninvasive, minimally invasive, and surgical treatment.
According to Sammon and Khachemoune7, the management goal in axillary hyperhidrosis is to provide patients with pain-free, low cost, and effective treatments. However, finding one treatment that meets this goal is challenging, they said.
Topical antiperspirant treatments are the recommended first-line treatment and are the least expensive option. However, they are not as effective as the other treatments in the long-term and can cause skin irritations. Botulinum toxin A injections are the recommended second-line treatment for patients who fail topical treatments. Results last on average between 4 and 9 months, but can be painful and costly. Other treatments include anticholinergic agents, a-adrenergic antagonists, botulinum toxin type B (Myoblock), microwave thermolysis (miraDry), and iontophoresis.7
Surgery is an option for those who fail all other methods or who want a more permanent solution. Surgical options include suction-curettage, thoracic sympathectomy, and local excision. However, surgery is not always a viable option for some patients due to costs and potential side effects.
Newer treatments, such as lasers, microwave thermolysis, ultrasound, and fractional microneedle radiofrequency, may provide options for pain-free and effective treatments, noted Sammon and Khachemoune. However, further studies comparing the cost-effectiveness, and studies to determine the number of treatment sessions are needed.
Story continues on page 2
Psychosocial Effects
Hyperhidrosis often impacts a person psychosocially as well.4,7,9 At this year’s American Academy of Dermatology meeting in Orlando, FL, Adelaide A. Herbert, MD, discussed novel approaches to treating hyperhidrosis and the wide-ranging effects of the condition. She reviewed a study by Bragança and colleagues10 that evaluated anxiety and depression prevalence in patients with primary severe hyperhidrosis. The questionnaire Hospital Anxiety and Depression Scale was used for 197 individuals, in addition to the chi square test and Fisher exact test, P <.05.
“Primary hyperhidrosis can lead to mood changes due to the inconvenience caused by the disorder,” she said. “There was an increased prevalence of anxiety (49.6%) but not of depression (11.2%) among patients with primary hyperhidrosis, with no link to gender, age, or amount of affected areas. Palmar and plantar primary hyperhidrosis were the most frequent but when associated with the presence of anxiety, the most frequent were the axillary and craniofacial forms. There was an association between patients with depression and anxiety.”
Other Considerations
Hyperhidrosis also can have an economic impact on those with the condition. Some people miss work due to embarrassment caused from excessive sweating, or they choose careers in which they do not have to interact with people, shake hands, or give presentations, according to the International Hyperhidrosis Society. In addition to psychological stress, excessive sweating can also cause skin problems, such as bacterial or fungal overgrowth, infections, and maceration of the skin.1
The cost associated with clothes (undershirts, dress shirts) and other items (antiperspirants, wipes) needed after sweat events can also be significant, noted Dr Herbert. These items need to be replaced repeatedly and the costs equal about $1000 or more a year, she added.
References
1. Two types of hyperhidrosis. International Hyperhidrosis Society website. https://www.sweathelp.org/home/types-of-hyperhidrosis.html. Accessed May 11, 2017.
2. Keaney T. Hyperhidrosis treatment options. The Dermatologist. 2014;22(7):24-28.
3. Sato K, Leidal R, Sato F. Morphology and development of an apocrine sweat gland in human axillae. Am J Physiol. 1987;252(1 Pt 2):R166-R180.
4. Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51(2):274-286.
5. Pariser DM. Novel approaches to treating hyperhidrosis. Presented at: The 34th Anniversary Fall Clinical Dermatology Conference; October 1-4, 2015; Las Vegas: NV.
6. Centindag IB, Boley TM, Webb KN, Hazelrigg SR. Long-term results and quality-of-life measures in the management of hyperhidrosis. Thorac Surg Clin. 2008;18(2):217-222.
7. Sammons JE, Khachemoune A. Axillary hyperhidrosis: a focused review [published online April 6, 2017]. J Dermatolog Treat. doi:10.1080/09546634.2017.1309347
8. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Arch Dermatol Res. 2016;308(10):743-749.
9. Herbert AA. Novel approaches to treating hyperhidrosis. Presented at: The American Academy of Dermatology Meeting; March 3-7, 2017; Orlando, FL.
10. Bragança GM, Lima SO, Pinto Neto AF, Marques LM, Melo EV, Reis FP. Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis. An Bras Dermatol. 2014;89(2):230-235.
Hyperhidrosis, or the condition of sweating in excess of that required to maintain normal thermoregulation, is divided into 2 categories: primary focal hyperhidrosis and secondary generalized hyperhidrosis. Primary focal hyperhidrosis, which often begins in childhood or adolescence, is usually idiopathic, excessive, bilateral, symmetrical sweating involving the axillae, palms, soles, and/or face.1 The condition also is associated with environmental and emotional triggers, such as anxiety or stress, heat, exercise, tobacco, alcohol, and hot spices.2
Axillary hyperhidrosis is the most common type of primary hyperhidrosis, followed by hyperhidrosis of the hands, feet, scalp, and groin. Axillary hyperhidrosis is more common after the onset of puberty and is linked to the development of apocrine glands.3 It may be associated with bromhidrosis or unpleasant odor from bacteria that colonize the axilla and breakdown the apocrine gland secretions.2
Secondary generalized hyperhidrosis is excessive sweating caused by an underlying condition or pharmacologic effect and it usually starts in adulthood. Unlike with primary focal hyperhidrosis, individuals with secondary generalized hyperhidrosis experience sweating on larger or other areas of the body. These individuals may often experience their sweating symptoms during sleep.1
The diagnostic criteria for primary focal hyperhidrosis includes focal, visible, excessive sweating of at least 6 months’ duration without apparent cause and at least 2 of the following characteristics: sweat is bilateral and relatively symmetric; excess sweat impairs daily activities; frequency of at least 1 episode a week; age of onset younger than 25 years; positive family history; and cessation of focal sweating during sleep.4,5
In addition, the impact of hyperhidrosis is significant and it can result in occupational, psychological and physical impairment, and potential social stigmatization.6,7 Excessive sweating can be a burden to affected individuals, interfering with daily activities and causing social embarrassment.
Prevalence
The prevalence of hyperhidrosis is thought to be substantially higher now than previously reported in the United States, according to a study by Doolittle and colleagues.8 Current results estimate hyperhidrosis prevalence across the United States has increased to 4.8%, or about 15.3 million people with highest prevalence among 18 to 39 year olds and lowest among adults 65 and older, as well as children and adolescents. A commonly referenced study of the prevalence of hyperhidrosis is based on the results of survey data from 2004. According to prior data, 2.8% to 3.1% of the US population has primary hyperhidrosis.7,8
Doolittle and colleagues based their current findings on a survey administered across the United States that was sent to 275,904 participants as a self-administered online survey. A total of 12,363 entered the survey with 8160 participants providing information regarding if they experience hyperhidrosis. Survey results showed that 85% of participants reported that hyperhidrosis negatively impacts their social life, sense of well-being, emotional, and mental health. Approximately 85% of respondents agreed that excessive sweating is embarrassing, 71% reported that hyperhidrosis has increased anxiety, and 35% said they have had to sacrifice many important things in life due to the condition. In addition, the study showed that 49% of people with hyperhidrosis have not discussed their condition with a health care professional as many respondents felt their condition was not treatable.8
Treatment Options
Numerous options are available for managing axillary hyperhidrosis, including noninvasive, minimally invasive, and surgical treatment.
According to Sammon and Khachemoune7, the management goal in axillary hyperhidrosis is to provide patients with pain-free, low cost, and effective treatments. However, finding one treatment that meets this goal is challenging, they said.
Topical antiperspirant treatments are the recommended first-line treatment and are the least expensive option. However, they are not as effective as the other treatments in the long-term and can cause skin irritations. Botulinum toxin A injections are the recommended second-line treatment for patients who fail topical treatments. Results last on average between 4 and 9 months, but can be painful and costly. Other treatments include anticholinergic agents, a-adrenergic antagonists, botulinum toxin type B (Myoblock), microwave thermolysis (miraDry), and iontophoresis.7
Surgery is an option for those who fail all other methods or who want a more permanent solution. Surgical options include suction-curettage, thoracic sympathectomy, and local excision. However, surgery is not always a viable option for some patients due to costs and potential side effects.
Newer treatments, such as lasers, microwave thermolysis, ultrasound, and fractional microneedle radiofrequency, may provide options for pain-free and effective treatments, noted Sammon and Khachemoune. However, further studies comparing the cost-effectiveness, and studies to determine the number of treatment sessions are needed.
Story continues on page 2
Psychosocial Effects
Hyperhidrosis often impacts a person psychosocially as well.4,7,9 At this year’s American Academy of Dermatology meeting in Orlando, FL, Adelaide A. Herbert, MD, discussed novel approaches to treating hyperhidrosis and the wide-ranging effects of the condition. She reviewed a study by Bragança and colleagues10 that evaluated anxiety and depression prevalence in patients with primary severe hyperhidrosis. The questionnaire Hospital Anxiety and Depression Scale was used for 197 individuals, in addition to the chi square test and Fisher exact test, P <.05.
“Primary hyperhidrosis can lead to mood changes due to the inconvenience caused by the disorder,” she said. “There was an increased prevalence of anxiety (49.6%) but not of depression (11.2%) among patients with primary hyperhidrosis, with no link to gender, age, or amount of affected areas. Palmar and plantar primary hyperhidrosis were the most frequent but when associated with the presence of anxiety, the most frequent were the axillary and craniofacial forms. There was an association between patients with depression and anxiety.”
Other Considerations
Hyperhidrosis also can have an economic impact on those with the condition. Some people miss work due to embarrassment caused from excessive sweating, or they choose careers in which they do not have to interact with people, shake hands, or give presentations, according to the International Hyperhidrosis Society. In addition to psychological stress, excessive sweating can also cause skin problems, such as bacterial or fungal overgrowth, infections, and maceration of the skin.1
The cost associated with clothes (undershirts, dress shirts) and other items (antiperspirants, wipes) needed after sweat events can also be significant, noted Dr Herbert. These items need to be replaced repeatedly and the costs equal about $1000 or more a year, she added.
References
1. Two types of hyperhidrosis. International Hyperhidrosis Society website. https://www.sweathelp.org/home/types-of-hyperhidrosis.html. Accessed May 11, 2017.
2. Keaney T. Hyperhidrosis treatment options. The Dermatologist. 2014;22(7):24-28.
3. Sato K, Leidal R, Sato F. Morphology and development of an apocrine sweat gland in human axillae. Am J Physiol. 1987;252(1 Pt 2):R166-R180.
4. Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51(2):274-286.
5. Pariser DM. Novel approaches to treating hyperhidrosis. Presented at: The 34th Anniversary Fall Clinical Dermatology Conference; October 1-4, 2015; Las Vegas: NV.
6. Centindag IB, Boley TM, Webb KN, Hazelrigg SR. Long-term results and quality-of-life measures in the management of hyperhidrosis. Thorac Surg Clin. 2008;18(2):217-222.
7. Sammons JE, Khachemoune A. Axillary hyperhidrosis: a focused review [published online April 6, 2017]. J Dermatolog Treat. doi:10.1080/09546634.2017.1309347
8. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Arch Dermatol Res. 2016;308(10):743-749.
9. Herbert AA. Novel approaches to treating hyperhidrosis. Presented at: The American Academy of Dermatology Meeting; March 3-7, 2017; Orlando, FL.
10. Bragança GM, Lima SO, Pinto Neto AF, Marques LM, Melo EV, Reis FP. Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis. An Bras Dermatol. 2014;89(2):230-235.
