Reviewed by Kevin O. Hwang, MD, MPH, Associate Professor, McGovern Medical School, Houston, TX 

Quality-of-life impairments may be different based on hyperhidrosis localization, which may influence how patients are prioritized in healthcare, a recent study suggests.1

The most common site of hyperhidrosis, or excessive sweating, is the armpits, which affects 50% of patients, followed by the palms of the hands and the soles of the feet.2 Other sites that

may be affected include the face, groin, back, and genitals.

the health of an individual using a score between 0 and 100.4

Studies have demonstrated that primary hyperhidrosis affects mental health and reduces quality of life in affected individuals, with varying symptoms based on the body parts involved.5,6

“Research on the quality of life when primary hyperhidrosis occurs outside the armpits and palms is scarce, and there are, to our knowledge, no studies comparing differences in mental and

physical health regarding the affected site on the body,” notes Alexander Shayesteh, MD, of Umeå University, Umeå, Sweden, and colleagues. Their study, which examined the mental and physical

impact of primary hyperhidrosis measured by the SF-36 according to sweating sites, was published recently in Dermatology.

“The aim of this study was to investigate whether the impacts of primary hyperhidrosis on quality of life differ depending on the localization of the sweating,” the authors wrote.

This retrospective study evaluated data from 2 previous studies investigating primary hyperhidrosis and quality of life in Sweden.5,7 A cross-sectional, population survey of 1353 random

individuals 18 to 60 years of age was designed to determine the prevalence of primary hyperhidrosis and the associated quality-of-life impairments.7 A questionnaire-based study of 114

patients diagnosed with axillary, palmar, and plantar hyperhidrosis examined the effect on mental and physical health, anxiety, depression, and alcohol consumption.5

Data on sex, age, age at onset, hyperhidrosis sites, family history, and results from the SF-36 and HDSS were collected. The cross-sectional population study provided data on hyperhidrosis

in locations other than axillary and palmar regions.

From the 2 studies, a total of 188 cases of primary hyperhidrosis were reviewed post hoc. Of these patients, 28 with multifocal primary hyperhidrosis were excluded.

The remaining 160 patients were between 11 and 62 years old, with an average age of 30.2 years. (Only 5.5% of patients had sought healthcare intervention, including topical remedies.) The

most common type of sweating was axillary hyperhidrosis (65.6%), followed by palmar (21.3%), plantar (6.2%), facial (3.1%), and other types of hyperhidrosis manifesting on the back, groin,

and genitals.

Individuals with palmar hyperhidrosis were significantly younger at onset compared with patients with axillary hyperhidrosis. Common comorbidities included asthma, psychiatric disease, and

hypothyroidism. Individuals with other types of primary hyperhidrosis were the most likely to have comorbidities (50%), which were described as neurological, psychiatric, and rheumatoid

diseases.

Based on HDSS results, individuals with axillary hyperhidrosis reported the highest interferences in their daily life. Severe hyperhidrosis was significantly more frequent in the axillary

and palmar regions. Mild sweating was more common in individuals with plantar, facial, and other sites of hyperhidrosis.

SF-36 physical scores were above the average Swedish norm score for all types of primary hyperhidrosis; however, SF-36 mental scores were below average. Individuals with facial hyperhidrosis

had the lowest mental scores, followed by palmar, axillary, plantar, and other types of hyperhidrosis. In patients without comorbidities, SF-36 mental scores were lowest for axillary,

palmar, and plantar hyperhidrosis.

In this study of individuals with primary hyperhidrosis, Shayesteh and colleagues reported that primary hyperhidrosis has a negative impact on mental health.

“Since the SF-36 survey is a broad instrument measuring quality of life, it is important to exclude comorbidities which could impact on the reported health impairments of the individuals,”

the authors noted. “By doing so, we noticed that hyperhidrosis in the axillary, palmar, and plantar regions had the highest negative impact on mental health compared with hyperhidrosis on

other sites of the body. This was consistent with the results of the HDSS, in which the proportion of individuals considering having severe hyperhidrosis was much higher in axillary and

palmar hyperhidrosis compared with plantar, facial, and other sites of the body affected.”

The authors say these results should be interpreted carefully. For one, it’s not possible to correlate results with clinical data because they were compiled from a cross-sectional study.

Furthermore, it’s challenging to find cases with less common localizations of primary hyperhidrosis because of the low number of individuals seeking medical assistance.

“In summary, we conclude that our SF-36 and HDSS results indicate that impairment in quality of life is different depending on the manifestation of primary hyperhidrosis on the body,” the

authors wrote. “This might have an influence on how patients with hyperhidrosis could be prioritized and how resources can be allocated in health care. However, our subgroup samples affected

by facial hyperhidrosis and other sites of primary hyperhidrosis were small, and more research is required to verify our findings.”