# Presentation: 065477

## Hyperhidrosis

- Dee Anna Glaser, M.D.
- Associate Professor
- Vice Chairman
- Department of Dermatology
- Saint Louis University

## What is Hyperhidrosis?

- Sweating that is more than required to maintain normal thermal regulation

## Sweating Nomenclature

- Areas:  Focal, regional, generalized
- Symmetry:  Symmetric or asymmetric
- Classification:  Primary vs. secondary
- Type of sweating:  Anhidrosis, euhydrosis, hyperhidrosis

**Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003.**

## Hyperhidrosis

## Causes of Generalized Hyperhidrosis

- Usually secondary in nature
- Drugs, toxins, substance abuse
- Cardiovascular disorders
- Respiratory failure
- Infections
- Malignancies
- Hodgkin’s, myleoproliferative disorders, cancers with increased catabolism
- Endocrine/metabolic disorders
- Thyrotoxicosis, pheochromocytoma, acromegaly, carcinoid tumor, hypoglycemia, menopause
-  Rarely Idiopathic  /  Primary HH

## Causes of Localized Hyperhidrosis

- Usually Idiopathic / Primary
- Social anxiety disorder
- Eccrine nevus
- Gustatory sweating
- Frey syndrome
- Impaired evaporation
- Stump hyperhidrosis after amputation

## Idiopathic (Primary) Focal Hyperhidrosis

## US Prevalence

- Survey mailed to a representative sample of 150,000 US households in January 2002

- Prevalence of hyperhidrosis in the US is 2.8% (7.8 million individuals)

- 64% response rate

- Approximately 6,800 respondents with hyperhidrosis

- 32.4% of individuals with axillary hyperhidrosis (**0.5% of the US population** or 1.3 million people) have sweating that is barely tolerable and frequently interferes with their daily activities, or is intolerable and always interferes with their daily activities (based on the HDSS).

- Projected to the US population

- 50.8% have axillary hyperhidrosis: US prevalence is 1.4% (4 million individuals)

**Strutton DR, Kowalski JW, Glaser DA, Stang PE.  American Academy of Dermatology**
** ****61st Annual Meeting; March 21-26, 2003; San Francisco, Calif. Abstract P362.**

## Mean Age of Onset

## Heredity/Genetics

- Herbst, Ann Surg 1994
- Retrospective questionnaire following ETS for 1° hyperhidrosis
- 270/323 patients responded
- 31.5% reported positive family history
- Ro, J Vasc Surg 2002
- Controlled prospective study of patients with 1° hyperhidrosis presenting for ETS
- 49/58 patients responded to detailed FH questionnaire
- 65% reported + FH (.28 risk offspring, .14 risk parents)
- Concluded gene present in 5% of population with 25% penetrance

**ETS = Endoscopic Thoracic Sympathectomy**

## Diagnosis of Primary Focal Hyperhidrosis

- Focal, visible, excessive sweating of at least 6 months duration without apparent cause with at least 2 of the following characteristics:
- Bilateral and relatively symmetric
- Impairs daily activities
- Frequency of at least one episode per week
- Age of onset less than 25 years
- Positive family history
- Cessation of focal sweating during sleep

**Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003.**

## Diagnostic Work-up

- History
- Age of onset
- Location
- Trigger factors
- Review of symptoms
- Physical exam
- Laboratory evaluation
- Gravimetric –
-     1° research tool
- Starch iodine – defines area of disease

- Starch iodine test, with the darkened area
- showing location of excessive sweating

## Axillary Sweat Production

**346.0**

**Hund et al. Arch Derm 2002;138(4):539-41**

## DLQI Total Scores and Ranges by Dermatological Disease/ConditionDiseases with DLQI Scores 10 or Greater

- DLQI Total Scores and Ranges by Dermatological Disease/Condition*Diseases with DLQI Scores 10 or Greater*

- Disease	DLQI Score  (baseline)** **
**	**
- Hyperhidrosis palms	18–8.8
- Hyperhidrosis axillary	17–10
- Eczema (inpatient)	16.2
- Focal hyperhidrosis (general)	15.5–9.2
- Psoriasis (inpatient)	13.9
- Hyperhidrosis forehead	12.5
- Atopic eczema	12.5–5.8
- Psoriasis (outpatient)	11.9–4.51
- Contact dermatitis	10.8
- Pruritus	10.5–10

**Spalding et al. Value in Health 2003;6(3):242(abstract)**

- Scores range from 0 to 30, with 30 indicating the worst quality of life.

## Quality of life: Primary Axillary Hyperhidrosis

- Less confident				72%
- Unhappy/depressed			49%
- Change type of leisure activities	45%
- Frustrated with daily activities	30%
- Miss outings/events			25%
- Decrease time in leisure activities	19%

**Naumann et al. Brit J Derm 2002;147:1218-26**

## Quality of Life:Primary Palmar Hyperhidrosis

- Interference with daily tasks	  95%
- Social embarrassment 		  90%
- Psychological difficulties          40%
- 100 patients, palmar, presenting for sympathectomy

**Adar et al  Ann Surg;186: 1977 34-41**

## Available Treatments

- Topical agents
- Iontopheresis
- Systemic agents
- Botulinum toxin
- Surgery
- Sweat gland resection
- ETS

## Treatment Response

## Summary

- Primary Focal Hyperhidrosis is a
-     separate and unique disease

- Bilateral & symmetric
- Axilla, palms, soles, craniofacial
- Onset in childhood and adolescence
- Significant impact on quality of life
- Effective therapies