Hyperhidrosis is an embarrassing condition that may interfere with routine activities, cause emotional distress, and disturb both professional and social lives of patients. Objective examination is variable and unreliable, so efforts have been made in the last 15 years to substantiate the limitations of these patients, especially in primary focal hyperhidrosis. Almost all therapeutic studies use standardized or self-designed instruments to evaluate the impact of the disease on quality of life and the improvement achieved by treatment. This article gives an overview of the difficulties with which patients with hyperhidrosis are confronted and of research investigating the restrictions.
Key points
- •
Primary focal hyperhidrosis severely affects many aspects of daily life including emotional well-being, interpersonal relationships, leisure activities, personal hygiene, work and productivity, and self-esteem.
- •
For evaluation of its impact on patients, disease-specific questionnaires, such as the Hyperhidrosis Disease Severity Scale, the Clinical Protocol for Quality of Life, and the comprehensive Hyperhidrosis Impact Questionnaire, have been developed.
- •
Limitations of hyperhidrosis as a dermatologic condition are commonly measured by the Dermatology Life Quality Index. The 36-item Short Form Health Survey is the most established instrument for recording the impairment of general health-related quality of life in patients with hyperhidrosis.
- •
Assessment of quality of life in patients with primary focal hyperhidrosis has particularly been used to prove the substantial benefits of endoscopic thoracic sympathectomy and botulinum toxin treatment.
Introduction
It has been known for a long time that hyperhidrosis is a stigmatizing condition that may severely affect many aspects of daily life including emotional well-being, interpersonal relationships, leisure activities, personal hygiene, work and productivity, and self-esteem. In 1977, Adar and colleagues pointed out that hyperhidrosis caused considerable social, professional, and emotional embarrassment in their patients with primary palmar hyperhidrosis (PPH), and claimed that sympathectomy led to improved quality of life (QoL). The first time the term QoL in context with hyperhidrosis appeared in the heading of a medical publication was in a short comment on therapeutic options in the Swedish medical journal Läkartidningen . However, serious efforts to scientifically evaluate the impact of hyperhidrosis on patients lasted until the turn of the century after endoscopic thoracic sympathectomy (ETS) and injections of botulinum toxin were introduced in the therapeutic armamentarium of primary focal hyperhidrosis (PFH).
General limitations caused by PFH include feelings of embarrassment, shame, insecurity, frustration, unhappiness, and depression. Patients often have a low self-esteem and lack of self-confidence. Difficulties with social and intimate relationships may lead to reclusiveness and avoidance of social interactions and leisure activities. Individual patients may even perceive suicidal ideation. Moreover, patients may experience functional restraints and may be compelled to adapt their behavior depending on whether axillae, palms, soles, or other sites are involved. For example, patients with primary axillary hyperhidrosis (PAH) spend much time and energy on their personal hygiene, whereas PPH often results in occupational impairment. Further site-related handicaps are summarized in Box 1 . In addition, PFH markedly increases site-specific risks of cutaneous infection, especially pitted keratolysis, dermatophytosis, and vulgar/plantar warts. The detriments of affected patients may be exacerbated by low awareness of PFH as a treatable medical condition and the little importance given to the patient’s complaints by others.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
