Table 1.
Studies investigating the effects of hyperhidrosis (HH) on QoL
| Source [citation] | QoL scale | Study manuscript type | Sample (patients with HH) | Effect on QoL |
|---|---|---|---|---|
| Shayesteh et al. 2019 [1] | Interview | Qualitative interviews | 15 | Patients with primary HH reported feeling filthy and had difficulty managing symptoms. HH causes stigma and stress, which perpetuates sweating. |
| Doolittle et al. 2018 [3] | HDSS, survey | Survey/cross-sectional study | 8160 | Prevalence of HH is 4.8%. Only 51% of patients had discussed the condition with a healthcare professional. This is due to not thinking it is a medical condition (60%) or believing that there is nothing that can be done to treat it (47%). 70% of patients had a HDSS score of 3 or 4. |
| Lenefsky et al. 2018 [4] | N/A | Review | N/A | HH impacts lifestyle, social life, mental health, and professional life. |
| Lessa et al. 2014 [5] | Trier Inventory of Chronic Stress, Skindex-16 | Prospective study | 40 | Patients with primary HH had worse QoL per Skindex-16 in the emotional (69.46 ± 30.55 vs 36.69 ± 33.84), symptom (17.15 ± 18.62 vs 27.44 ± 25.76), and functional domains (66.66 ± 33.54 vs. 24.59 ± 30.21) compared with patients without HH with other skin conditions (psoriasis, pigmentary conditions, skin infections). There was a higher incidence of anxiety disorder in patients with HH. |
| Hasimoto et al. 2018 [6] | HQLQ | Survey study | 23 | 48% reported poor or very poor QoL. Patients reported embarrassment (33.3%), shame (25%), and discomfort (16.7%). Six patients saw a medical professional. |
| Kamudoni et al. 2017 [7] | Focus groups, interviews, online survey | Survey study, qualitative interviews | 71 | HH impacted daily life, mental and physical health, social and professional life. Patients spent excessive time managing their symptoms. |
| Kristensen et al. 2020 [9] | N/A | Review | N/A | Anxiety and depression ranged from 0 to 49% and from 0 to 60%, respectively, in patients with primary HH. |
| Gross et al. 2014 [10] | Trier Inventory of Chronic Stress, Beck Depression Inventory | Prospective study | 40 | Patients with primary HH experience more depressive symptoms and have a higher level of chronic stress compared with patients without HH. |
| Dias et al. 2016 [11] | Hospital and Anxiety Depression Scale | Survey study | 54 | Anxiety and depression were found in patients with primary HH pre-sympathectomy. CH after sympathectomy is associated with anxiety and worse QoL. |
| Woo et al. 2022 [12] | PHQ-9 | Survey study, cross-sectional | 222 | Mean PHQ-9 score was 5.25 among patients with HH, which was higher than the general population during the COVID-19 pandemic. 10% of patients had progressively worsening symptoms and 30% had difficulty obtaining treatment. |
| Heiskanen et al. 2022 [13] | N/A | Retrospective study | 511 | 11.6% of patients with primary HH had depression. |
| Klein et al. 2020 [14] | N/A | Survey study, cross-sectional | 44,484 | Higher odds of depression and anxiety compared with controls. Majority of patients did not obtain antiperspirant prescription after diagnosis. |
| Dharmaraj et al. 2016 [15] | QoL questionnaire and Rosenberg Self-Esteem Questionnaire | Pre-post interventional study | 46 | Sympathectomy was found to improve social esteem in patients with primary HH. Patients were found to have an increased risk of cutaneous disease at baseline. |
| Rieger et al. 2015 [17] | Keller, HQLQ, SF-36 | Pre-post interventional study | 52 | Patients with pre-sympathectomy plantar HH had elevated Keller scores (denoting impairment in physical tasks such as putting on socks, wearing sandals, and walking barefoot) and HQLQ scores (3.69 in general domain, 2.08 in functional domain, 2.21 in personal domain, 2.70 in emotional response domain, and 3.04 in the special circumstances domain) that improved following treatment. Pre-operative SF-36 showed poor physical and mental component summary scores that increased following surgery. |
| Lima et al. 2018 [19] | HQLQ | Pre-post interventional study | 58 | 89.8% of patients with plantar HH have very poor QoL prior to sympathectomy. Patients reported: instability of feet using open shoes/heels, sprains, sweat puddles, and frequently changing socks. |
| Hajjar et al. 2019 [20] | HQLQ | Pre-post interventional study | 100 | Among patients with primary HH, 49% poor QoL, 34% reported very poor QoL. The mean decrease in QoL scores was − 42.0 points toward better QoL. |
| Hur et al. 2022 [21] | HQLQ | Pre-post interventional study | 30 | Mean pre-sympathectomy QoL score for patients with plantar HH was 91.8 (“very bad” QoL), and the postoperative 12 months (QoL) score improved to 29.1 (“much better” QoL). |
| Zhang et al. 2022 [22] | HQLQ | Pre-post interventional study | 367 | Median pre-sympathectomy QoL score for patients with plantar HH was 40, and postoperative 12 months (QoL) score improved to 20. |
| Gong et al. 2013 [23] | Beck Depression Inventory, Beck Anxiety Inventory | Pre-post interventional study | 19 | Patients with CH had reduced anxiety and depression after treatment with oral glycopyrrolate. |
| Shayesteh et al. 2016 [24] | HDSS, SF-36 | Pre-post interventional study | 114 | Patients with primary HH have lower mental (39.8 ± 11.2) and physical scores in the SF-36 compared with the general population denoting poorer QoL. No significant differences in anxiety, depression, or alcohol intake between patients with HH and controls. |
| Henning et al. 2022 [26] | SF-12 | Retrospective cohort |
2794 (self-reported HH) 284 (hospital diagnosed HH) |
Self-reported HH associated with reduced mental and physical SF-12 scores. Hospital diagnosed HH was associated with reduced mental SF-12 scores. |
| Parrish et al. 2020 [27] | HDSS, DLQI, Zung Self Rating Anxiety, Social Phobia Report | Pre-post interventional study | 24 | Among patients with axillary HH, 50% had social anxiety, 50% had generalized anxiety, 48% reported social avoidance, and 38% were anxious/depressed. Symptoms improved after microwave thermolysis. Pre- and post-treatment DLQI scores were 12.92 and 3.68, respectively. |
| Kjeldstrup et al. 2020 [28] | Skindex-16, DLQI | Prospective study | 98 | A Skindex-16 comparison among 98 patients showed that patients with HH scored similarly to patients with psoriasis in the emotion domain and higher than patients with eczema. In the functioning domain, patients with HH scored higher than psoriasis, eczema, and acne, indicating a more significant negative impact of the illness. |
| Glaser et al. 2018 [30] | Interview | Survey study, qualitative interviews | 1985 | The top three areas impacted by excessive sweating were daily activity, clothing choice, and work/career. |
| Hamm et al. 2014 [31] | N/A | Review | N/A | Describes the impact of primary HH on physical symptoms, i.e., axillary HH causes staining of clothes and frequent bathing. Palmar HH reportedly affects manual activities and handling objects. |
| Elalfy et al. 2017 [32] | Keller | Pre-post interventional study | 42 | Patients with palmo-axillo-plantar HH had elevated Keller scores in all domains plantar (i.e., impairment in tasks such as putting on socks, wearing sandals, and walking barefoot), axillary, and palmar. |
| Shayesteh et al. 2017 [33] | HDSS, SF-36 | Retrospective study | 188 | 5.5% sought medical healthcare help for problems. Lowest SF-36 mental component scores in axillary, palmar, and plantar HSS. HDSS severe in axillary and palmar, mild in plantar and facial. |
| Schick et al. 2016 [35] | HDSS, DLQI | Pre-post interventional study | 30 | Prior to radiofrequency thermotherapy, the DLQI score for axillary HH was 16 representing a severe baseline QoL effect. The DLQI score improved to 7 after treatment. |
| Cohen et al. 2019 [36] | DLQI, HDSS, Odor Scale | Pre-post interventional study | 20 | Prior to percutaneous radiofrequency, the DLQI score for axillary HH was 11.4 representing a severe baseline QoL effect. The DLQI score improved to 0.4 after treatment. |
| Abtahi-Naeini et al. 2015 [37] | DLQI | Pre-post interventional study | 25 | The mean ± SD of the DLQI score before microneedle radiofrequency treatment was 12.96 ± 5.93 denoting severe QoL. The mean DLQI post-treatment was 4.29 ± 2.21. |
| Zhang et al. 2022 [38] | HDSS, DLQI | Pre-post interventional study | 119 | Pre-microwave therapy for patients with primary HH had a mean DLQI score of 14, indicating severe QoL that improved to 2.89 following treatment. |
| Wolosker et al. 2020 [39] | HQLQ | Pre-post interventional study | 1658 | 94% of patients had poor/very poor QoL. Palmar HH was the most severe. QoL improved in 77% of patients after oral oxybutynin. |
| Wolosker et al. 2014 [40] | HQLQ | Pre-post interventional study | 565 | 65.5% of patients with very poor pre-treatment QoL and 75% patients with poor pre-treatment QoL had improved QoL after oral oxybutynin. |
| Almeida et al, 2020 [41] | HDSS | Pre-post interventional study | 30 | Patients with primary HH with HDSS scores of 3 or 4 have a significant improvement in their HDSS scores after oxybutynin treatment. |
| Wang et al. 2011 [42] | HQLQ | Pre-post interventional study | 120 | 63.3% of patients with palmar HH have very poor QoL pre-sympathectomy. |
| Dogru et al. 2020 [43] | HQLQ | Pre-post interventional study | 165 | Among patients with palmar HH, 38.2% have very poor QoL, 45.5% have poor QoL. The patients’ mean preoperative QoL score was 86.5 ± 12.5, which improved to 38.8 ± 16.3 post-operatively. |
| Baroncello et al. 2014 [44] | HQLQ | Pre-post interventional study | 51 | The average QoL related to primary HH with a score of 0–100 before sympathectomy was 34.6 and after was 77.1. |
| Kouris et al. 2014 [45] | HDSS, DLQI | Pre-post interventional study | 119 | Patients with primary HH have a median DLQI of 20, indicating severe QoL, which improved to 3 following treatments with botulinum toxin. |
| Asfour et al. 2022 [46] | HDSS, DLQI | Pre-post interventional study | 40 | Patients with axillary HH had a median HDSS score of three and a DLQI score of 13.5 (indicating a very large effect of HH on QoL). The median HDSS and DLQI score improved to one following treatment with botulinum toxin. |
| Ando et al. 2022 [47] | HDSS, DLQI | Pre-post interventional study | 15 | Patients with head and forehead HH receiving pre-botulinum toxin treatment had a mean HDSS score of 3.13 and a DLQI score of 8.625 (resulting in a very large effect on QoL). This improved significantly following treatment after up to 50 weeks. |
| Mirkovic et al. 2018 [48] | DLQI | Retrospective study | 366 | Median DLQI score pre-treatment was 11 for children aged 16–17 years and 12 for children aged younger than 16 years. Scores improved post-botulinum treatment. Examples of physical symptoms were cold hands, wet clothes, and eczema. |
| Bohaty et al. 2014 [49] | N/A | Review | N/A | HH affects psychosocial and social development. Children report difficulty handling a pen or pencil, keeping school papers dry, riding a bicycle, and using a game controller. |
| Wolosker et al. 2014 [50] | HQLQ | Pre-post interventional study | 45 | Prior to starting oral oxybutynin treatment in children aged under 14 years with palmar HH, 57.8% had a very poor QoL vs 40% post-treatment. |
| Kuijpers et al. 2013 [51] | HDSS, Skindex-29 | Pre-post interventional study | 100 | More than three quarters of patients with palmar and/or axillary HH have poor Skindex-29 scores in the emotions (57.7 ± 18.5) and functioning domain (54.2 ± 18.2). Pre-sympathectomy HDSS score was 3.69 ± 0.47 vs 1.06 ± 0.34 postoperatively. |
| Morard et al. 2019 [54] | HDSS and 10 question survey | Survey study, cross-sectional | 185 | Prevalence of primary HH was 20.56% in medical students (185/900). 23.89% had a HDSS score of 3 or 4, 89.20% had a HDSS score of 2–4. |
| Muthuswamy et al. 2016 [55] | HDSS, DLQI | Survey study, cross-sectional | 187 | 38% of college students had HH. Average DLQI scores for male students were 7.96 and for female students were 7.15, signifying a moderate effect. 35% of students needed appropriate management. |
| Kouris et al. 2015 [56] | cDLQI | Case series | 35 | cDLQI scores pre- and post-botulinum in adolescents was 14.65 ± 2.35 and 4.20 ± 1.41, respectively. Social isolation scores improved post-botulinum. |
| Dobosz et al. 2019 [57] | FACIT | Survey study, cross-sectional | 149 | Compared with the controls, patients with palmar HH had lower (poor QoL) FACIT scores especially in the emotional well-being and social well-being domains. Pre-sympathectomy scores were 66.57 ± 16.33 vs 91.29 ± 11.13 in the controls. FACIT improved post-surgery to 90.28 ± 11.13. |
| Augustin et al. 2013 [58] | N/A | Survey study | 2340 | 27% of patients consulted a physician. Excess of sweat increased the risk for fungal, bacterial, or viral infections. Psoriasis was a common comorbidity. |
cDLQI Children’s Dermatology Quality Life Index, CH compensatory hyperhidrosis, COVID-19 coronavirus disease 2019, DLQI Dermatology Quality Life Index, FACIT Functional Assessment of Chronic Illness Therapy, HDSS Hyperhidrosis Disease Severity Scale, HQLQ Milanez de Campos Questionnaire or Hyperhidrosis Quality of Life Questionnaire, N/A not applicable, PHQ-9 Patient Health Questionnaire-9, SD standard deviation, SF-12 Short Form Health Survey 12, SF-36 Short Form Health Survey 36, QoL quality of life