Understanding Patient Experience With Hyperhidrosis: A National Survey of 1,985 Patients
April 2018 | Volume 17 | Issue 4 | Original Article | 392 | Copyright © April 2018
Dee Anna Glaser MD,a Adelaide Hebert MD,b Lisa Pieretti,c and David Pariser MDd
aSaint Louis University, St. Louis, MO bUniveristy of Texas Medical School at Houston, Houston, TX cInternational Hyperhidrosis Society, Quakertown, PA dEastern Virginia Medical School, Norfolk, VA
Hyperhidrosis affects 4.8% of the US population, and despite the well documented negative impact of hyperhidrosis on patients’ lives, data are generally lacking on the patient experience with this condition. The International Hyperhidrosis Society (IHHS) conducted a study in 2014, and initial results confirmed the multifaceted impact of hyperhidrosis on quality of life and underscored the need for disease awareness and effective management. To provide further insight into the hyperhidrosis patient experience, additional results focusing on family history, physician interaction, impact on daily activities, and treatment satisfaction are presented here. The online survey included 22 multiple-choice questions (some allowing multiple responses). Respondents were IHHS newsletter registrants in the US self-identified as suffering with excessive sweating (ie, answering ‘yes’ to Question 1). Of 28,587 survey invitations, a total of 5,042 recipients (17.6%) opened the e-mail, and 2,045 respondents provided an answer to Question 1. Of these, 1,985 (6.9%) self-identified as having excessive sweating and continued the survey. Over 18% of survey respondents reported an immediate family member with excessive sweating. The top three areas impacted by excessive sweating were daily activity, clothing choice, and work/career (average rank scores over 3.0 for each area; range 1-8 with lower scores indicating greater impact). Nearly half (48.9%) of respondents reported waiting 10 or more years prior to seeking medical help, and 85.0% waited at least 3 years. Of the 87.2% of respondents who received treatment for hyperhidrosis, patients were most satisfied with injections and least satisfied with prescription and over-the-counter antiperspirants and liposuction. These survey results add important clinical insight for the underserved hyperhidrosis patient population. The reported delay in seeking proper medical attention highlights the need to increase hyperhidrosis awareness among the public and clinicians, to reduce stigma associated with the condition, and to encourage active treatment strategies.
J Drugs Dermatol. 2018;17(4):392-396.
Hyperhidrosis (HH) is a condition in which sweat production exceeds that which is physiologically necessary to maintain thermal homeostasis.1 The most recent estimate of HH prevalence in the United States is 4.8%, or approximately 15.3 million people.2 Numerous clinical trials have demonstrated the negative impact that HH has on a patient’s quality of life,1,3-5 and a recently published study in more than 2000 participants found that the prevalence of anxiety and depression was significantly higher in those with HH than those without HH (21.3% vs 7.5% and 27.2% vs 9.7%, respectively).6 Despite the negative impact to patients, the perception that HH is not a “real” medical condition persists, and can leave those with HH suffering in silence.2 Patients’ inability to interpret their symptoms as a medical condition leads to a delay in seeking (or a complete reluctance to seek) treatment, as seen in previous reports.2,7 Though specific treatment choices may differ depending upon location of excessive sweating and intrinsic patient characteristics, in general, treatments for HH span a broad range of therapeutic approaches.1 Commonly used therapies include topical use of antiperspirants (eg, aluminum salts), iontophoresis, botulinum toxin injections, and microwave thermolysis (for axillary HH only). Additionally, systemic anticholinergic drugs have been used with some success, though corresponding adverse events such as dry eyes, dry mouth, and bowel or bladder dysfunction are limiting.8 If these first-line treatments are ineffective or unavailable, invasive or surgical procedures, such as direct excision of the sweat glands, can be considered in selected cases.9 The most invasive surgical approach is endoscopic thoracic sympathectomy, which has shown positive results, though the potential for adverse effects, particularly compensatory sweating, remains a concern.9 The International Hyperhidrosis Society (IHHS) is currently the only non-profit organization advocating in the interest of patients with HH and supports ongoing research efforts in the therapeutic area.10 In 2014, a national questionnaire-based survey of IHHS newsletter registrants in the US was undertaken, and the results provided insight into HH multifocal patterns, changes in condition severity over time, and changes across