Results

1
A Demographical Study of Hyperhidrosis
Edward Kessler, B.A., Katherine Flanagan, M.D.
and Dee Anna Glaser, M.D. Department of
Dermatology, Saint Louis University, St. Louis, MO
Background
The most common aggravating factors reported were
stress, anxiety, heat, and exercise.
Significant associations were detected between
gender and affected site(s). Males were
significantly more likely to present with facial
HH. Females were significantly more likely to
present with isolated axillary HH than males.
Otherwise, both genders had similar presentations
for sites affected by HH. Patients
presenting with HH of palms, or soles (plantar),
or a combination of palms and soles
(palmoplantar) were significantly more likely to
list stress and anxiety as aggravating factors
compared to patients with other sites of HH.
Patients presenting with facial HH were
significantly more likely to list stress,
exercise, and heat as aggravating factors, and
patients with scalp HH listed anxiety as a
significantly aggravating factor. Other
significant predisposing factors were family
history and the age of onset of HH. Patients who
reported the onset of HH prior to the age of 20
years were more likely to have a positive family
history of HH than those reporting the onset of
HH after the age of 20 years old. Patients who
complained of axillary HH (isolated or in
addition to other areas) were more likely to have
a post-pubertal onset of HH. The post-pubertal
onset of axillary HH coincided with an age of
onset between the ages of 12 to 19 years.
Patients presenting with palmoplantar HH were
significantly more likely to have a pre-pubertal
onset, with an age of onset prior to the age of
12 years.
Hyperhidrosis (HH) is a disorder characterized
by perspiration in excess of the body's
physiologic needs. It can significantly impact
one's occupational, physical, emotional and
social life. HH is categorized as either
primary or secondary hyperhidrosis (1,2).
Primary focal HH is a chronic, idiopathic
disorder of excessive perspiration in a
bilateral, symmetrical manner (3). Primary focal
HH is associated with hyperactivity of the
sympathetic nervous system and can affect one or
several areas of the body (2, 3). Secondary HH
is due to an underlying condition, such as
infection, endocrine disorders, metabolic
disorders, neoplastic diseases, neurological
conditions, spinal cord injuries, cardiovascular
disorders, respiratory disorders, anxiety, and
stress (2, 4). Primary HH is a relatively common
disorder, affecting nearly 3 of the U.S.
population, with the highest prevalence rates
among those aged 18 to 64 years. The prevalence
rate is the same for males and females (2). The
most common sites of primary HH are palms, soles,
axillae, face, and scalp (4, 5). Various
treatments for primary focal HH exist, ranging
from topical treatments, iontophoresis, oral
anticholinergics, botulinum toxin injections,
and surgery (5, 6, 7, 8). A genetic component
may contribute to primary HH as family history
has been positive in 30-65 of patients (5, 9).
Current knowledge and research on this disease
has emphasized treatment, while few studies have
described the demographics of this population.
Discussion

• The patient population in our study differed with
  the population described in the US prevalence
  study by Strutton, et al. by having an earlier
  age of onset, higher severity rating on the HDSS,
  higher percentage of axillary disease, and many
  more past therapies attempted by the time of
  consultation. This difference between studies may
  be due to our patients greater disease severity
  which compelled them to seek treatment for their
  condition. The population described in the US
  prevalence study by Strutton et al. were assessed
  through a national survey and likely reflects a
  less severely affected population.
• Gender
• Our study also detected a gender difference in
  the presentation of HH. Female patients
  presented for evaluation in much higher
  frequencies despite past reports of similar
  prevalence of HH between the sexes. In both this
  study and the Strutton et al. study, HDSS scores
  were similar between genders, which suggests that
  a difference in interpretation of HH severity
  between males and females was unlikely. This
  discrepancy may reflect a disparity between
  females and males in their willingness to consult
  with a physician.
• Anatomic Sites
• Axillary HH was the most common presentation in
  our patients. This may reflect greater media
  attention and marketing for botulinum toxin A
  treatment for primary focal axillary HH. A
  remarkable difference was noted between genders
  regarding the affected site(s) of presentation.
  Females were more
• likely to present with isolated axillary HH.
  Males were more likely to present with facial HH,
  which was aggravated significantly more
  frequently by stress, exercise, and heat than
  hyperhidrosis of other sites.
• Age of Onset
• Patients with onset of HH prior to the age of 12
  years were more likely to present with
  palmoplantar HH. Patients with post-pubertal
  onset of HH were more likely to present with
  axillary HH. We anticipated this difference
  based on the hypothesis that axillary HH is due
  to dysfunction of the apocrine or apo-eccrine
  glands, which are highly dense in the axillary
  region and are non-functional until puberty (5,
  11). Thus, this data suggests that a similar
  pathophysiology is involved in the development of
  HH.
• CONCLUSIONS
• This large descriptive study of patients seeking
  care of primary focal HH has demonstrated novel
  findings
• Despite similar disease prevalence between
  genders, women were
• significantly more likely to seek medical
  care for hyperhidrosis than men.
• Distinct gender differences exist in the
  clinical patterns of hyperhidrosis.
• Patients seeking medical attention are severely
  affected by their disease.
• Axillary HH is the most common presentation.

Objective
To perform a descriptive study of this patient
population by identifying common trends and
associations of patients presenting with primary
focal HH.
Methods
Each category does not exclude other sites that
may also be involved
The medical records of 515 patients presenting to
a midwestern American academic outpatient
dermatology clinic between October 1998 and
November 2006 for evaluation and treatment of
primary focal HH were reviewed. Information
collected included the following gender, sites
of hyperhidrosis, age, date of birth, age of
onset, aggravating factors, pre- or post-puberty
onset, severity of disease on Hyperhidrosis
Disease Severity Scale (HDSS), family history,
handedness, tobacco or alcohol use, general
habitus, occupation, ethnicity, and past
treatment. The results were compiled using the
Statistical Package for the Social Sciences
(SPSS) version 14 and analyzed for descriptive
statistics. The data was grouped into nominal
categories for all variables, except HDSS and
age, which were analyzed as ordinal variables.
Chi-square statistics were used to test
differences between males and females, age of
onset, puberty onset and sites of hyperhidrosis
against all other variables. A p-value of lt0.05
was used to determine significance throughout
this paper.
Results
Of 515 patients, 67.2 were female and 32.8 were
male. The average age of our patients at date of
consultation was 27.94 11.82 years with a
median age of 25 years. The average age of HH
onset was 14.1 7.9 years with a median age of
13.0 years. Two-thirds of patients claimed a
post-pubertal onset of HH. The most common
disease pattern was isolated primary axillary HH.
An overwhelming majority of our patients were
severely affected by hyperhidrosis, rating their
condition as 4 out of 4 on the HDSS. The majority
(80) of our patients were considered normal
weight, with 16 considered overweight, and the
remaining 4 were considered underweight. The
preponderance of our patients were Caucasian
(86.8), followed by African-Americans (8.2),
Asians (2.5), Hispanics (0.8), and other
(1.6). Patients occupations ranged, in order
of descending frequency categorically, from
students, professionals (finance, law, medicine,
sales, education), clerical workers, homemakers,
tradespeople (electricians, plumbers,
construction workers), retirees, unemployed, and
disabled persons.
Females were significantly more likely to
present for evaluation of HH than males.