Hyperhidrosis: prevalence and impact on quality of life.

OBJECTIVE: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it. METHODS: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis. RESULTS: A total of 4,133 residents, in 1,351 households, were surveyed. Excessive sweating was reported by 85 residents (prevalence = 2.07%), of whom 51 (60%) were female. Of those 85 respondents, 51 (60%) agreed to undergo medical evaluation to confirm the diagnosis and only 23 (45%) were diagnosed with primary hyperhidrosis (prevalence = 0.93%). Of the 23 subjects diagnosed with primary hyperhidrosis, 11 (48%) reported poor or very poor quality of life. CONCLUSIONS: Although the prevalence of self-reported excessive sweating was greater than 2%, the actual prevalence of primary hyperhidrosis in our sample was 0.93% and nearly 50% of the respondents with primary hyperhidrosis reported impaired quality of life.

Hyperhidrosis: prevalence and impact on quality of life / Hiperidrose: prevalência e impacto na qualidade de vida

ABSTRACT Objective: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it. Methods: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis. Results: A total of 4,133 residents, in 1,351 households, were surveyed. Excessive sweating was reported by 85 residents (prevalence = 2.07%), of whom 51 (60%) were female. Of those 85 respondents, 51 (60%) agreed to undergo medical evaluation to confirm the diagnosis and only 23 (45%) were diagnosed with primary hyperhidrosis (prevalence = 0.93%). Of the 23 subjects diagnosed with primary hyperhidrosis, 11 (48%) reported poor or very poor quality of life. Conclusions: Although the prevalence of self-reported excessive sweating was greater than 2%, the actual prevalence of primary hyperhidrosis in our sample was 0.93% and nearly 50% of the respondents with primary hyperhidrosis reported impaired quality of life.

RESUMO Objetivo: Estabelecer a prevalência de hiperidrose primária no município de Botucatu (SP) e avaliar como o transtorno afeta a qualidade de vida dos seus portadores. Métodos: Foi realizado um levantamento populacional para identificar os casos de hiperidrose em moradores da região urbana da cidade, selecionados por amostragem sistemática de conglomerados. O número amostral de 4.033 participantes foi calculado usando os mapas censitários do município. Dez entrevistadores aplicaram um questionário que avaliou a presença de transpiração excessiva e convidaram os sujeitos que referiram hiperidrose para uma entrevista com um médico para a confirmação do diagnóstico. Resultados: Foram pesquisados 1.351 domicílios, com 4.133 moradores. Desses, 85 queixaram-se de sudorese excessiva (prevalência = 2,07%), sendo 51 (60%) do gênero feminino. Dos 85 indivíduos, 51 (60%) concordaram receber avaliação médica para confirmar o diagnóstico, e apenas 23 (45%) apresentaram hiperidrose primária (prevalência = 0,93%). Dos 23 indivíduos diagnosticados com hiperidrose primária, 11 (48%) referiram qualidade de vida ruim ou muito ruim. Conclusões: Embora as queixas de transpiração excessiva tenham sido superiores a 2%, a prevalência real de hiperidrose primária em nossa amostra foi de 0,93% e o distúrbio afetava a qualidade de vida em quase 50% dos indivíduos.

Classification of Systemic and Localized Sweating Disorders.

Hyperhidrosis can be subdivided into generalized hyperhidrosis, with increased sweating over the entire body, and focal hyperhidrosis, in which the excessive sweating is restricted to specific parts of the body. Generalized hyperhidrosis may be either primary (idiopathic) or secondary. Secondary generalized hyperhidrosis may be caused by infections such as tuberculosis, hyperthyroidism, endocrine and metabolic disturbances such as pheochromocytoma, neurological disorders, or drugs. Focal hyperhidrosis may also be primary (idiopathic) or secondary. Frey's syndrome is one form of secondary focal hyperhidrosis that occurs during eating together with reddening of the area in front of the ear following parotid gland surgery or injury. Primary focal hyperhidrosis is particularly common on the palms and soles of the feet, in the axilla, and on the head. Anhidrosis may be either congenital/genetic or acquired. Some of the most typical forms of congenital/genetic anhidrosis include hypohidrotic ectodermal dysplasia, congenital insensitivity to pain and anhidrosis, and Fabry disease. Acquired anhidrosis is classified as secondary anhidrosis, which may be due to an underlying disorder such as a neurological disorder, an endocrine or metabolic disturbance, or the effect of drugs, or idiopathic anhidrosis for which the pathology, cause, and mechanism are unknown. Idiopathic anhidrosis is classified into acquired idiopathic generalized anhidrosis (AIGA), idiopathic segmental anhidrosis, and Ross syndrome. AIGA is divided into three categories according to differences in the site of disturbance: (1) sudomotor neuropathy, (2) idiopathic pure sudomotor failure, and (3) sweat gland failure.

Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction.

OBJECTIVE: This prospective study aimed at investigating predictive factors for compensatory sweating after thoracoscopic sympathectomy. METHODS: From 2000 to 2002, 80 patients (53 females and 27 males) underwent thoracoscopic sympathectomy to treat hyperhidrosis. Patient ages ranged from 12 to 56 years, and the mean post-operative follow-up period was 42.51 +/- 5.98 months. Patient satisfaction with the results was evaluated through the use of a rating scale. The procedure was performed bilaterally: at the T2 level for facial hyperhidrosis; at the T3-T4 level for axillary hyperhidrosis; and at the T3 level for palmar hyperhidrosis. RESULTS: Post-operatively, 68 patients (85.0%) presented compensatory sweating, which was classified as mild in 23 (33.8%), moderate in 23 (33.8%) and severe in 22 (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, whereas 10 patients (12.5%) were dissatisfied. The level of patient satisfaction varied according to gender, age, body mass index (BMI) and extent of denervation. The compensatory sweating was more severe on the abdomen and back than on the legs. CONCLUSIONS: Although compensatory sweating, which is a common adverse effect of sympathectomy, occurred in the majority of cases, the level of patient satisfaction was high. The best candidates for thoracoscopic sympathectomy are young adult women with a BMI < 24.9 kg/m(2).

Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction / Hiperhidrose compensatória após simpatectomia toracoscópica: características, prevalência e influência na satisfação do paciente

OBJECTIVE: This prospective study aimed at investigating predictive factors for compensatory sweating after thoracoscopic sympathectomy. METHODS: From 2000 to 2002, 80 patients (53 females and 27 males) underwent thoracoscopic sympathectomy to treat hyperhidrosis. Patient ages ranged from 12 to 56 years, and the mean post-operative follow-up period was 42.51 ± 5.98 months. Patient satisfaction with the results was evaluated through the use of a rating scale. The procedure was performed bilaterally: at the T2 level for facial hyperhidrosis; at the T3-T4 level for axillary hyperhidrosis; and at the T3 level for palmar hyperhidrosis. RESULTS: Post-operatively, 68 patients (85.0 percent) presented compensatory sweating, which was classified as mild in 23 (33.8 percent), moderate in 23 (33.8 percent) and severe in 22 (32.4 percent). Considering the final surgical results, 70 patients (87.5 percent) were satisfied with the outcome of the operation, whereas 10 patients (12.5 percent) were dissatisfied. The level of patient satisfaction varied according to gender, age, body mass index (BMI) and extent of denervation. The compensatory sweating was more severe on the abdomen and back than on the legs. CONCLUSIONS: Although compensatory sweating, which is a common adverse effect of sympathectomy, occurred in the majority of cases, the level of patient satisfaction was high. The best candidates for thoracoscopic sympathectomy are young adult women with a BMI < 24.9 kg/m².

OBJETIVO: Este estudo prospectivo visou investigar fatores preditivos para a hiperidrose compensatória após a simpatectomia toracoscópica. MÉTODOS: De 2000 a 2002, 80 pacientes (53 mulheres e 27 homens), com idade entre 12 e 56 anos, foram submetidos à simpatectomia toracoscópica para o tratamento de hiperidrose e acompanhados em média por 42,51 ± 5,98 meses. A satisfação destes pacientes quanto aos resultados do procedimento foi aferida por meio de uma escala de avaliação. O procedimento foi executado bilateralmente: no nível de T2 para a hiperidrose facial; de T3 e T4 para a hiperidrose axilar; e de T3 para a hiperidrose palmar. RESULTADOS: No período pós-operatório, 68 pacientes (85,0 por cento) apresentaram hiperidrose compensatória, que foi classificada como leve em 23 (33,85 por cento), moderada em 23 (33,8 por cento) e grave em 22 (32,4 por cento). Quanto aos resultados da cirurgia, na avaliação dos pacientes, 70 deles (87,5 por cento) se consideraram satisfeitos, enquanto 10 pacientes (12,5 por cento) disseram estar insatisfeitos. O grau de satisfação do paciente variou de acordo com o sexo, a idade, o índice de massa corpórea (IMC) e a extensão da operação. A hiperidrose compensatória foi mais intensa no abdome e dorso do que nas pernas. CONCLUSÕES: Embora a hiperidrose compensatória seja um efeito adverso frequente após a simpatectomia, o grau de satisfação dos pacientes foi elevado. Os melhores candidatos para simpatectomia toracoscópica são mulheres adultas jovens com IMC < 24,9 kg/m².

The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases.

BACKGROUND: Compensatory hyperhidrosis is the most troublesome side effect and the leading cause of regret with sympathetic surgery. A new classification is proposed to make the procedure more selective and to minimize the side effects and regret rate. Also, a proposed mechanism for compensatory hyperhidrosis is discussed. METHODS: Between January 2002 and July 2003, 464 patients with various sympathetic disorders underwent thoracoscopic sympathectomy/sympathicotomy (ETS) or sympathetic block by clipping (ESB) at various levels according to the authors' classification. The surgery was performed on an outpatient basis. The rates of success, compensatory hyperhidrosis, and regret were recorded. RESULTS: All the patients were followed up for 17 to 35 months. All excessive sweating was effectively stopped to varying degrees. The 25 patients with palmar hyperhidrosis who insisted on receiving ETS of T4 experienced no compensatory hyperhidrosis. Of the 54 patients with facial blushing who received ESB of T2, 23 experienced compensatory hyperhidrosis. Nine patients expressed regret and requested removal of the clips. Of the 33 patients with craniofacial hyperhidrosis who received ESB of T3, 9 experienced compensatory hyperhidrosis. Three expressed regret, and reverse procedures were performed. For 324 patients with palmar hyperhidrosis receiving ESB of T4, no compensatory hyperhidrosis was found. Only two expressed regret because of discomfort. No compensatory hyperhidrosis or regret was noted with 28 patients who received ESB of T5 for axillary sweating. There was no recurrence in the entire series. CONCLUSIONS: Different procedures are recommended for different sympathetic disorders according to the classification. The higher the level of sympathetic ganglion blockade, the higher is the regret rate. Therefore, for T2 and T3 ganglion, endoscopic thoracic sympathetic block by the clipping method is strongly recommended because of its reversibility.

US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey.

BACKGROUND: The current epidemiologic data on hyperhidrosis are scarce and insufficient to provide precise prevalence or impact estimates. OBJECTIVE: We sought to estimate the prevalence of hyperhidrosis in the US population and assess the impact of sweating on those affected by axillary hyperhidrosis. METHODS: A nationally representative sample of 150,000 households was screened by mailed survey for hyperhidrosis and projected to the US population based on US census data. Ascertainment of hyperhidrosis was based on a question that asked whether participants experienced excessive or abnormal/unusual sweating. RESULTS: The prevalence of hyperhidrosis in the survey sample was 2.9% (6800 individuals). The projected prevalence of hyperhidrosis in the United States is 2.8% (7.8 million individuals), and 50.8% of this population (4.0 million individuals) reported that they have axillary hyperhidrosis (1.4% of the US population). Only 38% had discussed their sweating with a health care professional. Approximately one third of individuals with axillary hyperhidrosis (0.5% of the US population or 1.3 million individuals) reported that their sweating is barely tolerable and frequently interferes, or is intolerable and always interferes, with daily activities. CONCLUSION: Hyperhidrosis affects a much larger proportion of the US population than previously reported. More than half of these individuals have axillary hyperhidrosis, in which sweating can result in occupational, emotional, psychological, social, and physical impairment.

Treatment of hyperhidrosis.

Hyperhidrosis, or excessive sweating, is a disorder that may cause social isolation or occupational disability. It may be generalized or localized, and although frequently idiopathic it may be a manifestation of a number of important systemic diseases. Drugs, surgical procedures, and electrical devices may all be employed by the physician as therapeutic weapons to treat hyperhidrosis.

Type A botulinum toxin: a new treatment for axillary and palmar hyperhidrosis.

Hyperhidrosis is an invalidating condition, and one that is difficult to treat. It is characterized by an excessive and uncontrolled production of sweat by the sweat glands, often causing psychological, social, and occupational problems for the patient. Hyperhidrosis can be distinguished in two forms: idiopathic (of unknown etiology), or secondary, due to an alteration of the endocrine system (ex: hyperthyroidism, neuropathy, neoplasia etc.) It is found in about 0.3-0.5% of the population and can be localized (axillary, palmar, plantar, facial) or diffused. The subcutaneous injection of type A botulinum toxin, until now used only for the treatment of blepharospasm or hemifacial spasm, has shown to be a useful treatment for localized hyperhidrosis. The objective of the authors is to evaluate the therapeutic efficacy, safety, and management of botulinum toxin treatment in patients affected with axillary or palmar hyperhidrosis resistant to conventional therapies.

Hiperhidrosis localizada causada por nevus ecrino / Hyperhidrosis localized to cause for escrine nevus

Se presenta un caso de hiperhidrosis localizada en antebrazo izquierdo en un hombre de 28 años de edad. El diagnóstico se logró a traves de la prueba de Acetilcolina y el estudio histológico, cuya conclusión reporto: Nevus ecrino. Esta entidad consiste en la hiperplasia de las glándulas maduras en un área localizada. Es sumamente rara, y son escasos los reportes en la literatura. Se presenta una breve revision de la misma