Does Hyperhidrosis Impact Quality of Life? A Narrative Review of the Literature

🔍 Key Finding Hyperhidrosis significantly and negatively impacts patients’ quality of life across multiple domains, including psychological, physical, and social functioning, yet is underdiagnosed and undertreated due to a lack of awareness, stigma, and access barriers. Despite the availability of effective treatments, many patients do not seek care, highlighting the need for increased awareness among both patients and healthcare providers.

🔬 Methodology Overview

• Design: Narrative literature review
• Data Sources: PubMed
• Search Terms: “hyperhidrosis” and “quality of life” (2011-August 2022)
• Inclusion Criteria: English language, peer-reviewed clinical trials, prospective studies, retrospective studies, and review articles investigating patients with primary HH using a QoL instrument to assess pre-treatment QoL.
• Exclusion Criteria: Studies investigating secondary HH, meta-analyses, studies lacking a QoL instrument, and studies not investigating pre-treatment QoL.
• Analysis Approach: Qualitative synthesis of findings from selected articles.
• Scope: Impact of primary hyperhidrosis on quality of life.

📊 Results

• Prevalence and Underdiagnosis: Hyperhidrosis affects an estimated 4.8% of the US population (approximately 15.8 million people), yet only 51% of those affected have discussed the condition with a healthcare professional. Many do not consider it a medical condition or believe treatment is unavailable.
• Quality of Life Impairment: Hyperhidrosis significantly impacts quality of life (QoL), with up to 48% of patients reporting poor or very poor QoL. This negative impact is comparable to or greater than other chronic skin conditions like eczema and psoriasis, particularly in the functional domain.
• Psychological Impact: Patients with hyperhidrosis experience increased rates of anxiety and depression, often linked to feelings of shame, embarrassment, and lack of self-confidence. Social anxiety and avoidance behaviors are also common.
• Physical and Social Impacts: Excessive sweating interferes with daily activities, clothing choices, work/school, and social interactions. Patients report spending significant time managing symptoms, including frequent clothing changes and hygiene practices.
• Treatment Effectiveness: Various treatments, including antiperspirants, oral medications (e.g., oxybutynin), botulinum toxin injections, microwave thermolysis, radiofrequency, and sympathectomy, have demonstrated efficacy in improving QoL and reducing symptom severity. However, access to and awareness of these treatments remain limited.
• Barriers to Care: Stigma, lack of awareness among patients and healthcare providers, and perceived lack of effective treatments contribute to underdiagnosis and delayed treatment. Many patients suffer for 10 years or more before seeking professional help.

💡 Clinical Impact Hyperhidrosis significantly impacts patients’ physical, psychological, and social well-being, often comparable to other chronic illnesses like psoriasis and eczema, highlighting the need for increased awareness and treatment access. Early diagnosis and intervention are crucial to improving quality of life and preventing long-term effects on social and functional development, particularly in pediatric patients.

🤔 Limitations

• Lack of standardized QoL index for HH.
• Relative lack of QoL studies in HH compared to other skin conditions like eczema and psoriasis.
• Subjectivity and multifactorial nature of QoL measurements.
• Lack of prospective and retrospective studies identifying QoL independently.
• Qualitative data included in the review is subject to interpretation and limitations.
• Selection bias in pre-treatment populations potentially reporting more severe disease.
• Variability and intermittency of objective HH measurements using filter paper gravimetric testing.

✨ What It Means For You Physicians should be aware of the significant negative impact of hyperhidrosis (HH) on patients’ quality of life across multiple domains (physical, psychological, social) and screen for HH, especially since many patients do not seek treatment due to stigma or lack of awareness. Early diagnosis and treatment of HH can improve patient outcomes and potentially prevent or mitigate associated conditions like skin infections and other comorbidities. More research is needed to standardize QoL measurement tools in HH and to further investigate the relationship between HH and other medical and psychological conditions.

Reference Parashar K, Adlam T, Potts G. The Impact of Hyperhidrosis on Quality of Life: A Review of the Literature. American Journal of Clinical Dermatology. 2023;24:187–98. https://doi.org/10.1007/s40257-022-00743-7