A research study done by Brickell Biotech and Burke Healthcare, with collaboration from the International Hyperhidrosis Society in 2016, found that 4.8% of the US population, or 15.3 million Americans, live with severe excessive sweating.
Data from the International Hyperhidrosis Society researchers presented at the American Academy of Dermatology’s (AAD) 2017 Annual Meeting reported that 17% of teens experienced hyperhidrosis. Out of these teens, the average reported that the onset age was 11 years.
Primary and secondary hyperhidrosis
For practical clinical purposes, any degree of sweating that interferes with daily activities should be a cause for concern. The Hyperhidrosis Disease Severity Scale (HDSS) measures the severity of the patient’s condition based on its effects on daily activities.
There are two main types of hyperhidrosis, primary focal or secondary generalised. Primary focal hyperhidrosis usually begins in childhood or adolescence, and usually affects the soles or palms. It might have no obvious cause and is often an inherited condition.
On the other hand, secondary generalised hyperhidrosis usually starts in adulthoood. Sweating is observed on a larger area of the body. This condition has an identifiable cause, such as a medical condition like neurological or endocrine disorders, or a side effect of a certain medication. Unlike primary focal hyperhidrosis, patients with secondary generalised hyperhidrosis often experience this sweating symptom even while sleeping.
Psychosocial effects and red flags
Excessive sweating may lead to fungal overgrowth or infections. However, the psychosocial impact of this condition requires greater attention. Compared to general dermatological patients, those with hyperhidrosis usually have more emotional problems and poor coping abilities.
“People living with hyperhidrosis must not only live with its very visible symptoms but they also have to deal with the anxiety and social stigma associated with excessive sweating, which can be debilitating to their daily lives,” says Lisa J. Pieretti, co-founder and executive director of the International Hyperhidrosis Society.
A US national survey reported that in patients with axillary hyperhidrosis (excessive underarm sweating) more than half feel less confident, where 38% were frustrated by certain daily activities, 34% were unhappy, and 20% were depressed.
Those with palmar hyperhidrosis had increased social embarrassment along with avoiding shaking hands with people. Another US survey for households reported that those with axillary hyperhidrosis have limitations in romantic or intimate situations, along with 44% of people with limitations in sports activities.
Furthermore, there may be potential complications of hyperhidrosis as a chronic disease. In order to diagnose the causes of secondary hyperhidrosis, physicians should be able to identify common conditions and red flags presented with hyperhidrosis. These include hyperthyroidism, lymphoma, congestive heart failure, and hypoglycemia. With this, a targeted history and examination can be carried out.
The survey results highlighted that hyperhidrosis sufferers did not realise that excessive sweating was considered a medical condition, or they were unaware of effective treatment options. As such, only 49% of these individuals have discussed their condition with a healthcare professional. Furthermore, 53% of those who visited a healthcare professional about their excessive sweating remained undiagnosed.
There are current treatment strategies available to combat hyperhidrosis. Older treatments such as anti-perspirants and iontophoresis have existed for a long time, and improvements have been made. Iontophoresis uses a medical device to treat hyperhidrosis, involving the passing of an ionised substance through the intact skin by the application of a direct electrical current.
A study published in 1952 revealed that iontophoresis helped 91% of patients with excessive palmoplantar (hands and feet) sweating. With improvements in technology, newer treatments such as miraDry, Botox injections and lasers have been developed to treat hyperhidrosis. miraDry is a microwave-based device specific for axillary hyperhidrosis treatment.
A 2013 study reported that miraDry was effective in both axillary hyperhidrosis and axillary osmidrosis (foul-smelling sweat). Seven months after the treatment, 83.3% of the underarms treated reported a two-point improvement in the HDSS. In 2015, miraDry was the first U.S. FDA-cleared device available to stop unwanted underarm sweat and hair growth, along with eliminating odor-producing glands.
Pieretti, who was the lead investigator of the study says, “(The report on teen hyperhidrosis is important for) paediatricians, paediatric dermatologists, school nurses, parents and teens. By helping to increase awareness of the problem, we hope we can inspire teens to bring their excessive sweating issues out into the open – and for medical professionals to provide more empathetic, effective management.” MIMS
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