Primary Focal Hyperhidrosis Research Articles

Are Patients Better than the Laboratory in Assessing Sweating? Validation Study

Background Primary focal hyperhidrosis is a hereditary condition characterized by excessive sweating affecting a variety of areas, including the palms. In most cases, the decision to treat a patient is based only on the patient's own description of the symptoms because laboratory tests have not been established in clinical practice. Objective To validate a subjective self-assessment scale for sweating in comparison with an objective method of quantifying evaporation from the skin surface. Methods We studied palmar sweating in 20 patients with primary focal hyperhidrosis and 20 age- and gender-matched controls. Four times in each subject, we obtained measurements of the evaporation in palms and the self-evaluation scale (SES) scores on a proportional scale from 0 (no sweating) to 10 (worst imaginable sweating). Results Good correlation was found between the SES score and evaporation assessment (R = .65). The SES score was easier to obtain and provided better diagnostic sensitivity and specificity. They leveled out at over 80% when a score of 3 was used as the threshold level; for evaporimetry, sensitivity equalled specificity at 70% at the threshold 90 mg Conclusion We confirm the usefulness of the SES in assessing palmar sweating and discuss the current restrictions in its use in clinical diagnosis. We propose that the scale can be added effortlessly to research or clinical protocols to provide the necessary validation in wider spectra of patients.

Primary focal hyperhidrosis: Comparison of functional impairment, health-related quality of life, and medical history across a large cohort of patients by focal location and nonhyperhidrotic controls

Primary focal hyperhidrosis: Comparison of functional impairment, health-related quality of life, and medical history across a large cohort of patients by focal location and nonhyperhidrotic controls

Psychosocial aspects of patients with focal hyperhidrosis. Marked reduction of social phobia, anxiety and depression and increased quality of life after treatment with botulinum toxin A

Primary focal hyperhidrosis (PFH) is defined as excessive sweating typically localized to specific body areas such as axillae, hands and feet. An association between PFH and anxiety as well as depressive syndromes has been suggested. To investigate a possible association between PFH and anxiety, depression, social phobia and quality of life, and to study the effect of treatment with botulinum toxin A on these factors. PFH was confirmed clinically and by gravimetry. To measure anxiety and depressive syndromes several German versions of standardized questionnaires were used: State-Trait Anxiety Inventory G Form X2 (STAI), Social Phobia Scale (SPS), Symptom Checklist of Derogatis (SCL-90-R), subscales 'Social Insecurity', 'Depression', 'Anxiety' and 'Phobia', and Hospital Anxiety and Depression Scale (HADS-D). Quality of life was assessed using Skindex. Two analyses were performed. The first analysis included all patients with PFH, the second analysis only patients with PFH who were treated with botulinum toxin A. In the latter group the questionnaires were repeated 2-4 weeks after treatment. For the total group at baseline the values for STAI, SCL-90-R, HADS-D and SPS were well within the normal range. However, in the group of patients treated with botulinum toxin A, the mean +/- SD SPS score was 17.6 +/- 15.5, i.e. above the normal range. Quality of life was impaired, with a mean +/- SD Skindex score of 24.3 +/- 5.7 at baseline. Treatment with botulinum toxin A led to a significant reduction in all investigated symptoms. Despite an impaired quality of life, patients with PFH in general do not show increased symptoms of anxiety, depression or social phobia. Only in the subgroup of patients treated with botulinum toxin A was the SPS increased at baseline. Treatment with botulinum toxin A led to a marked improvement in all factors investigated.

No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis

Primary focal hyperhidrosis is caused by excessive secretion by eccrine sweat glands, usually at the palms, soles and axillae. The underlying mechanism is unclear. In recent years botulinum toxin A has emerged as a useful treatment. Compensatory sweating, which is a major problem in many patients who have undergone transthoracic endoscopic sympathectomy for hyperhidrosis, has only rarely been reported after botulinum toxin. However, this potential side-effect of botulinum toxin treatment has not been systematically examined. To investigate if treatment with botulinum toxin A in hyperhidrotic hands may cause compensatory sweating at other skin locations. In 17 patients with a history of palmar hyperhidrosis repeated measurements of evaporation were made before and up to 6 months after treatment of the hands with botulinum toxin A. Recordings were made at 16 skin areas and compared with subjective estimates of sweating. Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area. Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories.

A consensus statement that addresses the recognition, diagnosis and management of patients with primary focal hyperhidrosis has been published,

A consensus statement that addresses the recognition, diagnosis and management of patients with primary focal hyperhidrosis has been published,

Effect of pharmacologic treatment on dermatologic-specific quality of life (qol): a comparison of botulinum toxin type-a (bt-a) for primary focal hyperhidrosis (hh) to medical treatments for other dermatological diseases

Objectives: To review and compare via the Dermatology Life Quality Index (DLQI): 1) the effect of primary focal HH on QOL relative to other dermatological diseases; 2) the QOL treatment effect of BT-A for HH to the QOL treatment effect reported for other dermatological treatments and diseases.Methods: The DLQI is a 10 item dermatology-specific QOL questionnaire with a total score ranging from 0 to 30 (with 30 representing the worst impact on QOL). A literature search identified all publications reporting pre- and post-pharmacologic treatment DLQI scores for a variety of diseases. Using studies with data on at least 20 adult subjects to ensure sufficient sample size, an evidence table was constructed listing the pre- and post-pharmacologic DLQI score by dermatological disease and treatment. QOL treatment effect was defined as the reported mean or median difference in the pre- and post-treatment DLQI score.Results: 7 of 8 studies with pre- and post-pharmacologic treatment DLQI total scores reported data for at least 20 adult patients (3 on HH, 3 on moderate to severe psoriasis, and 1 on moderate to severe acne). Baseline DLQI total scores ranged from 9.1 to 18 for HH, 8.4 to 11.9 for psoriasis, and 8.3 to 9.2 for acne. Treatment effects ranged from −7.3 to −13 for BT-A in HH, −7 to −10 for cyclosporin in psoriasis, −2.4 to −6 for alefacept in psoriasis, and −5.8 to −6.1 for various treatments (oral isotretinoin, oral and topical antibiotics, and anti-androgens) in acne.Conclusion: The effect of primary focal hyperhidrosis on QOL as reported in the literature was similar to or greater than that reported at baseline for moderate to severe psoriasis and acne. In addition, the beneficial improvement in QOL reported for HH patients following the use of BT-A was similar to or greater than the magnitude of improvement in QOL reported for moderate to severe psoriasis following systemic treatment, and also was similar to or greater than the QOL benefit reported for moderate to severe acne following systemic and/or topical treatments. Objectives: To review and compare via the Dermatology Life Quality Index (DLQI): 1) the effect of primary focal HH on QOL relative to other dermatological diseases; 2) the QOL treatment effect of BT-A for HH to the QOL treatment effect reported for other dermatological treatments and diseases. Methods: The DLQI is a 10 item dermatology-specific QOL questionnaire with a total score ranging from 0 to 30 (with 30 representing the worst impact on QOL). A literature search identified all publications reporting pre- and post-pharmacologic treatment DLQI scores for a variety of diseases. Using studies with data on at least 20 adult subjects to ensure sufficient sample size, an evidence table was constructed listing the pre- and post-pharmacologic DLQI score by dermatological disease and treatment. QOL treatment effect was defined as the reported mean or median difference in the pre- and post-treatment DLQI score. Results: 7 of 8 studies with pre- and post-pharmacologic treatment DLQI total scores reported data for at least 20 adult patients (3 on HH, 3 on moderate to severe psoriasis, and 1 on moderate to severe acne). Baseline DLQI total scores ranged from 9.1 to 18 for HH, 8.4 to 11.9 for psoriasis, and 8.3 to 9.2 for acne. Treatment effects ranged from −7.3 to −13 for BT-A in HH, −7 to −10 for cyclosporin in psoriasis, −2.4 to −6 for alefacept in psoriasis, and −5.8 to −6.1 for various treatments (oral isotretinoin, oral and topical antibiotics, and anti-androgens) in acne. Conclusion: The effect of primary focal hyperhidrosis on QOL as reported in the literature was similar to or greater than that reported at baseline for moderate to severe psoriasis and acne. In addition, the beneficial improvement in QOL reported for HH patients following the use of BT-A was similar to or greater than the magnitude of improvement in QOL reported for moderate to severe psoriasis following systemic treatment, and also was similar to or greater than the QOL benefit reported for moderate to severe acne following systemic and/or topical treatments.

Evidence-based recommendations for recognition and diagnosis of primary focal hyperhidrosis

Evidence-based recommendations for recognition and diagnosis of primary focal hyperhidrosis

Treatments for primary focal hyperhidrosis

Treatments for primary focal hyperhidrosis

Botulinum A toxin improves life quality in severe primary focal hyperhidrosis.

Focal hyperhidrosis is a condition that may disturb emotional, social and professional life. Treatment options for severe cases are surgical sympathectomy and local chemical sweat gland denervation by intradermal injections of botulinum toxin A (Btx A). The Dermatology Life Quality Index (DLQI) is a simple validated questionnaire designed to measure and compare disability in different skin diseases. The aim of this study was to assess quality of life with the DLQI before and after treatment with botulinum toxin injections in a group of patients with severe hyperhidrosis. DLQI was administered to 58 randomly chosen patients before and after treatment. All patients answered the DLQI questionnaire prior to treatment and 53/58 at mean 5.2 months after treatment. The mean DLQI score in the 58 patients before treatment was 10.3 (2-23). In the group of 16/53 patients who had a relapse of sweating when answering the DLQI a second time, no significant improvement was seen [score 10.6 before and 8.8 after treatment (P = 0.21)]. In patients without relapse, a 76% improvement was obtained (DLQI was reduced from 9.9 to 2.4; P < 0.0001). The study showed that focal hyperhidrosis may considerably reduce life quality and the disability experienced by the patients can be largely reversed by botulinum toxin injections.

Cardiac Autonomic Function in Patients Suffering from Primary Focal Hyperhidrosis

Cardiac autonomic function in patients (n = 63) with primary focal hyperhidrosis and healthy controls (n = 28) was investigated by short-term frequency domain power spectral analysis of heart rate variability. The power of the very-low-frequency band (0.01–0.05 Hz) was significantly lower in patients with axillary hyperhidrosis than in controls. No differences between groups could be observed at investigation of the low-frequency band (0.05–0.15 Hz), which was a surprising finding because this band represents also sympathetic cardiac innervation. At the high-frequency band (0.15–0.5 Hz), which represents parasympathetic cardiac innervation, an interaction of type and position influencing spectral power was detected. Our highly interesting findings indicate that primary focal hyperhidrosis is based on a much more complex autonomic dysfunction than generalised sympathetic overactivity and seems to involve the parasympathetic nervous system as well.