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Supplements Examining Hyperhidrosis (Excessive Sweating): A Managed Markets Update on New Treatments, Featuring a Patient Perspective
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Hyperhidrosis and Its Impact on Those Living With It
Mary Lenefsky, PharmD, and Zakiya P. Rice, MD
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Hyperhidrosis and Its Impact on Those Living With It

Mary Lenefsky, PharmD, and Zakiya P. Rice, MD
To date, many QOL impact studies have been completed outside of the United States, but it is likely the results represent QOL in US patients. In a study from Brazil that included 85 respondents who reported excessive sweating, nearly half indicated an impaired QOL secondary to hyperhidrosis. Of 23 patients diagnosed with primary hyperhidrosis, 11 reported a poor or very poor QOL.16 Muthusamy et al reported on a study of college-aged students in India, where QOL was impacted in nearly 35% of respondents.15 While numerous QOL tools are available, other studies show an overall impact on a patient’s life, without quantifying it based on a specific tool. A study from the United Kingdom included 71 patients; 41% of the patients indicated that hyperhidrosis negatively affected their choice of hobby (eg, yoga, knitting), 69% experienced emotional sequelae, 50% felt restricted by their disease, and 57% had difficulty interacting with others.5

Comorbid Conditions and Unintended Consequences

The study by Kamudoni et al highlights other components of hyperhidrosis: emotional sequelae and secondary comorbidities.5 Hyperhidrosis negatively affects the mental health of patients.6 The State-Trait Anxiety Inventory G Form, the Social Phobia Scale, and the Hospital Anxiety and Depression Scale are commonly used tools to assess how the disease impacts emotional well-being.14 One international study used the Patient Health Questionnaire–9 and Generalized Anxiety Disorder–7 scales, and it was determined that the prevalence of anxiety and depression was 21.3% and 27.2%, respectively, in patients with hyperhidrosis compared with 7.5% and 9.7% in those without the disease.1 Lessa Lda et al documented that in patients with severe hyperhidrosis, the rate of social anxiety disorder was 47.1% compared with 13.8% in patients without hyperhidrosis.17 In a study reported by Bahar et al, rates of depression in patients with hyperhidrosis appeared to be higher, 27.2% compared with 9.7% in patients without the disease.1 Another study of patients with hyperhidrosis indicated that rates of anxiety were more than 4 times higher than rates for depression (49.6% vs 11.2%, respectively).18 The reason for the higher rate of anxiety compared with depression in this study is not clear. Results of this study also indicated that anxiety and depression were not associated with age group or gender.

Constant sweating leads to embarrassment for many patients. Other feelings caused by excessive sweating include anxiousness, sadness, anger, and hopelessness.5 Beyond emotional issues, excessive sweating can also lead to further consequences. Excessive sweat causes constant wetness and skin macerations that lead to sore or cracked skin and thus to conditions such as athlete’s foot.5,6,19 A study found a 3.5-fold increase in risk for patients with athlete’s foot to also have hyperhidrosis.20 The risk of skin infections, dermatophytes, psoriasis, and/or warts is increased secondary to sweating.5,6 Hyperhidrosis is considered a predisposing factor for both bacterial growth and the dermatologic condition known as pitted keratolysis.21 Pitted keratolysis is an infection on the bottom of the foot that is characterized by craters or pits.19

In a retrospective case-control study, the overall risk of any cutaneous infection was significantly increased in patients with hyperhidrosis compared with control patients (odds ratio [OR], 3.2; 95% CI, 2.2-4.6). Risks of fungal (OR, 5.0), bacterial (OR, 2.6), or viral infection (OR, 1.9) were also all significantly increased.22 The International Hyperhidrosis Society (IHHS) reports that those with hyperhidrosis have a 300% greater risk of skin infections than those not experiencing the disease.19,22 Although these rates are alarming, studies have not yet quantified what these increased rates of infection mean for the long term. For example, are more patients with hyperhidrosis being admitted to the hospital for management of these infections? Are repeat skin infections in this patient population leading to any antimicrobial resistance patterns? These questions remain to be answered, and more research is needed in this field.


It is important that we, as healthcare professionals, understand what it is like living with this disease, what these patients experience daily, and how it affects them. Of the estimated 15 million people with hyperhidrosis, just half report discussing their excessive sweating with a healthcare professional, despite nearly a third of patients presenting with a severe form of the disease.13 Additionally, for many individuals with hyperhidrosis, information about their disease is inadequate.5 Fortunately, the IHHS is attempting to change that. The IHHS website,, provides users with extensive up-to-date information and educational resources. The website is divided into sections that are tailored to, for instance, teenaged or adolescent patients, medical professionals, and the media. On the website, a translator tool can convert content into any language. Diagrams, support programs, a physician finder, continuing medical education programs, and original referenced material are among this website’s resources for users.9


Approximately 15.3 million Americans are impacted by hyperhidrosis. This disease negatively affects numerous aspects of life, with approximately 40% of individuals reporting some level of physical discomfort.5,14 Hyperhidrosis impairs emotional, mental, and professional facets of living, leading to a significantly decreased QOL. Patients experiencing hyperhidrosis must overcome obstacles that individuals without hyperhidrosis would never consider. Multiple changes of clothing, showering numerous times a day, and feelings of embarrassment, shame, and depression are just some considerations this patient population must endure daily. Excessive sweating may also lead to comorbid conditions, such as skin infections, psoriasis, or warts. It is imperative that healthcare practitioners understand the epidemiology and impact this disease has on individuals. 

Author affiliations: Mary Lenefsky, PharmD, is a freelance medical writer and editor from Denver, CO. Zakiya P. Rice, MD, is an associate at Dermatology Associates of Georgia and an adjunct clinical professor, Department of Dermatology, Emory University School of Medicine, Atlanta, GA.
Funding source: This activity is supported by an educational grant from Dermira, Inc.
Author disclosures: Mary Lenefsky, PharmD, and Zakiya P. Rice, MD, have no relevant financial relationships with commercial interests to disclose.
Authorship information: Analysis and interpretation of data; concept and design; critical revision of the manuscript for important intellectual content; drafting of the manuscript; supervision.
Address correspondence to:
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  2. Hosp C, Hamm H. Safety of available and emerging drug therapies for hyperhidrosis. Expert Opin Drug Saf. 2017;16(9):1039-1049. doi: 10.1080/14740338.2017.1354983.
  3. Fujimoto T. Pathophysiology and treatment of hyperhidrosis. Curr Probl Dermatol. 2016;51:86-9 doi: 10.1159/000446786.
  4. Ohshima Y, Tamada Y. Classification of systemic and localized sweating disorders. Curr Probl Dermatol. 2016;51:7-10. doi: 10.1159/000446753.
  5. Kamudoni P, Mueller B, Halford J, Schouveller A, Stacey B, Salek MS. The impact of hyperhidrosis on patients’ daily life and quality of life: a qualitative investigation. Health Qual Life Outcomes. 2017;15(1):121. doi: 10.1186/s12955-017-0693-x.
  6. Shayesteh A, Janlert U, Nylander E. Hyperhidrosis – sweating sites matter: quality of life in primary hyperhidrosis according to the sweating sites measured by SF-3 Dermatology. 2017;233(6):441-445. doi: 10.1159/000486713.
  7. Rzany B, Bechara FG, Feise K, Heckmann M, Rapprich S, Wörle B. Update of the S1 guidelines on the definition and treatment of primary hyperhidrosis. J Dtsch Dermatol Ges. 2018;16(7):945-952. doi: 10.1111/ddg.13579.
  8. Hu Y, Converse C, Lyons MC, Hsu WH. Neural control of sweat secretion: a review. Br J Dermatol. 2018;178(6):1246-1256. doi: 10.1111/bjd.1580
  9. Pieretti LJ. Resources for hyperhidrosis sufferers, patients, and health care providers. Dermatol Clin. 2014;32(4):555-564. doi: 10.1016/j.det.2014.06.011.
  10. Pathophysiology of excessive sweating. International Hyperhidrosis Society website. Accessed October 4, 2018.
  11. Moraites E, Vaughn OA, Hill S. Incidence and prevalence of hyperhidrosis. Dermatol Clin. 2014;32(4):457-465. doi: 10.1016/j.det.2014.06.006.
  12. Glaser DA, Hebert AA, Nast A, et al. Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials [published online July 10, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.07.002.
  13. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Arch Dermatol Res. 2016;308(10):743-749. doi: 10.1007/s00403-016-1697-9.
  14. Hamm H. Impact of hyperhidrosis on quality of life and its assessment. Dermatol Clin. 2014;32(4):467-476. doi: 10.1016/j.det.2006.004.
  15. Muthusamy A, Gajendran R, Ponnan S, Thangavel D, Rangan V. A study on the impact of
    hyperhidrosis on the quality of life among college students. J Clin Diagn Res. 2016;10(6):CC08-CC010. doi: 10.7860/JCDR/2016/19495.8061.
  16. Hasimoto EN, Cataneo DC, Reis TAD, Cataneo AJM. Hyperhidrosis: prevalence and impact on quality of life. J Bras Pneumol. 2018;44(4):292-298. doi: 10.1590/S1806-37562017000000379.
  17. Lessa Lda R, Luz FB, De Rezende RM, et al. The psychiatric facet of hyperhidrosis: demographics, disability, quality of life, and associated psychopathology. J Psychiatr Pract. 2014;20(4):316-323. doi: 10.1097/01.pra.0000452570.69578.31.
  18. Gatto Bragança GM, Oliveira Lima S, Ferreira Pinto Neto A, Marques LM, Melo EV, Reis FP. Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis. An Bras Dermatol. 2014;89(2):230-235. doi: 10.1590/abd1806-4841.20142189.
  19. The effects on patients’ lives: physical discomfort. International Hyperhidrosis Society website. Accessed October 17, 2018.
  20. Boboschko I, Jockenhöfer S, Sinkgraven R, Rzany B. Hyperhidrosis as risk factor for tinea pedis [in German]. Hautarzt. 2005;56(2):151-155.
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  22. Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. J Am Acad Dermatol. 2009;61(2):242-246. doi: 10.1016/j.jaad.2009.02.038.
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