A Demographical Study of Hyperhidrosis
Edward Kessler, B.A., Katherine Flanagan, M.D. and Dee Anna Glaser, M.D. Department of
Dermatology, Saint Louis University, St. Louis, MO
Current knowledge and research on this disease has emphasized
treatment, while few studies have described the demographics of this
population.
80
70
60
20
10
Sl
ee
p
O
Al
th
l li
er
st
*
ed
No
Fa
Kn
ct
or
ow
s
n
Fa
ct
or
s
er
cis
e
Ex
Percentage
80
60
40
20
0
Palmar
Plantar
(Soles)
Palms and
Soles
Face and
scalp
Groin
Other significant predisposing factors were family history and the age of onset of HH. Patients who
reported the onset of HH prior to the age of 20 years were more likely to have a positive family history of
HH than those reporting the onset of HH after the age of 20 years old. Patients who complained of axillary
HH (isolated or in addition to other areas) were more likely to have a post-pubertal onset of HH. The postpubertal onset of axillary HH coincided with an age of onset between the ages of 12 to 19 years. Patients
presenting with palmoplantar HH were significantly more likely to have a pre-pubertal onset, with an age of
onset prior to the age of 12 years.
Negative Family History
50%
The most common disease pattern was isolated primary axillary
HH. An overwhelming majority of our patients were severely
affected by hyperhidrosis, rating their condition as 4 out of 4 on
the HDSS.
32%
The majority (80%) of our patients were considered normal
weight, with 16% considered overweight, and the remaining 4%
were considered underweight. The preponderance of our patients
were Caucasian (86.8%), followed by African-Americans (8.2%),
Asians (2.5%), Hispanics (0.8%), and other (1.6%). Patients’
occupations ranged, in order of descending frequency
categorically, from students, professionals (finance, law,
medicine, sales, education), clerical workers, homemakers,
tradespeople (electricians, plumbers, construction workers),
retirees, unemployed, and disabled persons.
18%
Cross-section of Site(s) of Hyperhidrosis by Age of Onset*
Axillary
Palmoplantar
0 to 11 years
N (%)
51 (20.0)
12 to 19 years
N (%)
148 (58)
20 to 53 years
N (%)
50 (19.6)
94 (55.3)
59 (34.7)
15 (8.8)
Palmar
104 (47.7)
89 (40.8)
23 (10.6)
Plantar (Soles)
103 (52.3)
72 (36.5)
20 (10.2)
Face
24 (31.6)
33 (43.4)
17 (22.4)
Scalp
7 (31.8)
6 (27.3)
8 (36.4)
Groin
16 (32.7)
27 (55.1)
6 (12.2)
Additional Areas***
21 (33.3)
27 (42.9)
13 (20.6)
Gender Presentation
*For each affected site, other sites may also be involved. For those patients with multiple affected
sites, age of onset does not specify which site of hyperhidrosis occurred first and which occurred at a
later date
Male (32.8%)
Female
(67.2%)
*Females were significantly more likely to present for evaluation of HH than
males.
N
on
e
Unaware of Family History
Results
Of 515 patients, 67.2% were female and 32.8% were male. The
average age of our patients at date of consultation was 27.94 ±
11.82 years with a median age of 25 years. The average age of
HH onset was 14.1 ± 7.9 years with a median age of 13.0 years.
Two-thirds of patients claimed a post-pubertal onset of HH.
Anatomic Sites
Axillary HH was the most common presentation in our patients. This may
reflect greater media attention and marketing for botulinum toxin A treatment
for primary focal axillary HH. A remarkable difference was noted between
genders regarding the affected site(s) of presentation. Females were more
likely to present with isolated axillary HH. Males were more likely to present
with facial HH, which was aggravated significantly more frequently by stress,
exercise, and heat than hyperhidrosis of other sites.
Age of Onset
Patients with onset of HH prior to the age of 12 years were more likely to
present with palmoplantar HH. Patients with post-pubertal onset of HH were
more likely to present with axillary HH. We anticipated this difference based
on the hypothesis that axillary HH is due to dysfunction of the apocrine or apoeccrine glands, which are highly dense in the axillary region and are nonfunctional until puberty (5, 11). Thus, this data suggests that a similar
pathophysiology is involved in the development of HH.
Family History of Hyperhidrosis
Positive Family History
The patient population in our study differed with the population described in the
US prevalence study by Strutton, et al. by having an earlier age of onset, higher
severity rating on the HDSS, higher percentage of axillary disease, and many
more past therapies attempted by the time of consultation. This difference
between studies may be due to our patients’ greater disease severity which
compelled them to seek treatment for their condition. The population described
in the US prevalence study by Strutton et al. were assessed through a national
survey and likely reflects a less severely affected population.
Gender
Our study also detected a gender difference in the presentation of HH. Female
patients presented for evaluation in much higher frequencies despite past
reports of similar prevalence of HH between the sexes. In both this study and
the Strutton et al. study, HDSS scores were similar between genders, which
suggests that a difference in interpretation of HH severity between males and
females was unlikely. This discrepancy may reflect a disparity between females
and males in their willingness to consult with a physician.
*Each category does not exclude other sites that may also be involved
The results were compiled using the Statistical Package for the
Social Sciences (SPSS) version 14 and analyzed for descriptive
statistics. The data was grouped into nominal categories for all
variables, except HDSS and age, which were analyzed as
ordinal variables. Chi-square statistics were used to test
differences between males and females, age of onset, puberty
onset and sites of hyperhidrosis against all other variables. A pvalue of <0.05 was used to determine significance throughout
this paper.
Percentage
Discussion
Anatomic Sites of Hyperhidrosis*
Axillary
The medical records of 515 patients presenting to a midwestern
American academic outpatient dermatology clinic between
October 1998 and November 2006 for evaluation and treatment
of primary focal HH were reviewed. Information collected
included the following: gender, sites of hyperhidrosis, age, date
of birth, age of onset, aggravating factors, pre- or post-puberty
onset, severity of disease on Hyperhidrosis Disease Severity
Scale (HDSS), family history, handedness, tobacco or alcohol
use, general habitus, occupation, ethnicity, and past treatment.
He
at
ty
An
xie
Objective
A
lC
l
B
TX
-A
O
th
O
er
ra
lA *
nt
ic
Io
ho
nt
l
op
ho
re
si
s
Su
rg
er
y
30
Patients presenting with HH of palms, or soles (plantar), or a combination of palms and soles
(palmoplantar) were significantly more likely to list stress and anxiety as aggravating factors compared to
patients with other sites of HH. Patients presenting with facial HH were significantly more likely to list
stress, exercise, and heat as aggravating factors, and patients with scalp HH listed anxiety as a significantly
aggravating factor.
Methods
100
80
60
40
20
0
O
TC
40
0
To perform a descriptive study of this patient population by
identifying common trends and associations of patients
presenting with primary focal HH.
Past Treatment(s) Tried at Presentation
50
ss
Primary HH is a relatively common disorder, affecting nearly 3% of
the U.S. population, with the highest prevalence rates among those
aged 18 to 64 years. The prevalence rate is the same for males and
females (2). The most common sites of primary HH are palms,
soles, axillae, face, and scalp (4, 5). Various treatments for primary
focal HH exist, ranging from topical treatments, iontophoresis, oral
anticholinergics, botulinum toxin injections, and surgery (5, 6, 7, 8).
A genetic component may contribute to primary HH as family
history has been positive in 30%-65% of patients (5, 9).
Aggravating Factors
St
re
Hyperhidrosis (HH) is a disorder characterized by perspiration in
excess of the body's physiologic needs. It can significantly impact
one's occupational, physical, emotional and social life. HH is
categorized as either primary or secondary hyperhidrosis (1,2).
Primary focal HH is a chronic, idiopathic disorder of excessive
perspiration in a bilateral, symmetrical manner (3). Primary focal
HH is associated with hyperactivity of the sympathetic nervous
system and can affect one or several areas of the body (2, 3).
Secondary HH is due to an underlying condition, such as infection,
endocrine disorders, metabolic disorders, neoplastic diseases,
neurological conditions, spinal cord injuries, cardiovascular
disorders, respiratory disorders, anxiety, and stress (2, 4).
The most common aggravating factors reported were stress, anxiety, heat, and exercise. Significant
associations were detected between gender and affected site(s). Males were significantly more likely to
present with facial HH. Females were significantly more likely to present with isolated axillary HH than
males. Otherwise, both genders had similar presentations for sites affected by HH.
Percentage
Background
**Note: Bolded items with single asterisk are statistically significant, with p < 0.05
***Additional areas include patients presenting with other additional areas of hyperhidrosis (back,
chest, abdomen, forearm, and lower extremities)
CONCLUSIONS
This large descriptive study of patients seeking care of primary focal HH has
demonstrated novel findings:
• Despite similar disease prevalence between genders, women were
significantly more likely to seek medical care for hyperhidrosis than men.
• Distinct gender differences exist in the clinical patterns of hyperhidrosis.
• Patients seeking medical attention are severely affected by their disease.
• Axillary HH is the most common presentation.
• An early age of onset correlated with a positive family history.
• Patients aged 12 years or under were more likely to present with
palmoplantar HH.
• Patients over the age of 12 years were more likely to present with axillary
HH.
Our data offers a unique characterization of the demographic and clinical
features of patients seeking treatment for primary HH in a university-based
practice, and will hopefully aid management of these patients and the
development of future treatments.
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