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Unformatted text preview: Hyperhidrosis
Dee Anna Glaser, M.D. Associate Professor Associate Vice Chairman Vice Department of Dermatology Saint Louis University 1 What is Hyperhidrosis? Sweating that is more than required to maintain normal thermal regulation 2 Sweating Nomenclature Areas: Focal, regional, generalized Symmetry: Symmetric or asymmetric Classification: Primary vs. secondary Type of sweating: Anhidrosis, euhydrosis, hyperhidrosis Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003. 3 Hyperhidrosis 4 Causes of Generalized Hyperhidrosis
Usually secondary in nature Drugs, toxins, substance abuse Cardiovascular disorders Respiratory failure Infections Malignancies Endocrine/metabolic disorders Hodgkin’s, myleoproliferative disorders, cancers with increased catabolism Thyrotoxicosis, pheochromocytoma, acromegaly, carcinoid tumor, hypoglycemia, menopause Rarely Idiopathic / Primary HH 5 Causes of Localized Hyperhidrosis Usually Idiopathic / Primary Social anxiety disorder Eccrine nevus Gustatory sweating Frey syndrome Impaired evaporation Stump hyperhidrosis after amputation 6 Idiopathic (Primary) Focal Hyperhidrosis 7 US Prevalence
Survey mailed to a representative sample of 150,000 US households in January 2002 64% response rate Approximately 6,800 respondents with hyperhidrosis Projected to the US population Prevalence of hyperhidrosis in the US is 2.8% (7.8 million individuals) 50.8% have axillary hyperhidrosis: US prevalence is 1.4% (4 million individuals) 32.4% of individuals with axillary hyperhidrosis (0.5% of the US population or 1.3 million people) have sweating that is barely tolerable and frequently interferes with their daily activities, or is intolerable and always interferes with their daily activities (based on the HDSS).
Strutton DR, Kowalski JW, Glaser DA, Stang PE. American Academy of Dermatology 61st Annual Meeting; March 2126, 2003; San Francisco, Calif. Abstract P362. 8 Mean Age of Onset 9 Heredity/Genetics Herbst, Ann Surg 1994 • Retrospective questionnaire following ETS for 1° hyperhidrosis • 270/323 patients responded • 31.5% reported positive family history Ro, J Vasc Surg 2002 • Controlled prospective study of patients with 1° hyperhidrosis presenting for ETS • 49/58 patients responded to detailed FH questionnaire • 65% reported + FH (.28 risk offspring, .14 risk parents) • Concluded gene present in 5% of population with 25% penetrance
ETS = Endoscopic Thoracic Sympathectomy 10 10 Diagnosis of Primary Focal Hyperhidrosis Focal, visible, excessive sweating of at least 6 months duration without apparent cause with at least 2 of the following characteristics: • • • • • • Bilateral and relatively symmetric Impairs daily activities Frequency of at least one episode per week Age of onset less than 25 years Positive family history Cessation of focal sweating during sleep Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003. 11 11 Diagnostic Workup History
• • • • Age of onset Location Trigger factors Review of symptoms Physical exam Laboratory evaluation • Gravimetric – 1° research tool • Starch iodine – defines area of disease Starch iodine test, with the darkened area showing location of excessive sweating 12 12 Axillary Sweat Production
346.0 1° hyperhidrosis patients
Hund et al. Arch Derm 2002;138(4):539-41 healthy controls
13 13 DLQI Total Scores and Ranges by Dermatological Disease/Condition
Diseases with DLQI Scores 10 or Greater Disease Hyperhidrosis palms Hyperhidrosis axillary Eczema (inpatient) Focal hyperhidrosis (general) Psoriasis (inpatient) Hyperhidrosis forehead Atopic eczema Psoriasis (outpatient) Contact dermatitis Pruritus DLQI Score (baseline) 18–8.8 17–10 16.2 15.5–9.2 13.9 12.5 12.5–5.8 11.9–4.51 10.8 10.5–10
14 14 Scores range from 0 to 30, with 30 indicating the worst quality of life.
Spalding et al. Value in Health 2003;6(3):242(abstract) Quality of life: Primary Axillary Hyperhidrosis
x Less confident 72% x Unhappy/depressed 49% x Change type of leisure activities 45% x Frustrated with daily activities 30% x Miss outings/events 25% x Decrease time in leisure activities 19% Naumann et al. Brit J Derm 2002;147:1218-26 15 15 Quality of Life: Primary Palmar Hyperhidrosis
• • • Interference with daily tasks 95% Social embarrassment 90% Psychological difficulties 40% 100 patients, palmar, presenting for sympathectomy Adar et al Ann Surg;186: 1977 34-41 16 16 Available Treatments • • Topical agents Iontopheresis Systemic agents Botulinum toxin Surgery Sweat gland resection ETS 17 17 Treatment Response 18 18 Summary
Primary Focal Hyperhidrosis is a separate and unique disease
•Bilateral & symmetric •Axilla, palms, soles, craniofacial •Onset in childhood and adolescence •Significant impact on quality of life •Effective therapies
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- Fall '11