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Hyperhidrosis
Defining and Diagnosing Primary and Secondary Hyperhidrosis
Henning Hamm
Senior Physician and Vice Chairman, Department of Dermatology, University Clinics of Würzburg
Abstract
Hyperhidrosis means sweating beyond physiological needs. Although not dangerous or life-threatening, it negatively affects many areas of
daily life to a significant extent and can be a severe burden to sufferers. The most frequent type, primary focal hyperhidrosis, typically
occurs in young, otherwise healthy people in the axillae, palms, soles and/or face. The observation that family members are often affected
points to a complex genetic background. In contrast, secondary hyperhidrosis is an acquired disorder that can be caused by myriad internal
and neurological diseases, drugs and poisons. The physician is confronted with the task of diagnosing the type of hyperhidrosis and
searching for the origin of a secondary type. Identification of the cause may allow for its elimination, whereas in other cases only
symptomatic treatment can be offered.
Keywords
Sweating, primary focal hyperhidrosis, secondary hyperhidrosis, definition, diagnosis, epidemiology, evaluation
Disclosure: The author has no conflicts of interest to declare.
Received: 27 February 2009 Accepted: 11 March 2009
Correspondence: Henning Hamm, Professor of Dermatology, Department of Dermatology, Venereology and Allergology, University Clinics of Würzburg, Josef-Schneider-Str. 2,
hamm_h@klinik.uni-wuerzburg.de
Sweat and Sweating demonstrated that patients suffering from primary axillary hyperhidrosis
Hyperhidrosis is a functional disorder affecting morphologically produce on average four to five times more sweat than healthy
inconspicuous eccrine sweat glands. These merocrine glands are controls.
3
There are also significant sex differences to such an extent
independent of other adnexal structures, such as hair follicles and that male patients with axillary hyperhidrosis sweat on average about
sebaceous glands. Up to 4 million eccrine sweat glands are twice as much as female patients, and males who describe themselves
distributed over the entire skin surface in variable density. They are as normal sweaters sweat almost twice as much as normal females.
3
least numerous on the back and most numerous on the palms, soles
and forehead and in the axillae – the sites that are predominantly Sweating undoubtedly also has a subjective component, and the
involved in primary focal hyperhidrosis (PFH).
1
Eccrine sweat glands general definition mentioned at the beginning fails in a debatable
are innervated by post-ganglionic non-myelinated C fibres of case as, indeed, there is no clear-cut threshold distinguishing
sympathetic nerves. The mediator substance of the synapse is sweating that is still normal and that which is pathological. The same
acetylcholine. Sweat, the secretion that the glands produce, is a clear, amount of sweat may be perceived as normal by one and as
odourless, hypotonic fluid. Sweating is a physiological reaction pathological by another individual, so the level of personal disability
triggered essentially by thermal and emotional stimuli and is definitely has its place in the appraisal. The so-called Hyperhidrosis
controlled by different regulatory cycles. The main function of eccrine Disease Severity Scale (see Table 1), a single-item questionnaire
4
sweat glands consists of maintenance of the body’s core temperature allowing four gradations of the tolerability of sweating and its
by evaporative water loss in response to heat exposure and exercise. interference with daily activities, offers a simple and useful tool to
Thermoregulatory sweating is essentially regulated by the estimate how severely quality of life is impaired.
4
Only severity scores
hypothalamus, whereas emotional sweating is predominantly of 3 and 4 should be assigned to true hyperhidrosis. The negative
mediated by the limbic system and mainly involves the eccrine glands effect of hyperhidrosis on quality of life issues will be discussed below
at the sites of highest density mentioned above.
2
This finely tuned in more detail.
system may intermittently or permanently overreact so that more
sweat is produced than is required for holding the body temperature Epidemiology of Hyperhidrosis
steady or for improving the palmoplantar grip. Hyperhidrosis is a frequent problem. The best available data come
from a large epidemiological survey on the basis of 150,000
Hyperhidrosis and the representative households estimating the overall prevalence of
Problem of Its Definition hyperhidrosis at 2.8% in the US population. Axillary sweating that is
Hyperhidrosis can be defined as excessive sweating beyond barely tolerable or intolerable and frequently or always interferes with
physiological needs. By means of gravimetric assessment, we have daily activities (meeting stages 3 and 4 of the Hyperhidrosis Disease
82 © TOUCH BRIEFINGS 2009
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