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The Effects on Patients' Lives: Quality-of-life surveys
To assess the burden of hyperhidrosis, the Illness
Intrusiveness Rating Scale was used to survey a group of 68
patients via e-mail. Although the response rate of 36% was
too low to formulate definitive conclusions about the disease
burden, the rating scale was found to be reliable and valid.
The results of this initial survey do provide some insights
into the impact of the disease. The patients felt that they
were most affected in the areas of social relationships, self-improvement/self-expression,
work, and active recreation. Interestingly, the total score
for this small group of hyperhidrosis patients was higher
than that reported using the same rating scale by patients
with end-stage renal disease, those with rheumatoid arthritis, and those with multiple
sclerosis.[28]
A quality-of-life questionnaire was designed specifically
to assess the impact of hyperhidrosis.[5]
The questionnaire assessed the degree of impairment in functional,
social, interpersonal, and emotional areas as well as the
situations in which hyperhidrosis is more severe. Used to
evaluate patients with primary hyperhidrosis prior to surgery,[48] the
data show that women were more impaired by hyperhidrosis than
men. Those who had excessive sweating earlier in life suffered
more than those who became symptomatic later. Subjective suffering
was most strongly related to impairment in social function.
Another disease-specific questionnaire, the Hyperhidrosis
Impact Questionnaire (HHIQ), was used for baseline evaluation
and follow-up of patients treated with botulinum toxin for
axillary hyperhidrosis.[100]
The questionnaire has items for baseline evaluation and 10 more items for use in
follow-up of treatment.[41] At baseline, 320 patients enrolled
in the multicenter study were evaluated for many aspects of
the disease, including impact on daily life. Seventy-one percent
reported being less confident than they would like to be,
49% were unhappy or depressed, 45% pursued different leisure
activities, 30% were frustrated by many daily activities,
25% missed outings or events with loved ones, 32% felt at least
moderately limited with regard to sexual activities, and 81%
were limited with regard to meeting people for the first time.
Another standard questionnaire, the Dermatology Life Quality
Index (DLQI), was used to evaluate a series of 58 patients
prior to botulinum toxin treatments for primary palmoplantar
and axillary hyperhidrosis.[139]
The average score was higher than that reported in other studies
of patients with severe acne and outpatients with psoriasis.
A larger study compared the DLQI scores of 345 patients with
hyperhidrosis to the scores of 154 dermatology clinic patients
with other conditions and to the scores obtained from 20 published studies of patients with a range of skin diseases.[153] Combining all the data, patients with hyperhidrosis, either overall
or by area of involvement, were in four of the six highest-scoring
groups, with inpatient eczema and psoriasis being the other
dermatologic conditions with the greatest impact on quality
of life. Axillary hyperhidrosis was associated with a reduction
in quality of life similar to that caused by palmar hyperhidrosis,
but had a significantly greater negative effect in the subdomain
of daily activities. One explanation for this difference in
effect on daily activity is that patients with axillary hyperhidrosis
have to change clothes to obtain relief, while excessive palmar
sweating can be dealt with by wiping hands on towels or clothes.
The authors conclude that focal hyperhidrosis “is a debilitating
disease that impairs daily activities and results in substantially
diminished HRQOL [health-related quality of life].”
Today there is an easy-to-use diagnostic tool available to clinicians to help
determine the severity and impact of hyperhidrosis. Download the
Hyperhidrosis Disease Severity Scale (HDSS) and usage tips now.
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