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Epidemiology of Primary Hyperhidrosis
Until recently there were few data available on the prevalence
of primary hyperhidrosis. Many articles on hyperhidrosis quote
a pilot epidemiology study reported by Adar and colleagues in
1976 that found an incidence of 0.6% to 1.0% in a young Israeli
population.[2]
Recently a consumer survey of a nationally representative sample
of 150,000 households in the U.S. screened for the presence
of hyperhidrosis.[136]
The survey results showed that the prevalence of hyperhidrosis
in the U.S. is 2.8% (7.8 million Americans). Of those with
hyperhidrosis, only 38% consulted their physician about their
excessive sweating.[136]
The authors of the survey report conclude that hyperhidrosis
actually affects more people than previously thought.[136]
Several series of patients treated by endoscopic thoracic
sympathectomy (ETS) report a family history in 35% and 56%,
respectively.[35,82] A study of the familial aggregation of
hyperhidrosis also suggests that the disorder may be more
common than previously thought.[113]
When family history was analyzed in a group of patients with primary hyperhidrosis, 65% of patients reported
a family history compared to no family history in controls.[58]
On the basis of these findings, the disease allele is present
in 5% of the population, with an observed penetrance of 25%.[113]
Ro and colleagues conclude that because many of those with
hyperhidrosis are reluctant to seek treatment, the previously
reported incidence may be “a gross underestimation.”
Focal primary hyperhidrosis usually has an onset during
childhood or adolescence.[4]
In a series of Taiwanese patients with palmar hyperhidrosis,
75% had childhood onset, with the remainder presenting during
puberty.[82]
In a study of 850 patients with palmar, axillary, or facial hyperhidrosis,
62% said they had the symptoms “…as long as they
could remember,” 33% said the onset occurred during puberty,
and 5% reported their first symptoms as adults.[4]
Hölzle from Germany states that primary hyperhidrosis
starts in puberty, peaks in the third and fourth decade, but
can be seen in childhood and even infancy.[57]
In the U.S. consumer survey, the average age at onset was 25
years, but varied with location of hyperhidrosis.[136] The average
age of onset for those with palmar or axillary symptoms and
symptoms in one other location was 22 years, for those with axillary alone
age of onset was 19 years, and for those with palmar alone
age of onset was 13 years.
The highest prevalence rates were seen between 25 and 65 years
of age (3.5% to 4.5%), and the lowest under 12 years of age
(0.5% to 0.7%) prevalence. In this survey,
there were no gender differences in prevalence.
Prevalence of the types of primary hyperhidrosis based on
body location has been reported in several patient populations.
In 256 German patients reported by Hölzle, 115 had excessive
sweating in the axillae, 86 on the palms, and 75 on the soles.[57]
In a series of 382 French patients treated with ETS, 30% had
palmar and plantar hyperhidrosis, 51% had palmoplantar and
axillary hyperhidrosis, 6% had palmoplantar and facial hyperhidrosis,
5% had all areas involved, and 8% had axillary hyperhidrosis
only.[46] According
to the U.S. consumer survey, 51% of hyperhidrosis patients have
axillary hyperhidrosis alone or in combination with hyperhidrosis in another
location, 9.5% have axillary hyperhidrosis alone, 25% have
palmar hyperhidrosis alone or in combination with hyperhidrosis in another
area, and only 1% have palmar hyperhidrosis alone.[136]
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