The Effects on Patients' Lives: Quality-of-life surveys
A key aspect of assessing hyperhidrosis (Hh) severity -- and then a treatment path -- for a patient is gaining an understanding of how the condition is impacting that patient's day-to-day life, relationships, career or schooling, and social/emotional wellbeing. There are a variety of tools at the clinician's disposal for this purpose that have been used in research and there is a tool from the International Hyperhidrosis Society that can be downloaded now (scroll to the end of this page to access).
Illness Intrusiveness Rating Scale
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 Hh burden, the rating scale was found to be reliable and valid and the results provided some insights into the impact of the disease. Patients surveyed felt that they were most affected in the areas of social relationships, self-improvement/self-expression, work, and active recreation. Of note, the Illness Intrusiveness Rating of hyperhidrosis in this study was higher (Hh more intrusive) than end-stage renal disease, rheumatoid arthritis, or multiple sclerosis (when the same scale was used to survey patients with these other diseases). (See: Cina CS, Clase CM. The Illness Intrusiveness Rating Scale: a measure of severity in individuals with hyperhidrosis. Qual Life Res. 1999;8:693-698.)
In other research, a quality-of-life questionnaire was designed specifically to assess the impact of hyperhidrosis. The questionnaire assessed the degree of impairment due to Hh in functional, social, interpersonal, and emotional areas as well as other situations. Used to evaluate patients with primary hyperhidrosis prior to surgery, the data indicated 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. (See: Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci. 2000;37:25-31.)
Hyperhidrosis Impact Questionnaire (HHIQ)
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. The questionnaire had items for baseline evaluation and 10 more items for use in follow-up of treatment. 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. (See: Naumann MK, Hamm H, Lowe NJ. Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial. Br J Dermatol. 2002;147:1218-1226)
Dermatology Life Quality Index (DLQI)
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. Using the index to evaluate quality-of-life for Hh patients, psoriasis outpatients and severe acne patients, the researchers found that Hh negatively impacted quality-of-life more severely than these other conditions. (See: Swartling C, Naver H, Lindberg M. Botulinum A toxin improves life quality in severe primary focal hyperhidrosis. Eur J Neurol. 2001;8:247-252.)
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. 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 often have to change clothes to obtain relief, while excessive palmar sweating can be partially dealt with by wiping hands on towels or clothes. The authors concluded that focal hyperhidrosis “is a debilitating disease that impairs daily activities and results in substantially diminished HRQOL [health-related quality of life].” (See: Naumann MK, Hamm H, Spalding JR, Kowalski JW, Lee JT. Comparing the quality of life effect of primary focal hyperhidrosis as assessed by the Dermatology Life Quality Index (DLQI). Paper presented at the July 2003 meeting of the American Academy of Dermatology; July 25-29, 2003; Chicago, Ill.)
Hyperhidrosis Disease Severity Scale (HDSS)
While each of the above-mentioned patient surveys has been used to help evaluate patients with hyperhidrosis, and can be adapted for use by practitioners to suit their practices, there is also an easy-to-use diagnostic tool available through the International Hyperhidrosis Society to help determine the severity and impact of hyperhidrosis.
It is called the Hyperhidrosis Disease Severity Scale (HDSS) and usage tips are provided.