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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