Types of Hyperhidrosis

Dee Anna Glaser, MD: Hyperhidrosis is a medical condition of excessive sweating that affects millions of people. It can be very debilitating to patients, hugely affecting their quality of life. Current treatment options are still leaving patients suffering from this disease. This AJMC^® Peer Exchange^® panel of experts in dermatology and managed care will discuss today’s management of hyperhidrosis, including educating health care providers and payers about this disease and the role for newer treatment options.

I am Dr. Dee Anna Glaser, and I am a professor and interim chairman of the Department of Dermatology at Saint Louis University School of Medicine, as well as the president and a founding member of the International Hyperhidrosis Society. Participating today on our distinguished panel are Dr. Adam Friedman, an associate professor of dermatology, residency program director, director of translational research, and director of the Supportive Oncodermatology Clinic of the Department of Dermatology at the George Washington School of Medicine and Health Sciences; Dr. Adelaide Hebert, a professor of dermatology and pediatrics at UTHealth McGovern Medical School in Houston, Texas—she’s also a board member of the International Hyperhidrosis Society—and Dr. Andy Szczotka, vice president of Clinical Services at Change Healthcare. Thank you so much for joining us. Let’s begin.

I think we should really start by discussing what hyperhidrosis is. What is it?

Adelaide Hebert, MD: I recognize hyperhidrosis as a medical condition. This is not something to be considered a cosmetic challenge. Patients can start with hyperhidrosis in the earliest years of life, even as young as 5 years of age—sometimes sooner—and then it can progress throughout the age spectrum. We recognize that there are both primary and secondary forms of hyperhidrosis. Our focus today is on primary hyperhidrosis, meaning patients have this because of dysregulation in the autonomic nervous system. The common nature of this problem is that 15 million people in the United States suffer from primary hyperhidrosis—a tremendous impact. The demographics reveal that males and females are equally affected, although female patients sometimes seek medical attention a bit more often than male patients do. Patients will report that they feel sweating on their palms, sweating on their soles, or sweating in their axillae. They can have multiple areas involved. We also see patients who have sweating that involves the face, trunk, or other anatomic regions. This is a very impactful and often underdiagnosed, underrecognized condition that affects patients, as you mentioned, tremendously.

Dee Anna Glaser, MD: Adam, are there certain body sites or areas that you find to be more common when patients come in?

Adam Friedman, MD, FAAD: Sure. I think it certainly depends on what hyperhidrosis you’re talking about. There are 2 forms. There’s primary focal, though that can also involve multiple body sites, and there’s the secondary form. When we’re talking about the primary focal, we’re talking about the underarms. We’re talking about the hands and the feet but certainly other sites, even under the breasts and the scalp. The forehead can be involved. One of the key features of the primary form is that it’s usually symmetric. It’s not going to be on 1 side. It’s probably not going to be all over the body, but there are some unique features that help us distinguish from the secondary form, which can be associated with underlying medical issues that I’ll mention in a moment.

One of the key features for anyone trying to ascertain which type it is—does the person sweat at night? Typically, with primary hyperhidrosis, that sweating will stop during the night while they’re sleeping. The secondary form can be persistent throughout. The other part is timing. With primary hyperhidrosis, for us to really define it, it has to be going on for at least 6 months, if not longer. And, as Adelaide mentioned, it can start very early on in life. The secondary form may just pop up. It’s not to say that primary doesn’t do that, as well, but the secondary form…can be associated with anything from thyroid disease to diabetes, malignancy, infection, and even certain medications like antihypertensives, blood pressure medications, and medications for neurological diseases—these can be the inciting events that will really set it off. And typically, that is throughout the whole body and is persistent, day or night.

Adelaide Hebert, MD: One thing we also commonly see is that patients often report a family history of hyperhidrosis.

Adam Friedman, MD, FAAD: Correct.

Adelaide Hebert, MD: And this is one of the history-taking components that we use to make the diagnosis of primary hyperhidrosis.

Adam Friedman, MD, FAAD: Absolutely.

Dee Anna Glaser, MD: Right. And both of you mentioned that the age of onset tends to be much younger—sometimes even in early, early infancy and in toddlers. But certainly, most of the patients with primary hyperhidrosis are developing their symptoms before the age of 25 or 26, which can be helpful.