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Hyperhidrosis
Brought to you by 
What is Hyperhidrosis? 
 Sweating tthhaatt iiss mmoorree tthhaann rreeqquuiirreedd ttoo 
mmaaiinnttaaiinn nnoorrmmaall tthheerrmmaall rreegguullaattiioonn
Sweating Nomenclature 
Brought to you by 
 Areas: Focal, rreeggiioonnaall,, ggeenneerraalliizzeedd 
 SSyymmmmeettrryy:: SSyymmmmeettrriicc oorr aassyymmmmeettrriicc 
 CCllaassssiiffiiccaattiioonn:: PPrriimmaarryy vvss.. sseeccoonnddaarryy 
 TTyyppee ooff sswweeaattiinngg:: AAnnhhiiddrroossiiss,, eeuuhhyyddrroossiiss,, 
hhyyppeerrhhiiddrroossiiss 
Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003.
Brought to you by Hyperhidrosis
Causes of Generalized Hyperhidrosis 
Brought to you by 
UUssuuaallllyy sseeccoonnddaarryy iinn nnaattuurree 
 Drugs, toxins, substance abuse 
 Cardiovascular disorders 
 Respiratory failure 
 Infections 
 Malignancies 
 Hodgkin’s, myleoproliferative disorders, cancers with 
increased catabolism 
 Endocrine/metabolic disorders 
 Thyrotoxicosis, pheochromocytoma, acromegaly, carcinoid 
tumor, hypoglycemia, menopause 
 Rarely Idiopathic / Primary HH
Causes of Localized Hyperhidrosis 
Brought to you by 
 UUssuuaallllyy IIddiiooppaatthhiicc // PPrriimmaarryy 
 SSoocciiaall aannxxiieettyy ddiissoorrddeerr 
 EEccccrriinnee nneevvuuss 
 GGuussttaattoorryy sswweeaattiinngg 
 FFrreeyy ssyynnddrroommee 
 IImmppaaiirreedd eevvaappoorraattiioonn 
 SSttuummpp hhyyppeerrhhiiddrroossiiss aafftteerr aammppuuttaattiioonn
Idiopathic (Primary) Brought to you by Focal Hyperhidrosis
US Prevalence 
Brought to you by 
Survey mailed to a representative sample of 150,000 US households in January 2002 
64% response rate 
Approximately 6,800 respondents with hyperhidrosis 
Projected to the US population 
Prevalence of hyperhidrosis in the US is 2.8% (7.8 million individuals) 
50.8% have axillary hyperhidrosis: US prevalence is 1.4% (4 million individuals) 
32.4% of individuals with axillary hyperhidrosis (0.5% of the US population or 1.3 
million people) have sweating that is barely tolerable and frequently interferes with 
their daily activities, or is intolerable and always interferes with their daily activities 
(based on the HDSS). 
Strutton DR, Kowalski JW, Glaser DA, Stang PE. American Academy of Dermatology 
61st Annual Meeting; March 21-26, 2003; San Francisco, Calif. Abstract P362.
Brought to you by Mean Age of Onset
Heredity/Genetics 
Brought to you by 
 HHeerrbbsstt,, AAnnnn SSuurrgg 11999944 
• RReettrroossppeeccttiivvee qquueessttiioonnnnaaiirree ffoolllloowwiinngg EETTSS ffoorr 11°° 
hhyyppeerrhhiiddrroossiiss 
• 22770//332233 ppaattiieennttss rreessppoonnddeedd 
• 3311..55%% rreeppoorrtteedd ppoossiittiivvee ffaammiillyy hhiissttoorryy 
 RRoo,, JJ VVaasscc SSuurrgg 220022 
• CCoonnttrroolllleedd pprroossppeeccttiivvee ssttuuddyy ooff ppaattiieennttss wwiitthh 11°° 
hhyyppeerrhhiiddrroossiiss pprreesseennttiinngg ffoorr EETTSS 
• 4499//558 ppaattiieennttss rreessppoonnddeedd ttoo ddeettaaiilleedd FFHH qquueessttiioonnnnaaiirree 
• 6655%% rreeppoorrtteedd ++ FFHH ((..228 rriisskk ooffffsspprriinngg,, ..1144 rriisskk ppaarreennttss)) 
• CCoonncclluuddeedd ggeennee pprreesseenntt iinn 55%% ooff ppooppuullaattiioonn wwiitthh 2255%% 
ppeenneettrraannccee 
ETS = Endoscopic Thoracic Sympathectomy
Diagnosis of Primary 
Focal Hyperhidrosis 
Brought to you by 
 Focal, visible, excessive sswweeaattiinngg ooff aatt lleeaasstt 66 
mmoonntthhss dduurraattiioonn wwiitthhoouutt aappppaarreenntt ccaauussee wwiitthh aatt 
lleeaasstt 22 ooff tthhee ffoolllloowwiinngg cchhaarraacctteerriissttiiccss:: 
• BBiillaatteerraall aanndd rreellaattiivveellyy ssyymmmmeettrriicc 
• IImmppaaiirrss ddaaiillyy aaccttiivviittiieess 
• FFrreeqquueennccyy ooff aatt lleeaasstt oonnee eeppiissooddee ppeerr wweeeekk 
• AAggee ooff oonnsseett lleessss tthhaann 2255 yyeeaarrss 
• PPoossiittiivvee ffaammiillyy hhiissttoorryy 
• CCeessssaattiioonn ooff ffooccaall sswweeaattiinngg dduurriinngg sslleeeepp 
Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003.
Diagnostic Work-up 
 HHiissttoorryy 
• AAggee ooff oonnsseett 
• LLooccaattiioonn 
• TTrriiggggeerr ffaaccttoorrss 
• RReevviieeww ooff ssyymmppttoommss 
 PPhhyyssiiccaall eexxaamm 
 LLaabboorraattoorryy eevvaalluuaattiioonn 
• GGrraavviimmeettrriicc –– 
11°° rreesseeaarrcchh ttooooll 
• SSttaarrcchh iiooddiinnee –– ddeeffiinneess aarreeaa ooff ddiisseeaassee 
Starch iodine test, with the darkened area 
showing location of excessive sweating 
Brought to you by
Brought to you by Axillary Sweat Production 
346.0 
1° hyperhidrosis patients healthy controls 
Hund et al. Arch Derm 2002;138(4):539-41
DLQI Total Scores and Ranges by Dermatological 
Disease/Condition 
Diseases with DLQI Scores 10 or Greater 
Disease DLQI Score (baseline) 
Hyperhidrosis palms 18–8.8 
Hyperhidrosis axillary 17–10 
Eczema (inpatient) 16.2 
Focal hyperhidrosis (general) 15.5–9.2 
Psoriasis (inpatient) 13.9 
Hyperhidrosis forehead 12.5 
Atopic eczema 12.5–5.8 
Psoriasis (outpatient) 11.9–4.51 
Contact dermatitis 10.8 
Pruritus 10.5–10 
Scores range from 0 to 30, with 30 indicating the worst quality of life. 
Spalding et al. Value in Health 2003;6(3):242(abstract) 
Brought to you by
Quality of life: 
Primary Axillary Hyperhidrosis 
 LLeessss ccoonnffiiddeenntt 7722%% 
 UUnnhhaappppyy//ddeepprreesssseedd 4499%% 
 CChhaannggee ttyyppee ooff lleeiissuurree aaccttiivviittiieess 4455%% 
 FFrruussttrraatteedd wwiitthh ddaaiillyy aaccttiivviittiieess 3300%% 
 MMiissss oouuttiinnggss//eevveennttss 2255%% 
 DDeeccrreeaassee ttiimmee iinn lleeiissuurree aaccttiivviittiieess 1199%% 
Naumann et al. Brit J Derm 2002;147:1218-26 
Brought to you by
Quality of Life: 
Primary Palmar Hyperhidrosis 
• IInntteerrffeerreennccee wwiitthh ddaaiillyy ttaasskkss 9955%% 
• SSoocciiaall eemmbbaarrrraassssmmeenntt 9900%% 
• PPssyycchhoollooggiiccaall ddiiffffiiccuullttiieess 4400%% 
110000 ppaattiieennttss,, ppaallmmaarr,, pprreesseennttiinngg ffoorr ssyymmppaatthheeccttoommyy 
AAddaarr eett aall AAnnnn SSuurrgg;;118866:: 11997777 3344--4411 
Brought to you by
Available Treatments 
 TTooppiiccaall aaggeennttss 
 IIoonnttoopphheerreessiiss 
 SSyysstteemmiicc aaggeennttss 
 BBoottuulliinnuumm ttooxxiinn 
 SSuurrggeerryy 
• SSwweeaatt ggllaanndd rreesseeccttiioonn 
• EETTSS 
Brought to you by
Brought to you byTreatment Response
Summary 
PPrriimmaarryy FFooccaall HHyyppeerrhhiiddrroossiiss iiss aa 
sseeppaarraattee aanndd uunniiqquuee ddiisseeaassee 
•BBiillaatteerraall  ssyymmmmeettrriicc 
•AAxxiillllaa,, ppaallmmss,, ssoolleess,, ccrraanniiooffaacciiaall 
•OOnnsseett iinn cchhiillddhhoooodd aanndd aaddoolleesscceennccee 
•SSiiggnniiffiiccaanntt iimmppaacctt oonn qquuaalliittyy ooff lliiffee 
•EEffffeeccttiivvee tthheerraappiieess 
Brought to you by
Brought to you by 
This platform has bbeeeenn ssttaarrtteedd bbyy PPaarrvveeeenn 
KKuummaarr CChhaaddhhaa wwiitthh tthhee vviissiioonn tthhaatt nnoobbooddyy 
sshhoouulldd ssuuffffeerr tthhee wwaayy hhee hhaass ssuuffffeerreedd 
bbeeccaauussee ooff llaacckk aanndd iimmpprrooppeerr hheeaalltthhccaarree 
ffaacciilliittiieess iinn IInnddiiaa.. WWee nneeeedd lloottss ooff ffuunnddss 
mmaannppoowweerr eettcc.. ttoo mmaakkee tthhiiss vviissiioonn aa rreeaalliittyy 
pplleeaassee ccoonnttaacctt uuss.. JJooiinn uuss aass aa mmeemmbbeerr ffoorr 
aa nnoobbllee ccaauussee..
Brought to you by 
OOuurr vviieewwss hhaavvee iinnccrreeaasseedd 
tthhee mmaarrkk ooff tthhee 
3388,,000000 
 TThhaannkk yyoouu vviieewweerrss 
 LLooookkiinngg ffoorrwwaarrdd ffoorr ffrraanncchhiissee,, 
ccoollllaabboorraattiioonn,, ppaarrttnneerrss..
:-Contact Us 
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othermotherindia@9g8m1a8il5.c6o9m476 
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Hyperhidrosis

  • 1. Brought to you by Hyperhidrosis
  • 2. Brought to you by What is Hyperhidrosis?  Sweating tthhaatt iiss mmoorree tthhaann rreeqquuiirreedd ttoo mmaaiinnttaaiinn nnoorrmmaall tthheerrmmaall rreegguullaattiioonn
  • 3. Sweating Nomenclature Brought to you by  Areas: Focal, rreeggiioonnaall,, ggeenneerraalliizzeedd  SSyymmmmeettrryy:: SSyymmmmeettrriicc oorr aassyymmmmeettrriicc  CCllaassssiiffiiccaattiioonn:: PPrriimmaarryy vvss.. sseeccoonnddaarryy  TTyyppee ooff sswweeaattiinngg:: AAnnhhiiddrroossiiss,, eeuuhhyyddrroossiiss,, hhyyppeerrhhiiddrroossiiss Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003.
  • 4. Brought to you by Hyperhidrosis
  • 5. Causes of Generalized Hyperhidrosis Brought to you by UUssuuaallllyy sseeccoonnddaarryy iinn nnaattuurree  Drugs, toxins, substance abuse  Cardiovascular disorders  Respiratory failure  Infections  Malignancies  Hodgkin’s, myleoproliferative disorders, cancers with increased catabolism  Endocrine/metabolic disorders  Thyrotoxicosis, pheochromocytoma, acromegaly, carcinoid tumor, hypoglycemia, menopause  Rarely Idiopathic / Primary HH
  • 6. Causes of Localized Hyperhidrosis Brought to you by  UUssuuaallllyy IIddiiooppaatthhiicc // PPrriimmaarryy  SSoocciiaall aannxxiieettyy ddiissoorrddeerr  EEccccrriinnee nneevvuuss  GGuussttaattoorryy sswweeaattiinngg  FFrreeyy ssyynnddrroommee  IImmppaaiirreedd eevvaappoorraattiioonn  SSttuummpp hhyyppeerrhhiiddrroossiiss aafftteerr aammppuuttaattiioonn
  • 7. Idiopathic (Primary) Brought to you by Focal Hyperhidrosis
  • 8. US Prevalence Brought to you by Survey mailed to a representative sample of 150,000 US households in January 2002 64% response rate Approximately 6,800 respondents with hyperhidrosis Projected to the US population Prevalence of hyperhidrosis in the US is 2.8% (7.8 million individuals) 50.8% have axillary hyperhidrosis: US prevalence is 1.4% (4 million individuals) 32.4% of individuals with axillary hyperhidrosis (0.5% of the US population or 1.3 million people) have sweating that is barely tolerable and frequently interferes with their daily activities, or is intolerable and always interferes with their daily activities (based on the HDSS). Strutton DR, Kowalski JW, Glaser DA, Stang PE. American Academy of Dermatology 61st Annual Meeting; March 21-26, 2003; San Francisco, Calif. Abstract P362.
  • 9. Brought to you by Mean Age of Onset
  • 10. Heredity/Genetics Brought to you by  HHeerrbbsstt,, AAnnnn SSuurrgg 11999944 • RReettrroossppeeccttiivvee qquueessttiioonnnnaaiirree ffoolllloowwiinngg EETTSS ffoorr 11°° hhyyppeerrhhiiddrroossiiss • 22770//332233 ppaattiieennttss rreessppoonnddeedd • 3311..55%% rreeppoorrtteedd ppoossiittiivvee ffaammiillyy hhiissttoorryy  RRoo,, JJ VVaasscc SSuurrgg 220022 • CCoonnttrroolllleedd pprroossppeeccttiivvee ssttuuddyy ooff ppaattiieennttss wwiitthh 11°° hhyyppeerrhhiiddrroossiiss pprreesseennttiinngg ffoorr EETTSS • 4499//558 ppaattiieennttss rreessppoonnddeedd ttoo ddeettaaiilleedd FFHH qquueessttiioonnnnaaiirree • 6655%% rreeppoorrtteedd ++ FFHH ((..228 rriisskk ooffffsspprriinngg,, ..1144 rriisskk ppaarreennttss)) • CCoonncclluuddeedd ggeennee pprreesseenntt iinn 55%% ooff ppooppuullaattiioonn wwiitthh 2255%% ppeenneettrraannccee ETS = Endoscopic Thoracic Sympathectomy
  • 11. Diagnosis of Primary Focal Hyperhidrosis Brought to you by  Focal, visible, excessive sswweeaattiinngg ooff aatt lleeaasstt 66 mmoonntthhss dduurraattiioonn wwiitthhoouutt aappppaarreenntt ccaauussee wwiitthh aatt lleeaasstt 22 ooff tthhee ffoolllloowwiinngg cchhaarraacctteerriissttiiccss:: • BBiillaatteerraall aanndd rreellaattiivveellyy ssyymmmmeettrriicc • IImmppaaiirrss ddaaiillyy aaccttiivviittiieess • FFrreeqquueennccyy ooff aatt lleeaasstt oonnee eeppiissooddee ppeerr wweeeekk • AAggee ooff oonnsseett lleessss tthhaann 2255 yyeeaarrss • PPoossiittiivvee ffaammiillyy hhiissttoorryy • CCeessssaattiioonn ooff ffooccaall sswweeaattiinngg dduurriinngg sslleeeepp Multi-specialty Working Group on Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis, 2003.
  • 12. Diagnostic Work-up  HHiissttoorryy • AAggee ooff oonnsseett • LLooccaattiioonn • TTrriiggggeerr ffaaccttoorrss • RReevviieeww ooff ssyymmppttoommss  PPhhyyssiiccaall eexxaamm  LLaabboorraattoorryy eevvaalluuaattiioonn • GGrraavviimmeettrriicc –– 11°° rreesseeaarrcchh ttooooll • SSttaarrcchh iiooddiinnee –– ddeeffiinneess aarreeaa ooff ddiisseeaassee Starch iodine test, with the darkened area showing location of excessive sweating Brought to you by
  • 13. Brought to you by Axillary Sweat Production 346.0 1° hyperhidrosis patients healthy controls Hund et al. Arch Derm 2002;138(4):539-41
  • 14. DLQI Total Scores and Ranges by Dermatological Disease/Condition Diseases with DLQI Scores 10 or Greater Disease DLQI Score (baseline) Hyperhidrosis palms 18–8.8 Hyperhidrosis axillary 17–10 Eczema (inpatient) 16.2 Focal hyperhidrosis (general) 15.5–9.2 Psoriasis (inpatient) 13.9 Hyperhidrosis forehead 12.5 Atopic eczema 12.5–5.8 Psoriasis (outpatient) 11.9–4.51 Contact dermatitis 10.8 Pruritus 10.5–10 Scores range from 0 to 30, with 30 indicating the worst quality of life. Spalding et al. Value in Health 2003;6(3):242(abstract) Brought to you by
  • 15. Quality of life: Primary Axillary Hyperhidrosis LLeessss ccoonnffiiddeenntt 7722%% UUnnhhaappppyy//ddeepprreesssseedd 4499%% CChhaannggee ttyyppee ooff lleeiissuurree aaccttiivviittiieess 4455%% FFrruussttrraatteedd wwiitthh ddaaiillyy aaccttiivviittiieess 3300%% MMiissss oouuttiinnggss//eevveennttss 2255%% DDeeccrreeaassee ttiimmee iinn lleeiissuurree aaccttiivviittiieess 1199%% Naumann et al. Brit J Derm 2002;147:1218-26 Brought to you by
  • 16. Quality of Life: Primary Palmar Hyperhidrosis • IInntteerrffeerreennccee wwiitthh ddaaiillyy ttaasskkss 9955%% • SSoocciiaall eemmbbaarrrraassssmmeenntt 9900%% • PPssyycchhoollooggiiccaall ddiiffffiiccuullttiieess 4400%% 110000 ppaattiieennttss,, ppaallmmaarr,, pprreesseennttiinngg ffoorr ssyymmppaatthheeccttoommyy AAddaarr eett aall AAnnnn SSuurrgg;;118866:: 11997777 3344--4411 Brought to you by
  • 17. Available Treatments  TTooppiiccaall aaggeennttss  IIoonnttoopphheerreessiiss  SSyysstteemmiicc aaggeennttss  BBoottuulliinnuumm ttooxxiinn  SSuurrggeerryy • SSwweeaatt ggllaanndd rreesseeccttiioonn • EETTSS Brought to you by
  • 18. Brought to you byTreatment Response
  • 19. Summary PPrriimmaarryy FFooccaall HHyyppeerrhhiiddrroossiiss iiss aa sseeppaarraattee aanndd uunniiqquuee ddiisseeaassee •BBiillaatteerraall ssyymmmmeettrriicc •AAxxiillllaa,, ppaallmmss,, ssoolleess,, ccrraanniiooffaacciiaall •OOnnsseett iinn cchhiillddhhoooodd aanndd aaddoolleesscceennccee •SSiiggnniiffiiccaanntt iimmppaacctt oonn qquuaalliittyy ooff lliiffee •EEffffeeccttiivvee tthheerraappiieess Brought to you by
  • 20. Brought to you by This platform has bbeeeenn ssttaarrtteedd bbyy PPaarrvveeeenn KKuummaarr CChhaaddhhaa wwiitthh tthhee vviissiioonn tthhaatt nnoobbooddyy sshhoouulldd ssuuffffeerr tthhee wwaayy hhee hhaass ssuuffffeerreedd bbeeccaauussee ooff llaacckk aanndd iimmpprrooppeerr hheeaalltthhccaarree ffaacciilliittiieess iinn IInnddiiaa.. WWee nneeeedd lloottss ooff ffuunnddss mmaannppoowweerr eettcc.. ttoo mmaakkee tthhiiss vviissiioonn aa rreeaalliittyy pplleeaassee ccoonnttaacctt uuss.. JJooiinn uuss aass aa mmeemmbbeerr ffoorr aa nnoobbllee ccaauussee..
  • 21. Brought to you by OOuurr vviieewwss hhaavvee iinnccrreeaasseedd tthhee mmaarrkk ooff tthhee 3388,,000000  TThhaannkk yyoouu vviieewweerrss  LLooookkiinngg ffoorrwwaarrdd ffoorr ffrraanncchhiissee,, ccoollllaabboorraattiioonn,, ppaarrttnneerrss..
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