Introduction
Hyperhidrosis is defined as excessive production of sweat, that is, more than is required for thermoregulation. It can be defined gravimetrically as greater than 2 standard deviations above mean values of sweat secretion for a normal population in various sites (palmar 50 mg/min/m2, plantar 50 mg/min/m2, axillary 150 mg/min/m2 and facial 50 mg/min/m2).
It is estimated that approximately 3% of the world's population suffers from this condition.1 Normal sweating is considered essential for thermoregulation but in the case of hyperhidrosis, this sweating majorly exceeds the body's need for physiological thermal regulation.1 Based on the distribution of sweat it can be either systematic or localized and on basis of the cause of sweating it can be a primary or secondary hyperhidrosis. 2
Hyperhidrosis is a social, emotional, and occupational disability that results in a decreased quality of life.3, 4, 5, 6, 7 Several studies talk about what primary and secondary hyperhidrosis is and their occurrence.2, 3, 8 Few articles discuss the affected quality of life of individuals (HidroQoL) in college students. 1, 9 Previous studies employing qualitative methods have reported negative emotions among patients and substantially impaired QoL such as limitations in daily activities, social relationships, study, work, and emotional well-being. 10, 11, 12, 13, 14, 15 Often people feel isolated and feel like they are the only ones with this problem. 16
Hyperhidrosis in general is underreported by the patients and left underdiagnosed by the health care professionals due to a lack of knowledge based on this topic. The general population is seldom aware of this condition and sparsely seeks medical attention. Patients in general often try various over-the-counter remedies before approaching a general practitioner. 17 The tropical climate and the environment also influence and aggravate this condition. A lot of patients’ first approach is to try and modify their lifestyle and get themselves adapted to this problem. This population may also be vulnerable to mental health conditions. There is thus a major need for practitioners to not only understand this silent disorder but also be aware of how to deal with it. 2
Creating awareness will immensely help in understanding the hardships one has to go about in even daily chores. An in-depth understanding of the extent and nature of daily life and quality of life of various individuals suffering from hyperhidrosis and its correlation with mental health issues like anxiety especially in a developing country like India is still lacking. A qualitative study including semi-structured interviews, and online surveys along with the use of inventories like the STAI would definitely give us an insight into the subject, their lifestyle, and how they are affected by hyperhidrosis physically, socially, and mentally.
Aims and Objective
Assess the impact of hyperhidrosis on quality of life across different age groups and occupational sectors.
Investigate the correlation between hyperhidrosis and anxiety levels compared to the general population.
Materials and Methods
Study participants
Were recruited after screening as per our inclusion and exclusion criteria from the department of Dermatology of the hospital associated with the college the student is enrolled at and also from school and college acquaintances, family, and friends.
Inclusion criteria
This included individuals of the age of 15 years and above, self-reported cases of excessive sweating over a course of at least 6 months without any apparent cause.
Exclusion criteria
This included individuals with excessive sweating related to a specific underlying health issue (based on self-report or late onset of sweating along with the presence of other known health conditions or use of medication known to be associated with sweating).
Sample size
Initial screening of 366 individuals was conducted via the screening questionnaire out of which a few were selected in accordance with the inclusion and exclusion criteria and were thereafter inducted as participants in the study. The sample size came to be around 70.
Sampling
Snowball sampling was employed in the study. The sampling strategy was such, as to aim at including patients of hyperhidrosis of all severity levels, and areas of involvement and catering to different demographics.(Figure 1)
Recruitment of the participants
It was purely by application of resources available i.e about 400 people were approached which included the outpatients of the dermatology department of the hospital and the via the existing social media platforms. They were further asked to spread information about the study on their own social media platforms (if they were willing) to make the most of the opportunity and to be able to recruit more participants. Around 366 people diligently took part in the screening out of which a small proportion of 70 was finally recruited as participants based on the results of the screening.(Figure 2)
Methodology
Initially, an online screening process via a series of questions was initiated. The screening took place with the help of a questionnaire which was presented as a Google form and sent forth. Around an average of 366 people filled out the initial screening questionnaire of which about 70 fulfilled the criteria for further investigation.
Those that fulfilled the screening criteria were then contacted and sent a participant information sheet for their further recruitment as participants of the study and their informed consent was taken. Once informed consent had been obtained an online survey was conducted using the QoL questionnaire allowing us to explore the various facets of the life of the participants and how homogenous and reflectively heterogeneous the experiences of different participants were about living with hyperhidrosis.
The recruited participants were also asked to partake in the State-Trait Anxiety Inventory (STAI) to help us establish a correlation between hyperhidrosis and the prevalence of anxiety in them.
Ethical considerations and confidentiality
This research was carried out only after clearance from the Institutional Ethics Committee (IEC) of the concerned college.
Informed consent was duly obtained before the participation and recruitment of the subject in the study.
The data identifying each individual by name was kept confidential and was accessible only to the researcher.
The investigator may publish the results of the study.
Results
A total of 70 people out of the initial 366 who were screened for the study responded with a yes to the question of whether they experience an excessive amount of sweating, which came out to a bare of 19.1% of the total.
Out of the 70 participants of the study who experienced an excessive amount of sweating, different people had different responses on how it affected them and their everyday life. (Table 1)
6 of 70 never really noticed it and said that their sweating never really interfered with their daily activities.
36 of 70 felt that their sweating was tolerable but sometimes it did tend to interfere with their daily activities.
15 out of 70 felt that their sweating was barely tolerable and frequently interfered with their daily activities.
13 out of 70 felt their sweating was intolerable and always interfered with their daily activities in some way or the other.
Table 1
Sweat tolerance
|
Sweat tolerance |
Number of participants |
Percentage |
|
Not affected |
6 |
8.6% |
|
Tolerable |
36 |
51.4% |
|
Barely tolerable |
15 |
21.4% |
|
Intolerable |
13 |
18.6% |
Out of the 70 participants who experience an excessive amount of sweating, a bare minimum of 8.6% felt that their daily activities were not hampered by their condition. The rest 91.4% felt that the excessive amount of sweating took a toll on their daily life in varied forms. (Table 2)
26 participants out of 70 (37.1%) felt that their physical activities were affected quite a lot as a result of excessive sweating.
35 participants (50%) felt that their hobbies and everyday chores were gravely affected and many avoided performing or acting out even certain simple household tasks like cooking, cleaning, and ironing
17 of the participants (24.3%) felt that their work and career decisions were affected. They felt major interference in the performance of tasks at work or school; the majority regarded this as the most important impact of the condition as it changed the whole trajectory of who they were and what they did for a living.
27 participants (37.5%) found it either slightly or majorly difficult to use touch technology due to their excessive sweating
44 participants (62.8%) faced physical discomfort and skin problems in relation to an excessive amount of sweating.
35 participants (50%) felt that their choice of clothing and footwear was majorly affected more so by their sweating instead of the weather.
10 of 70 participants (14.3%) also agreed to the fact that their holiday planning was affected
37 of the participants (52.8%) worried about the additional chores brought to the surface in response to dealing with their condition.
39 of the participants (55.7%) worried about the additional time and money that went into dealing with it.
Table 2
Effect on daily life
Along with the daily life of individuals the psychosocial life of the individuals is also affected in varied aspects due to hyperhidrosis.(Table 3)
62 out of 70 (88.6%) of the participants associated negative emotions with the excessive amount of sweating that they experienced including frustration, embarrassment etc.
55 out of 70 (78.5%) of the participants felt nervous in performing any task, careful of what others might say and lacked confidence.
58 participants (82.8%) avoided social interactions and tried to run as far away from them as they could. Being the centre of attraction and various curious faces looking at them and pitying them with the basic concern of their condition was not something most of the participants appreciated and found it comforting being away and on their own.
47 participants (67.1%) often worried about what people would say, how they would react.
39 participants of 70 (55.7%) found it really hard expressing affection physically and were extremely uncomfortable doing so. They avoided it to the best they could and hoped people would understand
30 participants of 70 (42.8%) avoided public speaking , escaping from the eyes of others.
28 participants of 70 (40%) were concerned about their appearance, how they would look and how others would perceive them.
42 participants (60%) worried about leaving sweat marks and dripping through their clothes.
49 participants of 70 (70%) felt that sweating was a constant burden and it was always at the back of their mind
Table 3
Effect on psychosocial life
The State-Trait Anxiety Inventory assesses both state and trait anxiety separately. Low scores on the test indicate a mild form of anxiety and high scores are indicative of a severe form of anxiety. There are two forms of the STAI, one for children, and one for adults. The scale is useful for many different socio-economic backgrounds and groups and therefore can be utilized for many people.
On getting our 70 subjects to fill out the STAI, the following were the results.(Table 4)
8 (11.4%) of the study population have a score lying between 20-37 which is indicative of a low score and thus corresponds to NO OR LOW ANXIETY.
37(52.8%) of the participants have a score lying between 38-44, which is indicative of a moderate score and thus corresponds to MODERATE ANXIETY.
25(35.7%) of the participants have a score lying between 45-80 which is indicative of a high score and corresponds to HIGH ANXIETY.
Table 4
STAI
|
Severity of anxiety |
Number of participants |
Percentage |
|
Low or no Anxiety |
8 |
11.4 |
|
Moderate Anxiety |
37 |
52.8 |
|
High Anxiety |
25 |
35.7 |
Depicted above are the results of effect of excessive sweating and the result of STAI respectively, we can now interpret the correlation between hyperhidrosis and anxiety and confirm. According to our study, 8.4% of participants didn’t really notice it and reported not really being bothered by it. In a similar fashion, 11.4% of individuals were reported to have NO or LOW ANXIETY. 51.4% of the participants tolerated their sweating and reported interference with their daily activities either sometimes. This comes to being consistent with the 52.8% of the participants that reported MODERATE ANXIETY. 40% of the participants felt that either their sweating was intolerable or only barely tolerable or that it frequently or most often always interfered with their daily activities. This was consistent with the 35.7% of the participants that had HIGH ANXIETY. With these stats in mind, a clear interpretation of hyperhidrosis being associated with anxiety can be made.18
Conclusion
Our study as a whole suggests that hyperhidrosis affects various to almost all aspects of a person’s life but what might come as a shock is the fact that the very people who suffer from hyperhidrosis are not really aware of what it is and they go through its consequences on a daily basis.
Hyperhidrosis not only affects all aspects of an individual’s life but also predisposes the individuals that suffer from it to high amounts of stress, and anxiety. They don’t know whom they can talk to or where they can go for help. They consider the fact that no one else really understands what they go through and that there’s no treatment out there for this condition. Creating awareness about hyperhidrosis amongst people, and breaking down the stigmas/myths associated with it is integral.
Summary
Hyperhidrosis is a benign disorder, that is rare and is less known and understood however, it does affect a small percentage of people and affects their quality of life and psychosocial well-being. The overhanging question that formed the basis of the study was how it affected various aspects of an individual’s life, their quality of life, and how it correlated to anxiety along with increasing its awareness amongst the general public.
The results were conclusive with the fact that hyperhidrosis impaired day-to-day activities and in doing so had a negative impact on quality of life. The results showed that associated negative emotions like embarrassment, frustration, and nervousness become second nature. People who experienced excessive sweating reported being self-conscious and having low self-esteem, and self-confidence. Some people even reported them avoiding any kind of social situations, and being in the public eye entirely pertaining of the fear of judgment and being ridiculed by others. The results were consistent with very few people approaching a doctor for their condition, those who did were suggested how they could greatly benefit from counseling and therapy in reducing the burden and dealing with excessive sweating during all aspects of their lives.
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