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How to diagnose and measure primary hyperhidrosis: a systematic review of the literature

  • Review Article
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Abstract

Purpose

Hyperhidrosis (i.e. excessive sweating) is diagnosed from patient medical history and physical examination. In addition, focal sweat measurements can substantiate the hyperhidrosis diagnosis. Likewise, the impact of living with hyperhidrosis can be assessed with patient-reported outcome measures. However, no consensus exists on how to diagnose hyperhidrosis, how to quantify the disease, or how to measure the impact hyperhidrosis has on patients. Therefore, the objective of this review was to summarize the literature on diagnostic criteria, focal sweat measurement methods, and patient-reported outcome measures of hyperhidrosis.

Methods

A literature search of Cochrane Library, Embase, and PubMed was conducted. Studies that included and aimed at developing or validating hyperhidrosis diagnostic criteria, focal sweat measurement methods, or patient-reported outcome measures for individuals with hyperhidrosis were eligible for inclusion. The methodological quality of diagnostic accuracy studies about focal sweat measurement methods was determined using the Quality Assessment of Diagnostic Accuracy Studies-2.

Results

Overall, 33 studies were included. We identified two sets of hyperhidrosis diagnostic criteria, one scale for assessment of severity of hyperhidrosis sweating, four focal sweat measurement methods, and 15 patient-reported outcome measures.

Conclusion

The algorithm for diagnosing hyperhidrosis and focal sweat measurement methods needs validation in large cohorts. Most patient-reported outcome measures for hyperhidrosis are not adequately validated. A potential solution is to develop a core outcome set that can standardize outcomes reported in clinical trials.

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Code availability is not applicable to this article as no new data were created or analyzed in this study, nor was coding conducted.

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Acknowledgements

The generous support of the Leo Foundation, Denmark (number LF 18002) is gratefully acknowledged.

Funding

Dr. Henning was provided a grant for research from the Leo Foundation, Denmark (number LF 18002).

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Author notes

  1. Kristina S. Ibler and Gregor B.E. Jemec shared senior authorship.

Authors and Affiliations

  1. Department of Dermatology, Faculty of Health and Medical Sciences, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark

    Mattias A. S. Henning, Linnea Thorlacius, Kristina S. Ibler & Gregor B. E. Jemec

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  1. Mattias A. S. Henning
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  2. Linnea Thorlacius
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Contributions

MASH, LT, KSI, and GBEJ meet the ICMJE criteria for authorship. All authors have substantially contributed to the design of the research, the analysis and interpretation, and the writing of the manuscript. GBEJ had the idea for the article. LT and MASH conducted the literature search. MASH drafted the first version of the article, and LT, KSI, and GBEJ critically revised the work. All authors have approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Mattias A. S. Henning.

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Conflict of interest

Dr. Henning reports grants from the Leo Foundation, Denmark (number LF 18002) during the conduct of the study. Dr. Thorlacius reports personal fees from UCB, nonfinancial support from Abbvie, and nonfinancial support from Janssen, outside the submitted work. Dr. Ibler reports personal fees from LEO pharma, Astra Zeneca, and Sanofi. Dr. Jemec reports grants and personal fees from Abbvie, personal fees from Coloplast, personal fees from Chemocentryx, personal fees from LEO pharma, grants from LEO Foundation, grants from Afyx, personal fees from Incyte, grants and personal fees from InflaRx, grants from Janssen-Cilag, grants and personal fees from Novartis, grants and personal fees from UCB, grants from CSL Behring, grants from Regeneron, grants from Sanofi, personal fees from Kymera, and personal fees from VielaBio, outside the submitted work.

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Henning, M.A.S., Thorlacius, L., Ibler, K.S. et al. How to diagnose and measure primary hyperhidrosis: a systematic review of the literature. Clin Auton Res 31, 511–528 (2021). https://doi.org/10.1007/s10286-021-00794-6

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  • DOI: https://doi.org/10.1007/s10286-021-00794-6

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