Skip to main content

Advertisement

SpringerLink
Log in

Diagnosis of palmar hyperhidrosis via questionnaire without physical examination

  • Research Article
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Objectives

In order to determine the reliability of a self-administered instrument to diagnose excessive sweating conditions, including palmar hyperhidrosis (PH), we designed two successive questionnaires and compared responses with physical examination and sweat measurement in normal volunteers and a cohort of patients with documented PH. The reliable diagnosis of PH via questionnaire would enable molecular epidemiological studies without the need for physical examination or direct sweat measurement.

Methods

Subjects self identified as either normal or affected by PH. Each completed one or both questionnaires and underwent physical examination. Sweat production from the thenar eminence and forehead was measured at rest and following mental/emotional stress. Correlation among sweat measurement, physical examination, and questionnaire score was assessed.

Results

Forty-seven subjects enrolled in the study, 29 of whom underwent sweat measurements. The participants’ perception of whether they were affected agreed with the examiner’s visual and tactile observation of PH in all cases (P < 0.0005). The mean peak sweat rate for those participants with PH was 1.59 mg/cm2/min, while that of the normal cohort was 0.37 mg/cm2/min (P = 0.001). The mean questionnaire #1 and #2 scores for those participants with PH and the normal cohort was 7.10 versus 0.36 (P = 0.0005) and 5.145 versus 0.045 (P = 0.0005), respectively. Peak sweat rate correlated with questionnaire score (Pearson correlation coefficient = 0.723).

Interpretation

Palmar hyperhidrosis can be accurately diagnosed via questionnaire. Molecular epidemiological studies of PH may be reliably conducted without the need for direct physical examination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Adar R, Kurchin A, Zweig A, Mozes M (1977) Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg 186:34–41

    Article  PubMed  CAS  Google Scholar 

  2. Andrisin TE, Humma, Johnson JA (2002) Collection of genomic DNA by the noninvasive mouthwash method for use in pharmacogenetic studies. Pharmacotherapy 22:954–960

    Article  PubMed  CAS  Google Scholar 

  3. Baumgartner FJ, Bertin S, Konecny J (2009) Superiority of thoracoscopic sympathectomy over medical management for the palmoplantar subset of severe hyperhidrosis. Ann Vasc Surg 23:1–7

    Article  PubMed  Google Scholar 

  4. Birner P, Heinzl H, Schindl M, Purmprla J, Schnider P (2000) Cardiac autonomic function in patients suffering from primary focal hyperhidrosis. Eur Neurol 44:112–116

    Article  PubMed  CAS  Google Scholar 

  5. Boley TM, Belangee KN, Markwell S, Hazelrigg SR (2007) The effect of thoracoscopic sympathectomy on quality of life and symptom management of hyperhidrosis. J Am Coll Surg 204:435–438

    Article  PubMed  Google Scholar 

  6. Bonde P, Nwaejike N, Fullerton C, Allen J, Mcguigan J (2008) An objective assessment of the sudomotor response after thoracoscopic sympathectomy. J Thorac Cardiovasc Surg 135:635–641

    Article  PubMed  Google Scholar 

  7. Cantor-Chiul RM, Chandra F, Dorrani N, Swatling C, Glaser D, Ahn S (2006) Evidence of a hyperhidrosis risk gene at 5q11.2. Abstract #1706, Presented at the annual meeting of Am Soc Human Genetics, 10 October 2006, New Orleans, Louisiana. Available from http://www.ashg.org/genetics/ashg/annmeet/2006

  8. Garcia-Closas M, Egan KM, Abruzzo J, Newcomb PA, Titus-Ernstoff L, Franklin T, Bender PK, Beck JC, Le Marchand L, Lum A, Alavanja M, Hayes RB, Rutter J, Buetow K, Brinton LA, Rothman N (2001) Collection of genomic DNA from adults in epidemiological studies by buccal cytobrush and mouthwash. Cancer Epidemiol Biomarkers Prev 10:687–696

    PubMed  CAS  Google Scholar 

  9. Hamm H, Naumann MK, Kowalski JW, Kutt S, Kozma C, Teale C (2006) Primary focal hyperhidrosis: disease characteristics and functional impairment. Dermatology 212:343–353

    Article  PubMed  Google Scholar 

  10. Higashimoto I, Yoshiura K, Hirakawa N, higashimoto K, Soejima H, Totoki T, Mukai T, Niikawa N (2006) Primary palmar hyperhidrosis locus maps to 14q11.2-q13. Am J Med Genet 140A:567–572

    Article  CAS  Google Scholar 

  11. Hornberger J, Grimes K, Naumann M, Glaser DE, Lowe NJ, Naver H, Ahn S, Stolman LP (2004) Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 51:274–286

    Article  PubMed  Google Scholar 

  12. Kaufmann H, Saadia D, Polin C, Hague S, Singleton A, Singleton A (2003) Primary hyperhidrosis: evidence of autosomal dominant inheritance. Clin Auton Res 13:96–98

    Article  PubMed  Google Scholar 

  13. Kaya D, Karaca S, Barutcu I, Esen AM, Kulac M, Esen O (2005) Heart rate variability I patients with essential hyperhidrosis: dynamic influence of sympathetic and parasympathetic maneuvers. Ann Noninvasive Electrocardiol 10:1–6

    Article  PubMed  Google Scholar 

  14. Keller SM, Sekons D, Scher H, Homel P, Bookbinder MB (2001). A novel scale for assessing quality of life following bilateral endoscopic thoracic sympathectomy for palmar and plantar hyperhidrosis. In: 4th International Symposium on Sympathetic Surgery, Tampere, Finland, June 2001. Abstract O-22

  15. Kobayashi M, Tomioka N, Ushiyama Y, Ohhashi T (2003) Arithmetic calculation, deep inspiration or handgrip exercise-mediated pre-operational active palmar sweating responses in humans. Autonom Neurosci 104:58–65

    Article  Google Scholar 

  16. Krogstad A-L, Mork C, Piechnik SK (2006) Daily pattern of sweating and response to stress and exercise in patients with palmar hyperhidrosis. Br J Derm 154:1118–1122

    Article  CAS  Google Scholar 

  17. Krogstad A-L, Skymne A, Pegenius G, Elam M, Wallin BG (2004) Evaluation of objective methods to diagnose palmar hyperhidrosis and monitor effects of botulinum toxin. Clin Neurophys 115:1909–1916

    Article  CAS  Google Scholar 

  18. Kumagai K, Kawase H, Kawanishi M (2005) Health-related quality of life after thoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg 80:461–466

    Article  PubMed  Google Scholar 

  19. Lear W, Kessler E, Solish N, Glaser DA (2007) An epidemiologic study of hyperhidrosis. Dermatol Surg 33:S69–S75

    Article  PubMed  CAS  Google Scholar 

  20. Leom-Sarmiento FE, Hernandez HG, Scroder N (2008) Abnormal tactile discrimination and somatosensory plasticity in familial primary hyperhidrosis. Neurosci Lett 441:332–334

    Article  Google Scholar 

  21. Lowe NJ, Yamauchi PS, Lask GP, Patnaik R, Iyer S (2002) Efficacy and safety of botulinum toxin type A in the treatment of palmar hyperhidrosis: a double blind, randomized, placebo-controlled study. Dermatol Surg 28:822–827

    Article  PubMed  Google Scholar 

  22. Ohhashi T, Sakaguchi M, Tsuda T (1998) Human perspiration measurement. Physiol Meas 19:449–461

    Article  PubMed  CAS  Google Scholar 

  23. Reisfeld R, Nguyen R, Pnini A (2002) Endoscopic thoracic sympathectomy for hyperhidrosis. Surg Laparosc Endosc Percutan Tech 12:255–267

    Article  PubMed  Google Scholar 

  24. Ro KM, Cantor RM, Lange KL, Ahn SA (2002) Palmar hyperhidrosis: evidence of genetic transmission. J Vas Surg 35:386–388

    Article  Google Scholar 

  25. Satchell P, Ware S, Barron J, Tuck R (1994) Finger sudorometry and assessment of the sudomotor drive. J Neurosci Methods 53:217–223

    Article  PubMed  CAS  Google Scholar 

  26. Skinos http://members.aol.com./junzos. Accessed 22 Aug 2008

  27. Solish N, Bertucci V, Dansereau A, Chih-Ho Hong H, Lynde C, Lupin M, smith KC, Storwick G (2007) A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian hyperhidrosis advisory committee. Dermatol Surg 33:908–923

    Article  PubMed  CAS  Google Scholar 

  28. Strutton DR, Kowalski JW, Glaser DA, Stang PE (2004) US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 51:241–248

    Article  PubMed  Google Scholar 

  29. Tu Y-R, Li X, Lin M, Lai FC, Li YP, Chen JF, Ye JG (2007) Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People’s Republic of China. Eur J Cardio-thorac Surg 31:737–739

    Article  Google Scholar 

  30. Yamashita N, Shimizu H, Kawada M, Yanagishita T, Watanabe D, Tamada Y, Matsumoto Y (2008) Local injection of botulinum toxin A for palmar hyperhidrosis: usefulness and efficacy in relation to severity. J Derm 35:325–329

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank Sandra Goodman NP, Maria Serrano NP, Peggy Cottrell, Dahlia Favreau and Jamie Jones for their efforts on the project. This work was supported by NINDS/NIH 1R21NS43549-01.

Author information

Author notes

  1. Gary Swergold

    Present address: Regeneron Pharmaceuticals, New York, USA

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Montefiore Medical Center, 3400 Bainbridge Ave, Suite 5A, Bronx, NY, 10467, USA

    Steven M. Keller & Riccardo Bello

  2. Department of Pediatrics, Albert Einstein College of Medicine, Bronx, USA

    Betsy Vibert

  3. Department of Medicine, Columbia University, New York, USA

    Gary Swergold

  4. Departments of Pediatrics, Microbiology and Immunology, Epidemiology and Population Health, Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, USA

    Robert Burk

Authors
  1. Steven M. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Bello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Betsy Vibert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gary Swergold
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Burk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven M. Keller.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Appendix 2 (PDF 92 kb)

Appendix

Appendix

Hyperhidrosis scale

Questions about distress caused by sweating of the hands.

How much distress do you experience when you:

  1. 1.

    Shake hands with others?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  2. 2.

    Hold hands with a boyfriend/girlfriend/spouse?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  3. 3.

    Writing (by hand) on paper to complete examinations, applications or other important documents?

    • (None) 0 12 3 4 5 6 7 8 9 10 (worst)

  4. 4.

    Grasp heavy objects and/or tools?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  5. 5.

    Attempt to initiate intimate contact?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  6. 6.

    Turn knobs or faucets?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  7. 7.

    Drive a car?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  8. 8.

    Eat with forks, knives, or spoons?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  9. 9.

    Wear fabric, leather or rubber gloves?

    • (None) 0 12 3 4 5 6 7 8 9 10 (worst)

Questions related to sweating of your feet

  1. 10.

    Put on socks or stockings?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  2. 11.

    Walk barefoot?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  3. 12.

    Wear sandals?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  4. 13.

    Wear high-heel shoes?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

Questions related to sweating from areas of the body other than the hands and feet

  1. 14.

    Sweat from your axilla (underarms)?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

  2. 15.

    Sweat from other parts of the body other than hands and axilla?

    • (None) 0 1 2 3 4 5 6 7 8 9 10 (worst)

    • Is yes, where (please describe)______________________

©Hyperhydrosis scale, 1998. Keller, Sekons, Scher, Bookbinder, Portenoy (HYPERQUE).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keller, S.M., Bello, R., Vibert, B. et al. Diagnosis of palmar hyperhidrosis via questionnaire without physical examination. Clin Auton Res 19, 175–181 (2009). https://doi.org/10.1007/s10286-009-0006-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-009-0006-5

Keywords

Search

Navigation