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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.84 no.4 Rio de Janeiro July/Aug. 2009
CLINICAL, EPIDEMIOLOGICAL, LABORATORY AND THERAPEUTIC INVESTIGATION
Romero FeliniI; Alexandre Roberto DemarchiII; Eder Deivis FistarolIII; Mariana MatielloIV; Lílian Mathias DelorenzeV
in Thoracic Surgery by Universitat Autònoma de Barcelona (1996). Professor
of the subject of Thoracic Surgery at Fundação Universidade Regional
de Blumenau (FURB) Blumenau (SC), Brazil
IIUndergraduate student of the sixth year of the course of medicine of Fundação Universidade Regional de Blumenau (FURB) Blumenau (SC), Brazil
IIIUndergraduate student of the sixth year of the course of medicine of Fundação Universidade Regional de Blumenau (FURB) Blumenau (SC), Brazil
IVUndergraduate student of the sixth year of the course of medicine of Fundação Universidade Regional de Blumenau (FURB) Blumenau (SC), Brazil
VUndergraduate student of the sixth year of the course of medicine of Fundação Universidade Regional de Blumenau (FURB) Blumenau (SC), Brazil
Hyperhidrosis is a little known disorder, characterized by excessive production
of sweat. Hyperhidrosis may occur under several circumstances and appears in
body parts like armpits, hands, feet, and face, consequently causing problems
to the patient like job limitation, social embarrassment, and psychological
OBJECTIVES: Using these theoretical views as a starting point, the study aimed to evaluate the prevalence of hyperhidrosis in Blumenau.
METHODOLOGY: Utilizing interviews, the research was conducted with 500 subjects randomly approached, in the period ranging from August 21 to September 1st, 2006.
RESULTS: 45 respondents (9%) matched the pre-requisites, being classified as hyperhidrosis patients. The age group most affected was from 18 to 30 years (11.8%). Hyperhidrosis was more frequent among men both in absolute (24 men against 21 women) and relative numbers (10.62% of men against 7.66% of women). The most prevalent characteristic was "at least one occurrence per week", in 91.11% of patients; the least prevalent occurrence was "cessation of sweat during sleep", in 37.77% of respondents.
CONCLUSIONS: The data show that the prevalence of hyperhidrosis in Blumenau is higher when compared with other studies, thus indicating that it is not a rare phenomenon.
Keywords: Hyperhidrosis; Prevalence, Sweat
Hyperhidrosis is a condition characterized by the excessive production of sweat by the body. It can be primary or secondary. The origin of primary hyperhidrosis is unknown, but it occurs due to the hyperactivity of the sympathetic nervous system. It is focal, usually symmetric and it may affect the armpits, palms of hands, plant of feet, face and other areas.1
Recent evidence suggests that primary hyperhidrosis has a familial component that points towards a genetic base for this condition.2
It can manifest itself in areas like the armpits, hands, feet, and face and causes considerable problems for the patient, including limitations in work, social interaction, physical activities, leisure, as well as psychological and relationship disorders.1
According to a research on quality of life, the negative effects of hyperhidrosis are comparable to other conditions such as severe psoriasis, terminal renal failure, rheumatoid arthritis, and multiple sclerosis.2
Epidemiological data on the prevalence of primary hyperhidrosis are scarce and insufficient to provide an accurate estimation. Strutton et al. cite in their paper, a study conducted by Adar et al. among young Israelis in 1977, in which these authors found a prevalence of hyperhidrosis between 0.6 and 1%.1
Moya et al. report in their study an incidence of hyperhidrosis as a condition that affects more than 1% of the population.3 Han et al. report an incidence of 0.15-1%.4
Strutton et al., in a recent epidemiological research including more than 150,000 homes in the US, reveal that the prevalence of primary hyperhidrosis is 2.8% of the population investigated. They show that hyperhidrosis affects equally both sexes and that its prevalence is greater in the age group between 25 and 64 years.1
Lee et al. describe palmar hyperhidrosis as a functional disorder, common in subtropical areas, with an incidence estimated between 0.6-1% in Israel and 1.6 to 3% in Taiwan 5.
According to Alric et al., the palmar form is the most debilitating, affecting 0.5 to 1% of the population. The symptoms usually appear in puberty and 12 to 33% of patients have a family history. This condition is more common among women (50 to 83%). Epidemiological studies have demonstrated that there is no evidence of its predominance in different ethnical groups or geographic locations. 6
The prevalence of palmar hyperhidrosis has been found to be 4.59% of adolescents in the city of Fuzhou in China, without any significant difference in the prevalence between sexes, and family history of hyperhidrosis is present in 15.3% of the cases.7
According to a research by Haider et al., axillary hyperhidrosis affects 51%, plantar affects 29%, palmar affects 25% and facial affects 20% of the patients. No study was found on the natural course of the disease with aging, but based on our clinical experience, the severity of sweating seems to go down in patients older than 50 years.8
The average age of onset is 25 years, but it depends chiefly on the area affected. Palmar hyperhidrosis and axillary hyperhidrosis have an early onset, on average, between 13 and 19 years, respectively; whereas for the palmar form, approximately 82% report its onset in childhood.1
Primary hyperhidrosis has been found to start in childhood, but the people affected usually do not seek medical help until they are adults.8
No documented research
was found in Brazil, where it is an issue little investigated.
This research aims to provide an estimate of the prevalence of hyperhidrosis in the city of Blumenau, located in the region of the valley of river Itajaí, in the state of Santa Catarina. It is the city with the third largest population in the state, with 292,972 inhabitants and its population is predominantly of European ascent.9
MATERIAL AND METHODS
This is a cross-section prospective study.
Population and sample
This study was conducted in urban terminals in the municipality of Blumenau, in the period from August 21 to September 1 2006. Five hundred people of both sexes and aged 18 or more were included in this research.
Based on the study by Strutton et al. (who estimated a prevalence of 2.8% in the population), the research universe was evaluated through intentional sampling, using a 5% sample error, which means a sample of at least 400 people.
The study was approved by Human Research Ethics Committee of Universidade Regional de Blumenau, under number 061/06.
Data collection and analysis
Data collection was conducted by means of an interview with the application of a questionnaire (Table 1) containing the diagnostic criteria for hyperhidrosis, according to the research by Haider et al8. Hyperhidrosis was considered present when the answer to the first question was positive and there was an affirmative answer to at least two of the subsequent questions.
Data analysis and procedures
Data were analyzed through descriptive analysis and chi-square tests for independence to check associations between the factors researched and hyperhidrosis. Associations were considered significant when P ≤ 0.05.
People aged 18 years randomly approached in the urban terminals of Blumenau were interviewed.
A total of 500 people were interviewed, 274 of which were women and 226 were men. There was no significant difference between the number of men and women interviewed in terms of hyperhidrosis (χ2 = 0.98; gl = 1; P = 0. 32). Therefore, it cannot be said that hyperhidrosis is gender dependent. Among the people interviewed, 45 (9%) met the diagnostic criteria for primary hyperhidrosis and 455 (91%) not meet such criteria (Chart 1).
The sample was divided per age in three groups: 18 to 30 years, 31 to 59 years and 60 to 83 years.
Among the age groups analyzed, the smallest prevalence (7.66%) of hyperhidrosis was found between 31 and 59 years of age, although this group had the broadest age interval and the most people interviewed; the age group between 60 and 83 years had a prevalence of 8.92%; and the age group comprehending people aged between 18 and 30 years was the one with the highest prevalence of hyperhidrosis with 11.80%. However, the use of the qui-square test to check if there was an association between age and hyperhidrosis showed that, χ2 = 2.04; gl = 2; P = 0.3614. Therefore, it cannot be said that hyperhidrosis depends on age. (Chart 2).
The characteristic at least one occurrence per week was the most frequently mentioned in the research, 41 times, and the characteristic cessation of sweat during sleep was the least frequently mentioned, 17 times (Chart 3).
As to the associations between sexes and characteristics, only the characteristics positive family history and gets worse in stressful situations were more prevalent among women (Chart 4).
On the whole, in relation to the characteristics identified among respondents who suffer from hyperhidrosis, the following ascending order of prevalence was found: cessation of sweat during sleep, positive family history, age of onset: less than 25 years, affects daily activities, little or no interference of temperature, gets worse in stressful situations, bilateral and relatively symmetrical sweat, and at least one occurrence per week (Chart 5).
As to the research by Moya et al.3, Han et al.4 and Strutton et al.1, who described hyperhidrosis as a condition that affects respectively more than 1%, 0.15-1% and 2.8%, this study found quite greater numbers, revealing that 9% of the population interviewed in Blumenau have this disorder. This number makes hyperhidrosis no longer a rare event, exceeding levels close to 5%.
This research also provided evidence that there is a greater prevalence among men (10.62%) than among women (7.66%), which slightly disagrees with the information of Strutton et al.1, who said that an equal number of men and women were affected by the disease, and Tu et al.7, who said there was no significant differences between sexes.
According to Tu et al.7,15.3% of the cases observed by them in adolescents in the city of Fuzhou in China had a positive family history for hyperhidrosis. Alric et al.6, in contrast, found that 12 to 33% of the patients had a positive family history.
In this study, we found that about 44.44% of the people affected have a family history of hyperhidrosis.
Strutton et al.1 demonstrated in their research that the prevalence of primary hyperhidrosis is greater among people aged between 25 and 64 years, whereas, in this study, it was the age group between 18 and 30 years that presented the highest prevalence (11.80%), followed by the age groups between 60 and 83 years (8.92%) and between 31 and 59 years (7.66%).
According to the authors above, the average age for the emergence of hyperhidrosis is 25 years.1
Although this study did not include a question about the onset of hyperhidrosis symptoms, 25 of the patients, corresponding to 55.55% of the total number of patients, reported its onset before 25 years of age.
This work made it possible to find an estimate of the prevalence of hyperhidrosis in a sample of the adult population of Blumenau. The number of people affected by this disorder was found to be considerably greater than the numbers reported in other studies, showing that, in the city of Blumenau, hyperhidrosis is a more common disorder than previously thought.
It is important to conduct further studies to clarify the real prevalence of this disorder in Brazil, because, as this work showed, hyperhidrosis seems to be much more frequent than reported.
1. Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol. 2004;51:241-8 [ Links ]
2. Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51:274-86 [ Links ]
3. Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, et al. Thoracic sympathicolysis for primary hyperhidrosis: a review of 918 procedures. Surg Endosc. 2006;20:598-602 [ Links ]
4. Han PP, Gottfried ON, Kenny KJ, Dickman CA. Biportal thoracoscopic sympathectomy: surgical techniques and clinical results for the treatment of hyperhidrosis. Neurosurgery. 2002;50:306-11 [ Links ]
5. Lee KS, Chuang CL, Lin CL, Tsai LC, Hwang SL, Howng SL. Percutaneous CT-guided chemical thoracic sympathectomy for patients with palmar hyperhidrosis after transthoracic endoscopic sympathectomy. Surg Neurol. 2004;62:501-5 [ Links ]
6. Alric P, Branchereau P, Berthet JP, Léger P, Mary H, Mary-Ané C. Video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: results in 102 cases. Ann Vasc Surg. 2002;16:708-13 [ Links ]
7. Tu YR, Li X, Lin M, Lai FC, Li YP, Chen JF, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China. Eur J Cardiothorac Surg. 2007;31:737-9 [ Links ]
8. Haider A, Nowell S. Focal hyperhidrosis: diagnosis and management. CMAJ. 2005;172:69-75 [ Links ]
9. Instituto Brasileiro de Geografia e Estatística (IBGE) [homepage]. Contagem da população 2007 [acesso 11 Nov 2008]. Disponível em: www.ibge.gov.br/home/estatistica/populacao/ contagem2007/popmunic2007layoutTCU14112007.pdf [ Links ]
Fundação Universidade Regional de Blumenau,
Departamento de Medicina.
Rua Antonio da Veiga, 140 - Vila Nova
CEP: 89010-971 - Blumenau - SC
Tel./fax: 47 3321-0381 47 3321-0381
Conflict of interest:
Nenhum / Financial funding: None
How to cite this article: Fenili R, Demarchi AR, Fistarol ED, Matiello M, Delorenze LM. Prevalência de hiperidrose em uma amostra populacional de Blumenau SC, Brasil. An Bras Dermatol. 2009;84(4):361-6.