Addressing the mental, social impact of hyperhidrosis in teens

Key takeaways:

• Primary hyperhidrosis, or excessive sweating, can impact daily functioning and psychosocial well-being.
• Dermatology and psychology should collaborate to address mental health comorbidities in affected children.

Children and adolescents with primary hyperhidrosis often report an underappreciated but substantial psychosocial burden, presenting an opportunity for dermatology and psychiatry to collaborate and develop integrated treatment plans.

Pediatric hyperhidrosis, a condition characterized by excessive sweating of the axilla, palms, soles and face, remains an under-researched disease despite its high prevalence and profound effects on emotional well-being, daily functioning and quality of life, according to Sheila Sharifi, BA, a medical student at Georgetown University School of Medicine and predoctoral research fellow at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at University of Miami Miller School of Medicine. Sharifi and mentor Mohammad Jafferany, MD, FAPA, MCPS (Derm), professor of psychodermatology, psychiatry and behavioral sciences at Central Michigan University College of Medicine, conducted a systematic review to highlight this research gap and call for interdisciplinary collaboration and early screening for affected youths.

“Pediatric hyperhidrosis is more than a physical condition — it is a psychologically burdensome disease that can impair self-esteem and social development from a young age” Sharifi told Healio. “We urge clinicians and researchers alike to prioritize this population and integrate mental health considerations into routine dermatological care. Dermatologists should feel empowered to recognize and address these psychosocial outcomes within their clinical practice, serving as the first line of support for affected patients.”

Sharifi and Jafferany analyzed data from 12 studies assessing the psychosocial burden of hyperhidrosis conducted between 2012 and 2023, with cohort sizes ranging from 10 adolescents participating in an interview study to 1,671 pediatric and adolescent patients participating in a cross-sectional study. The review was published in the Journal of Cosmetic Dermatology.

Data showed that most pediatric and adolescent patients with primary hyperhidrosis reported severe impacts on quality of life and emotional well-being. Reported symptoms included poor interpersonal functioning, isolation and loneliness, issues with work or school-related tasks, perceived stigma and high social visibility.

In the cross-sectional study, researchers found that children with hyperhidrosis had the highest rates of depression (40.9%) and anxiety (31.8%).

The review included several studies examining the psychosocial benefits of available treatments, which include anticholinergics, neurotoxins and surgery. In one nonrandomized, open-label study with 121 adolescent participants, researchers found that emotional distress improved 4 and 8 weeks after treatment with OnabotulinumtoxinA (P < .001). Thoracic sympathectomy, typically reserved for refractory disease, also enhanced psychosocial functioning. In a prospective cohort study with 220 pediatric and adolescent participants, researchers observed that 96% reported improvements in quality of life after surgery (P < .01). In prospective study with 45 pediatric patients, researchers noted that 80% of the children reported an improvement in quality-of-life scores 6 weeks after treatment with oxybutynin (P < .001).

“Collaborations between dermatology and psychiatry can take many forms, from routine mental health screenings in dermatological settings to streamlined referral systems for behavioral health support,” Sharifi told Healio. “These screenings should employ validated psychiatric tools to ensure accurate identification of comorbidities. Enlisting both psychiatry and psychology is also essential to provide a full continuum of care, including diagnostic evaluation and therapeutic support. The development of interdisciplinary psychodermatology clinics represents the next frontier — offering truly integrated patient management.”

Sharifi said that available data on the psychosocial impacts of pediatric hyperhidrosis are limited by small sample sizes and a lack of standardized assessment tools.

“Additionally, there is a pressing need to establish and evaluate integrated care models that combine dermatological and psychological care,” Sharifi told Healio. “Longitudinal studies examining both clinical and mental health outcomes will be essential in guiding best practices.”

For more information:

Sheila Sharifi, BA, can be reached at ss4647@georgetown.edu.