The Effects on Patients' Lives: Social Embarrassment and Psychological Effects
Embarrassment, shame and social anxiety associated with sweat-soaked or stained clothing, wet palms, puddling feet, and/or a dripping face/scalp can be severe. Indeed, studies have shown that hyperhidrosis’ impact on quality of life is equal to or greater than that of psoriasis, severe acne, Darier’s disease, Hailey-Hailey disease, vitiligo, and chronic pruritus.1c
Here are some of the statistics reported in the medical literature related to the social and emotional impacts of Hh:
- Decreased confidence and depression reported among Hh sufferers.1a
- Prevalence of anxiety and depression is significantly higher in those with Hh than those without Hh (21.3% vs 7.5% and 27.2% vs 9.7%, respectively).1b
- 75% of those with excessive sweating say the condition has had negative impacts on their social life, sense of well-being, and emotional and mental health. 1d
- 5% of Hh sufferers indicate they take antidepressants or anti-anxiety medications due to their sweating.1e
Additionally, in a 2017 study, researchers surveyed 71 people who self-identified as having primary hyperhidrosis and found the following results:
- 69% of study participants said they experience emotional ramifications from hyperhidrosis. Most participants reported being constantly worried about noticeable sweating. Some also said they experience sadness, anger, and hopelessness.1f
- The majority of respondents reported having low self-esteem and self-confidence as a result of hyperhidrosis. One participant said, “It massively eats away at my self-confidence, it makes me feel awful...”1f
- Most participants said they are uncomfortable being physically close to others because they are afraid of people’s reactions to their sweating. As a result, they avoid touching, holding or shaking hands, sitting next to others, standing in a line, and dancing. Some participants said they are uncomfortable with any physical affection.1f
- 75% of those in the study said they find it difficult to be in public view.
- 57% reported difficulties interacting with others.
- Common situations such as being in a shared office or shared classroom, going to a party, eating at a restaurant, using public transportation, or sitting in a movie theater were reported as challenging. Participants said they often avoid such situations.1f
In older data:
- Over 50% of patients with axillary hyperhidrosis identified in a U.S. national consumer survey reported feeling less confident, 38% said they were frustrated by some daily activities, 34% felt unhappy, and 20% noted being depressed. (2003)
- In a series of patients with palmar hyperhidrosis who were to undergo sympathectomy, 77% avoided shaking hands and 17% had to wear gloves to do some tasks. (2003)
- Baseline evaluation of a series of patients treated for axillary hyperhidrosis found 90% of the group reported an effect on their emotional status, and over 70% had to change clothes two or more times per day. (2002)
- Social embarrassment was reported by 90% of patients with palmar hyperhidrosis evaluated prior to sympathectomy, and 40% had psychological difficulties attributed to their symptoms. (1977)
To try to avoid social embarrassment, patients with hyperhidrosis often use varying strategies to deal with the potential for excessive sweat to soak through their clothing, shoes, or handheld items. These "tricks" may include: using pads, towels, gloves, shields, absorbent tissues, layers of clothing, dark colors of clothing, bulky clothing, and/or frequent clothing changes in a daily effort to "disguise" or hide their symptoms. For those with palmar hyperhidrosis, handshakes are avoided whenever possible.  Unfortunately, anxiety about how their sweating appears to others may itself be a stimulus for increased sweating by the Hh sufferer, creating a vicious cycle.
1a. Hamm H, Naumann MK, Kowalski JW, Kutt S, et al. Primary focal hyperhidrosis: disease characteristics and functional impairment. Dermatology 2006;212:343–353.
1b. Bahar R, Zhou P, Liu Y, et al. The prevalence of anxiety and depression in patients with or without hyperhidrosis (HH). J Am Acad Dermatol. 2016;75(6):1126-1133.
1c. Swartling C, Naver H, Lindberg M. Botulinum A toxin improves life quality in severe primary focal hyperhidrosis. Eur Med J Neurol 2001;8:247-52.
1d. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Archives of Dermatological Research. 2016;308(10):743-749. doi:10.1007/s00403-016-1697-9.
1e. Naumann MK et al. Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial. Brit J Dermatol 147 (2002): 1218-1226.
1f. Kamudoni P, Mueller B, Halford J, Schouveller A, Stacey B, Salek MS. The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation. Health and Quality of Life Outcomes. 2017 15:121.