Psychosocial Impact of Pediatric and Adolescent Hyperhidrosis: A Systematic Review and Call for Research

Abstract

Hyperhidrosis is characterized by excessive sweating of the axilla, palms, soles, and face, estimated to affect 3% of the United States population [1]. The disease extends beyond physical impairment, significantly impacting daily functioning and psychosocial well-being. The onset of primary hyperhidrosis is thought to be during the adolescent years or earlier, although studies examining the psychological impacts of the disease in pediatric and adolescent populations remain limited [1]. This systematic review is the first to synthesize and evaluate the literature on the psychosocial effects of primary hyperhidrosis in these populations.

A search of the PubMed, EMBASE, and Web of Science databases was conducted using the search terms “pediatric hyperhidrosis” or “childhood hyperhidrosis” or “adolescent hyperhidrosis” and “psychosocial” or “mental health” or “psychological” or “emotional” or “social impact” or “quality of life” or “self-esteem” or “anxiety” or “depression” or “well-being” or “social functioning.” After removal of duplicate articles, our search yielded 277 studies for screening. Studies were included if they discussed the appropriate topic, were the correct study type (e.g., clinical trials, cohort studies, case–control studies, cross-sectional studies, case reports, case series, or interview studies), and were published in peer-reviewed journals in English. Exclusion criteria consisted of studies irrelevant to the topic, incorrect publication types (i.e., review articles, commentaries, protocols, or letters to the editor), and publications in languages other than English. Ultimately, 12 studies were included in our review, from which data was extracted and synthesized. Quality assessment included validating study methodologies, population characteristics and any diagnostic tools used for psychological diagnoses. A PRISMA diagram is outlined in Figure 1, with detailed findings of each study in Table 1.

Our results highlight that the majority of pediatric and adolescent patients with primary hyperhidrosis report severe impacts on quality of life and emotional well-being [2, 3]. Specific symptoms include poor interpersonal functioning, personal isolation and loneliness, issues with work or school-related tasks, perceived stigma, and high social visibility [3-5]. A cross-sectional study of 1671 pediatric and adolescent patients with chronic skin conditions found that children with hyperhidrosis had the highest rates of depression (40.9%) and anxiety (31.8%) [4].

Studies have examined the psychosocial benefits of treatment options, including anticholinergics, neurotoxins, and surgery. Within a cohort of 121 adolescents, Glaser et al. demonstrated that OnabotulinumtoxinA significantly improved emotional distress (p < 0.001) [2]. Thoracic sympathectomy, typically reserved for refractory disease, also enhanced psychosocial functioning. In Lima et al.'s cohort of 220 pediatric and adolescent patients, over 96% reported significant improvements in quality of life (QOL) following surgery (p < 0.01) [3]. Finally, Wolosker et al. administered a 6-week course of oxybutynin to their cohort of 45 children with a significant increase in QOL scores in 80% of patients (p < 0.001) [6]. Importantly, none of these treatment options were associated with safety concerns in children and adolescents [2, 3, 5].

Our findings highlight the substantial psychosocial burden of primary hyperhidrosis in children and adolescents, profoundly affecting emotional well-being, interpersonal relationships, daily functioning, and overall quality of life. Mainstay treatment options have shown promising efficacy in reducing symptoms, although further investigations with prospective designs and larger patient cohorts are needed to validate these results. Limitations of our review include small sample sizes, short follow-up periods, and lack of standardized diagnostic tools, underscoring the need for future research. Greater collaborations between dermatology and psychiatry may aid in developing integrated treatment plans and early screening for mental health comorbidities.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.