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Causes of Secondary Hyperhidrosis: Hyperhidrosis and psychiatric illness, including social anxiety disorder
Several psychiatry texts state that patients with hyperhidrosis
have excessive anxiety. This characterization is apparently
based on case reports of successful decrease in symptoms through
psychotherapy. Several small studies of the incidence of psychopathology
in hyperhidrosis gave conflicting results and used “suboptimal
measures of personality.”[116]
Forty-two patients scheduled for sympathectomy with primary
hyperhidrosis were evaluated with two psychometric instruments,
the Minnesota Multiphasic Personality Inventory (MMPI) and
the State-Trait Anxiety Inventory (STAI). Scales of the MMPI
measuring anxiety, depression, and conversion phenomena were
within the normal range for 88% of patients, and 86% had normal
scores on the STAI. The authors concluded that most patients
with hyperhidrosis have no psychopathology and that symptoms
of anxiety, depression, and social isolation in some of the
patients were a reaction to the disorder rather than the cause.[116]
Hyperhidrosis is a common symptom in social anxiety disorder
(SAD), seen as part of increased physiologic arousal along with
other symptoms such as blushing and tremor.[32]
A retrospective review of data from several studies of patients
with social anxiety disorder determined that 25% to 32%
of patients had symptoms of hyperhidrosis at baseline, depending
on the assessment used. Patients with hyperhidrosis had more
disability, fear, avoidance, and other arousal symptoms. Patients
were treated with fluoxetine, clonazepam, gabapentin, cognitive
behavior therapy, or placebo. Statistically significant reductions
in hyperhidrosis were found only with fluoxetine using one
assessment scale and with gabapentin using another. It was concluded
that hyperhidrosis is common in patients with SAD, correlates
with higher amounts of other physiologic symptoms, and has
a variable response to psychopharmocologic therapy.[32]
Treating hyperhidrosis associated with social anxiety by endoscopic
thoracic sympathectomy (ETS) in 51 patients, Teleranta reported
a significant decrease in hyperhidrosis, blushing, tachycardia,
tremor, and anxiety, leading to speculation that a central
effect on anxiety occurs with alleviation of peripheral symptoms,
possibly by feedback inhibition.[143]
A similar interruption of the cycle of anxiety-hyperhidrosis-anxiety
may be obtained by using botulinum toxin A injections as adjunctive
therapy in SAD patients.[32]
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