Next Article in Journal
Hematological- and Immunological-Related Biomarkers to Characterize Patients with COVID-19 from Other Viral Respiratory Diseases
Previous Article in Journal
Dynamics of HIV Reservoir and HIV-1 Viral Splicing in HCV-Exposed Individuals after Elimination with DAAs or Spontaneous Clearance
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 11
Issue 13
10.3390/jcm11133576
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study

by
Wongi Woo
1,
Jooyoung Oh
2,
Bong Jun Kim
1,
Jongeun Won
1,
Duk Hwan Moon
1 and
Sungsoo Lee
1,*
1
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
2
Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(13), 3576; https://doi.org/10.3390/jcm11133576
Submission received: 28 May 2022 / Revised: 17 June 2022 / Accepted: 17 June 2022 / Published: 21 June 2022
(This article belongs to the Section Dermatology)
Browse Figures
Review Reports Versions Notes

Abstract

:
Background: We aimed to investigate the impact of the COVID-19 pandemic on the degree of depression among hyperhidrosis patients and their quality of life. Methods: 222 patients were contacted through an online questionnaire. Patients reported quality of life (QoL), including treatment and changes in symptoms during the pandemic, and also responded to the Patient Health Questionnaire-9 (PHQ-9) to evaluate the severity of depression. Those were compared with the result from the general population. Spearman correlation and multiple linear regression were performed to identify the factors related to the PHQ-9 score. Results: Half of the patients were female. The mean PHQ-9 score (5.25) of hyperhidrosis patients was higher than the general population, and female patients displayed significantly higher PHQ-9 scores than males (p = 0.002). QoL was impaired more in females. About 10% of patients experienced worsening symptoms, and 30% had difficulties getting appropriate management. Significant negative correlations were found between the PHQ-9 and age or disease duration. Predictive factors for the PHQ-9 were female (p = 0.006) and facial hyperhidrosis (p = 0.024). Conclusions: The level of depression among hyperhidrosis patients was higher than the general population during the COVID-19 pandemic; female and facial hyperhidrosis patients need much more psychiatric attention. Though hyperhidrosis is classified as benign and often neglected by clinicians, we need to give more awareness to the mental burden imposed by the COVID-19 pandemic.

1. Introduction

The COVID-19 pandemic has drastically changed the daily lives of people around the world, causing mental health problems in many. Evidence from previous research suggests that the prevalence of depression has increased during the pandemic [1,2,3,4,5]. Among health care workers, the rate was as high as 50.4% in China [1] and 63.5% in India [6]. Other than these frontline workers, the general public also saw an increase in the prevalence of depression: 17.5% in South Korea [3] and 27.8% in the United States [2]. Due to the increased burden of mental distress, the pandemic may have had a greater impact on mentally vulnerable patients [7].
Mental health problems, such as depression and anxiety, in hyperhidrosis patients, have been investigated in previous studies [8,9,10,11,12]. Although patients with hyperhidrosis lack overt psychopathology, their complaints about mental distress appear to be associated with the degree of symptoms and quality of life [13]. Treatments, such as endoscopic sympathetic surgery [14,15,16] and botulinum toxin injection [17], have shown to significantly improve the symptoms and mental health-related problems. However, the level of evidence is still insufficient due to the limited number of studies; additionally, a recent report on dermatologic disease revealed that patients with dermatologic conditions faced barriers to having appropriate management during the pandemic [18].
In this study, we aimed to investigate the level of depression among hyperhidrosis patients during the pandemic and explore possible risk factors related to a higher level of depression. Additionally, this research investigated how the COVID-19 pandemic impacted the quality of life and management in hyperhidrosis patients.

2. Methods

2.1. Study Population and Design

Participants were contacted from the largest online community (Community of people overcoming excessive sweating, https://m.cafe.daum.net/hyperhydrosis, accessed on 15 July 2021) of hyperhidrosis patients in South Korea, which has 36,015 registered members and 120 average daily visits. The online questionnaire with informed consent was distributed to all members of this community.

2.2. Online Survey

The online survey was performed using Google Forms, and code numbers were used to avoid disclosing patients’ names or other personally identifiable information. Patients’ online ID was used to limit duplicated reports. The questionnaire contained 22 questions, divided into the following three sections: the quality of life (QOL); the shift in symptoms and treatments during the COVID-19 pandemic; and Patient Health Questionnaire-9 (PHQ-9) (Supplementary Table S1).
Each question regarding the QOL measures was derived based on a comprehensive discussion amongst subject matter experts, including surgeons, psychiatrists, nurses, researchers, and statisticians. These questions also referenced previously published studies and were modified to reflect the culture of South Korea. Patients answered each question on a 5-point Likert scale, ranging from 0–4, with 4 reflecting the poorest QOL; a score of 3 or 4 was categorized into poor QOL. Patients reported their residential areas in demographic variables, and they were later divided into two categories (urban or metropolitan area and suburban or rural area).
In the PHQ-9 score analysis, we compared the PHQ-9 score of hyperhidrosis patients with that of the general population survey, which was performed during the same period under the supervision of the government. Korean people aged between 19 to 70 were randomly contacted through telephone call or online survey platforms. The selection of participants accounted for the population ratio per city among 17 metropolitan areas. The final cohort included 2063 participants (sampling error = ±2.2% at 95% confidence level). The general population survey expressed the PHQ-9 score [19] as a mean without the description of normality test. Thus, in this study, we attempted to express the results of hyperhidrosis patients as the mean and standard deviation for comparison. Due to the limited availability of participants data in this national report, a direct comparison with these values should be interpreted cautiously.

2.3. Statistical Analysis

Continuous variables (age, body-mass index, the duration of hyperhidrosis, PHQ-9 score, time, hospital duration period) were described as the median and interquartile ranges (IQR), or the mean and standard deviation. Categorical variables were indicated as characteristics or percentages of patients based on the group. As we analyzed the continuous variables, the Mann–Whitney test or two-sample t-test was used after testing for normality via the Shapiro–Wilk method. The Chi-square test or Fisher’s exact test was used to analyze categorical variables. Due to the non-normality of data, Spearman correlation analyses were performed to investigate the correlation between PHQ-9 and age, BMI, or duration of the disease. Multiple linear regression was used to identify predictive factors related to the PHQ-9 score. We used R package version 4.0.5 for statistical analysis. p-values of less than 0.05 were defined as significant.

2.4. Ethical Statements

This study was approved by the Institutional Review Board of our institution (Approval No. 3-2021-0312). Participants’ consents were received through the online process, and their private information was protected under the supervision of the department.

3. Results

3.1. Characteristics of Participants

A total of 222 patients participated in the questionnaire, and their PHQ-9 score was compared with that of the general population, which was based on the study by the Korean government (19). Half of the participants were female, and the median age of participants was 39.0 years (IQR 31.3–45.0). Two-thirds of them were from urban or metropolitan areas, and about half were married. The median duration of hyperhidrosis was 29.0 years; and more than two-thirds of them had palmar (72.5%) or plantar (73.9%) hyperhidrosis (Table 1).

3.2. PHQ-9 Score and Relationship with Hyperhidrosis

The PHQ-9 score and the proportion of mild to moderate depression were demonstrated in Table 1 and Figure 1. The median PHQ-9 score was significantly higher in females (p < 0.001); the percentage of mild (50.5% vs. 30.6%, p = 0.004) and moderate (28.8% vs. 14.4%, p = 0.014) depression was also higher in females. Compared to the general population, male patients aged between 30–59 demonstrated a relatively lower mean PHQ-9 score (Figure 1). However, the mean PHQ-9 score in female patients was higher than the public, especially in the younger age groups (age between 20 to 39 years) (Figure 1). Furthermore, similar results (Figure 2) were observed after matching for patients’ age, gender, and disease duration (Supplementary Table S1).
The Spearman correlation showed a significant correlation between gender (ρ = +0.278, p < 0.001), age (ρ = −0.264, p < 0.001) or the duration of hyperhidrosis (ρ = −0.212, p = 0.001), and the PHQ-9 score. To understand what factors may influence the severity of depression, a multiple linear regression analysis was performed to identify possible predictors of the PHQ-9 score. Table 2 summarizes the results of the linear regression. The regression analysis indicated that female (β = +2.36, p = 0.006) residents in urban or metropolitan areas (β = −1.98, p = 0.017) and facial hyperhidrosis (β = +1.87, p = 0.024) are predictors for the PHQ-9 score.

3.3. The Effect of COVID-19 Pandemic on Patients’ Experience

3.3.1. Quality of Life Measurements

With respect to the parameters related to the QOL (Figure 3), about half of all participants reported a poor rating in intimate personal contacts (60.4%), public speaking or presentation (58.6%), dressing (47.3%), the use of public spaces (45.9%), interpersonal relationship (44.1), and academic activity (43.2%) (Table 3). After matching for age, gender, and disease duration (Supplementary Table S2), females showed lower QOL in the use of public spaces (p = 0.030), public speaking or presentation (p = 0.027), and interpersonal relationship (p = 0.044) compared with male patients.

3.3.2. Treatments and Symptoms

Most patients reported that symptoms stayed the same during the pandemic; only 10.4% of patients reported worsening and 4.1% experienced improvement (Figure 4). Additionally, about 70% of patients did not experience difficulty in getting treatment when compared with the pre-pandemic period. However, 11.7% of them complained of difficulty visiting the outpatient clinics due to restrictive measures or fear of contracting COVID-19, and 14% reported problems in getting appropriate medical information related to the disease. When patients were asked about their treatments during the pandemic, about half of them reported not receiving any treatments. Moreover, less than 20% of patients (outpatient visits, 15.4%; surgery, 1.4%) were managed under the guidance of specialists (Figure 5).

4. Discussion

The burden of mental problems after the COVID-19 pandemic has impacted the worldwide community, particularly those with predispositions. However, mental problems in patients with dermatologic conditions, such as hyperhidrosis, have not gotten much attention from physicians due to its relatively low severity. This study first tried to evaluate the impact of the COVID-19 pandemic on disease severity, treatment, and quality of life. Additionally, this study compared the level of depression in hyperhidrosis patients with that in the general population.
The role of gender has been well recognized as a predictive factor for elevated depressive symptoms during the pandemic [20,21]. Compared to the general female population, female hyperhidrosis patients demonstrated a much higher PHQ-9 score. Moreover, male hyperhidrosis patients seemed to have a lower PHQ-9 score than female hyperhidrosis patients. It could be explained by relatively lower proportions of patients reporting poor QOL after matching for age and disease duration (Supplementary Table S2). Male patients had a significantly lower percentage of QOL-specific problems: the use of public spaces, interpersonal relationships, and public speaking or presentation. This could be attributable to different responses between male and female patients against restrictive social measures that minimized personal contacts. However, since there is not enough data on the pre-pandemic period, more consistent and serial studies would be warranted.
The location of hyperhidrosis is essential in predicting the quality of life and the improvement after treatments. Those with facial hyperhidrosis seemed to have reduced quality of life compared to those with palmar or axillary hyperhidrosis [22]; this could be related to the increased incidence of social phobia [23]. Even the benefit of endoscopic thoracic sympathectomy was not as rewarding in craniofacial hyperhidrosis as it was in other locations [24,25]. In this study, facial hyperhidrosis was found to be the risk factor for depressive symptoms. Due to these complex problems in craniofacial hyperhidrosis, much attention should be paid to the management of these patients, both in their sweating and mental problems.
Age and PHQ-9 score exhibited a negative relationship. A similar pattern was observed in the national analysis in Japan [26] among the general population; after middle adulthood, the PHQ-9 score decreased, though it increased in early adulthood. Additionally, hyperhidrosis patients with a longer disease duration seemed to have a low PHQ-9 score. It appears that patients may adjust their lifestyles and change their perception of the disease over time, as a similar psychosocial adjustment was observed in skin disease patients [27]. Further studies investigating the impact of disease period and age in hyperhidrosis would be necessary to find relevant factors to the process of psychosocial adaptation.
In terms of treatments during the pandemic, most hyperhidrosis patients did not report much difficulty in seeking treatments during the COVID-19 pandemic. This contradicts other medical or dermatological conditions that were impacted significantly due to measures to prevent the spread of SARS-CoV-2. Due to restrictions or impacts of the pandemic, patients experienced functional impairment in their quality of life [28]; marked reduction of face-to-face consultations, especially in dermatology [29]; delayed or under-reported diagnosis of skin malignancy [30]; and even decrease in urgent visit for dermatologic conditions [31]. However, this study showed that these kinds of impacts were not serious among hyperhidrosis patients; even the reduction in the outpatient visit might not be recognizable. It could be related to the negligence of hyperhidrosis among the medical professionals, as there is a limited number of good quality studies on this issue [32]. As this study showed, less than 20% of hyperhidrosis patients evaluated were under the guidance of medical professionals. Patients also complained of problems related to reliable information for the treatment and the lack of guidance. Many patients managed the disease by self-medication or non-medically-approved strategies. This lack of supervision could induce more complications, adverse events, or even life-threatening situations [33]. Thus, further involvement from professional medical staff would be warranted to improve the quality of care.
There are several limitations to this study. First, this was a cross-sectional study based on an online surveillance. Thus, it could not measure how the score of PHQ-9 has changed over time, and there is no data about their mental well-being before the pandemic. Therefore, further follow-up studies of these patients are warranted to better understand the impact of COVID-19 pandemic on the population suffering from hyperhidrosis. Second, a direct comparison between the study population with the general population [19] should be interpreted cautiously. Due to the lack of raw data, we could not compare the distribution of the PHQ-9 score, and it was statistically challenging to demonstrate the difference among hyperhidrosis patients. Third, due to the online questionnaire-based study design, there may be respondent bias. As we enrolled patients through the online community, patients interested in hyperhidrosis or those with a longer disease duration became more interested, and thus, participated in the study. To demonstrate more generalized results, a large-scale multinational study is warranted. Moreover, the questions used to assess the QOL of hyperhidrosis patients are yet under the process of validation and the QOL of the general population was not assessed as we performed. Therefore, the direct comparison of the QOL between hyperhidrosis patients and the public would be difficult and further studies are necessary.
Hyperhidrosis patients had a relatively higher level of depression during the pandemic, especially among female patients, and a proportion of hyperhidrosis patients complained of difficulty in treatment during the pandemic. Psychiatric interventions are warranted for female or facial hyperhidrosis patients. Further multi-institutional prospective studies should be done to better investigate the burden of mental distress among hyperhidrosis patients.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jcm11133576/s1.

Author Contributions

Conceptualization, W.W. and S.L.; Data curation, W.W., J.W. and B.J.K.; Formal analysis, W.W. and J.W.; Investigation, W.W., B.J.K. and J.O.; Methodology, J.O. and W.W.; Project administration, S.L. and D.H.M.; Resources, S.L. and D.H.M.; Software, W.W.; Supervision, S.L. and D.H.M.; Validation, W.W., J.O., D.H.M. and S.L.; Visualization, W.W. and J.W.; Writing—original draft, W.W.; Writing—review &editing, W.W., J.O., B.J.K., J.W., D.H.M. and S.L. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was approved by the Institutional Review Board of our institution (Approval No. 3-2021-0312).

Informed Consent Statement

Participants’ consents were received through the online process, and their private information was protected under the supervision of the department.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgments

The authors thank hyperhidrosis patients in the online community (Community of people overcoming excessive sweating, https://m.cafe.daum.net/hyperhydrosis, accessed on 15 July 2021) for sharing their personal struggles.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Liu, Y.; Chen, H.; Zhang, N.; Wang, X.; Fan, Q.; Zhang, Y.; Huang, L.; Hu, B.; Li, M. Anxiety and depression symptoms of medical staff under COVID-19 epidemic in China. J. Affect. Disord. 2020, 278, 144–148. [Google Scholar] [CrossRef]
  2. Ettman, C.K.; Abdalla, S.M.; Cohen, G.H.; Sampson, L.; Vivier, P.M.; Galea, S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw. Open 2020, 3, e2019686. [Google Scholar] [CrossRef]
  3. Hyun, J.; Kim, S.; Kim, H.; Choi, Y.-J.; Lee, Y.-R.; Paik, J.-W.; Lee, J.-S.; Kim, K.; Jun, J.Y.; Lee, S.H.; et al. COVID-19 and Risk Factors of Anxiety and Depression in South Korea. Psychiatry Investig. 2021, 18, 801–808. [Google Scholar] [CrossRef]
  4. Lingelbach, K.; Piechnik, D.; Gado, S.; Janssen, D.; Eichler, M.; Hentschel, L.; Knopf, D.; Schuler, M.; Sernatinger, D.; Peissner, M. Effects of the COVID-19 Pandemic on Psychological Well-Being and Mental Health Based on a German Online Survey. Front. Public Health 2021, 9, 655083. [Google Scholar] [CrossRef]
  5. Kim, D.M.; Bang, Y.R.; Kim, J.H.; Park, J.H. The Prevalence of Depression, Anxiety and Associated Factors among the General Public during COVID-19 Pandemic: A Cross-sectional Study in Korea. J. Korean Med. Sci. 2021, 36, e214. [Google Scholar] [CrossRef] [PubMed]
  6. Das, A.; Sil, A.; Jaiswal, S.; Rajeev, R.; Thole, A.; Jafferany, M.; Ali, S.N. A Study to Evaluate Depression and Perceived Stress Among Frontline Indian Doctors Combating the COVID-19 Pandemic. Prim. Care Companion CNS Disord. 2020, 22, 26168. [Google Scholar] [CrossRef]
  7. Fonseca, E.; Quintana, M.; Lallana, S.; Luis Restrepo, J.; Abraira, L.; Santamarina, E.; Seijo-Raposo, I.; Toledo, M. Epilepsy in time of COVID-19: A sur-vey-based study. Acta Neurol. Scand. 2020, 142, 545–554. [Google Scholar] [CrossRef]
  8. Bahar, R.; Zhou, P.; Liu, Y.; Huang, Y.; Phillips, A.; Lee, T.K.; Su, M.; Yang, S.; Kalia, S.; Zhang, X.; et al. The prevalence of anxiety and depression in patients with or without hyperhidrosis (HH). J. Am. Acad. Dermatol. 2016, 75, 1126–1133. [Google Scholar] [CrossRef]
  9. Bragança, G.M.G.; Lima, S.O.; Neto, A.F.P.; Marques, L.M.; de Melo, E.V.; Reis, F.P. Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis. An. Bras. Dermatol. 2014, 89, 230–235. [Google Scholar] [CrossRef] [Green Version]
  10. Klein, S.Z.; Hull, M.; Gillard, K.K.; Peterson-Brandt, J. Treatment Patterns, Depression, and Anxiety Among US Patients Diagnosed with Hyperhidrosis: A Retrospective Cohort Study. Dermatol. Ther. 2020, 10, 1299–1314. [Google Scholar] [CrossRef]
  11. Kristensen, J.K.; Möller, S.; Vestergaard, D.G.; Horsten, H.-H.; Swartling, C.; Bygum, A. Anxiety and Depression in Primary Hyper-hidrosis: An Observational Study of 95 Consecutive Swedish Outpatients. Acta Derm. Venereol. 2020, 100, adv00240. [Google Scholar] [CrossRef]
  12. Shayesteh, A.; Boman, J.; Janlert, U.; Brulin, C.; Nylander, E. Primary hyperhidrosis: Implications on symptoms, daily life, health and alcohol consumption when treated with botulinum toxin. J. Dermatol. 2016, 43, 928–933. [Google Scholar] [CrossRef] [PubMed]
  13. Ruchinskas, R.; Narayan, R.; Meagher, R.; Furukawa, S. The relationship of psychopathology and hyperhidrosis. Br. J. Dermatol. 2002, 147, 733–735. [Google Scholar] [CrossRef]
  14. Li, D.C.; Hulbert, A.; Waldbaum, B.; Ober, C.; Hooker, C.M.; Huang, P.; Molena, D.; Yang, S.C.; Ito, T.; Perry-Parrish, C.; et al. Endoscopic thoracic sympathectomy for primary focal hyperhidrosis: Impact on psycho-social symptomatology and psychotropic medication use. Eur. J. Cardio-Thoracic Surg. 2018, 54, 904–911. [Google Scholar] [CrossRef]
  15. Hirakawa, N.; Higashimoto, I.; Takamori, A.; Tsukamoto, E.; Uemura, Y. The impact of endoscopic thoracic sympathectomy on sudomotor function in patients with palmar hyperhidrosis. Clin. Auton. Res. 2021, 31, 225–230. [Google Scholar] [CrossRef]
  16. Ureña, A.; Masuet-Aumatell, C.; Escobar, I.; Villalonga, R.; Moya, J.; Ramos, R.; Rivas, F.; Macia, I. An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis. Eur. J. Cardio-Thoracic Surg. 2009, 36, 360–363. [Google Scholar] [CrossRef] [Green Version]
  17. Weber, A.; Heger, S.; Sinkgraven, R.; Heckmann, M.; Elsner, P.; Rzany, B. Psychosocial aspects of patients with focal hyperhidrosis. Marked reduction of social phobia, anxiety and depression and increased quality of life after treatment with botulinum toxin A. Br. J. Dermatol. 2005, 152, 342–345. [Google Scholar] [CrossRef]
  18. Turkmen, D.; Altunisik, N.; Sener, S.; Colak, C. Evaluation of the effects of COVID-19 pandemic on hair diseases through a web-based questionnaire. Dermatol. Ther. 2020, 33, e13923. [Google Scholar] [CrossRef]
  19. Korean Ministry of Public health and Welfare—the Fourth Assessment of Mental Well-Being of Korean Populations, Collaborating with Korean Association of Stress and Trauma. 2021. Available online: http://kstss.kr/?p=2065 (accessed on 14 January 2022).
  20. Hu, Y.; Chen, Y.; Zheng, Y.; You, C.; Tan, J.; Hu, L.; Zhang, Z.; Ding, L. Factors related to mental health of inpatients with COVID-19 in Wuhan, China. Brain Behav. Immun. 2020, 89, 587–593. [Google Scholar] [CrossRef]
  21. Hyland, P.; Shevlin, M.; McBride, O.; Murphy, J.; Karatzias, T.; Bentall, R.P.; Martinez, A.; Vallières, F. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatr. Scand. 2020, 142, 249–256. [Google Scholar] [CrossRef]
  22. Shayesteh, A.; Janlert, U.; Nylander, E. Hyperhidrosis—Sweating Sites Matter: Quality of Life in Primary Hyperhidrosis according to the Sweating Sites Measured by SF-36. Dermatology 2017, 233, 441–445. [Google Scholar] [CrossRef]
  23. Pohjavaara, P.; Telaranta, T.; Väisänen, E. The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block? Nord. J. Psychiatry. 2003, 57, 55–60. [Google Scholar] [CrossRef]
  24. Fukuda, J.M.; Varella, A.Y.M.; Teivelis, M.P.; de Campos, J.R.M.; Kauffman, P.; Pinheiro, L.L.; Wolosker, N. Video-Assisted Thoracoscopic Sym-pathectomy for Facial Hyperhidrosis: The Influence of the Main Site of Complaint. Ann. Vasc. Surg. 2018, 46, 337–344. [Google Scholar] [CrossRef]
  25. Smidfelt, K.; Drott, C. Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing. Br. J. Surg. 2011, 98, 1719–1724. [Google Scholar] [CrossRef]
  26. Tomitaka, S.; Kawasaki, Y.; Ide, K.; Akutagawa, M.; Ono, Y.; Furukawa, T.A. Stability of the Distribution of Patient Health Questionnaire-9 Scores Against Age in the General Population: Data from the National Health and Nutrition Examination Survey. Front. Psychiatry 2018, 9, 390. Available online: https://www.frontiersin.org/article/10.3389/fpsyt.2018.00390 (accessed on 1 October 2021). [CrossRef]
  27. Zhang, X.-J.; Wang, A.-P.; Shi, T.-Y.; Zhang, J.; Xu, H.; Wang, D.-Q.; Feng, L. The psychosocial adaptation of patients with skin disease: A scoping review. BMC Public Health 2019, 19, 1404. [Google Scholar] [CrossRef]
  28. Teuschl, Y.; Bancher, C.; Brainin, M.; Dachenhausen, A.; Matz, K.; Pinter, M.M. COVID-19-related delays of botulinum toxin injections have a negative impact on the quality of life of patients with dystonia and spasticity: A single-center ambulatory care study. J. Neural Transm. 2021, 129, 49–53. [Google Scholar] [CrossRef]
  29. Gisondi, P.; Piaserico, S.; Conti, A.; Naldi, L. Dermatologists and SARS-CoV-2: The impact of the pandemic on daily practice. J. Eur. Acad. Dermatol. Venereol. 2020, 34, 1196–1201. [Google Scholar] [CrossRef]
  30. Kartal, S.P.; Çelik, G.; Sendur, N.; Aytekin, S.; Serdaroğlu, S.; Doğan, B.; Yazıcı, A.C.; Çiçek, D.; Borlu, M.; Kaçar, N.G.; et al. Multicenter study evaluating the impact of COVID-19 outbreak on dermatology outpatients in Turkey. Dermatol. Ther. 2020, 33, e14485. [Google Scholar] [CrossRef]
  31. Demirel Öğüt, N.; Tabak, G.H.; Gülseren, D.; Yalıcı-Armağan, B.; Akdoğan, N.; Doğan, S.; Doğan, S.; Elçin, G.; Karaduman, A.; Evans, S.E.; et al. The effect of the COVID-19 pandemic on dermatology consultation requests from adult and paediatric emergency departments. Int. J. Clin. Pract. 2021, 75, e14906. [Google Scholar] [CrossRef]
  32. Chudry, H. The treatment of palmar hyperhidrosis—A systematic review. Int. J. Dermatol. 2021; ahead of print. [Google Scholar] [CrossRef]
  33. Choudhary, N.; Lahiri, K.; Singh, M. Increase and consequences of self-medication in dermatology during COVID -19 pandemic: An initial observation. Dermatol. Ther. 2020, 34, e14696. [Google Scholar] [CrossRef] [PubMed]
Jcm 11 03576 g001 550
Figure 1. Patient Health Questionnaire –9 (PHQ –9) score for hyperhidrosis patients and the general population.
Figure 1. Patient Health Questionnaire –9 (PHQ –9) score for hyperhidrosis patients and the general population.
Jcm 11 03576 g001
Jcm 11 03576 g002 550
Figure 2. Adjusted Patient Health Questionnaire–9 (PHQ–9) score for hyperhidrosis patients and the general population (age, gender, and disease duration were adjusted).
Figure 2. Adjusted Patient Health Questionnaire–9 (PHQ–9) score for hyperhidrosis patients and the general population (age, gender, and disease duration were adjusted).
Jcm 11 03576 g002
Jcm 11 03576 g003 550
Figure 3. The proportion of hyperhidrosis patients with impairment in the quality of life.
Figure 3. The proportion of hyperhidrosis patients with impairment in the quality of life.
Jcm 11 03576 g003
Jcm 11 03576 g004 550
Figure 4. Problems that hyperhidrosis patients faced during the pandemic.
Figure 4. Problems that hyperhidrosis patients faced during the pandemic.
Jcm 11 03576 g004
Jcm 11 03576 g005 550
Figure 5. Treatments that hyperhidrosis patients experienced during the pandemic.
Figure 5. Treatments that hyperhidrosis patients experienced during the pandemic.
Jcm 11 03576 g005
Table
Table 1. Participants’ demographic, hyperhidrosis characteristics and PHQ-9 score.
Table 1. Participants’ demographic, hyperhidrosis characteristics and PHQ-9 score.
TotalMaleFemalep Value
n = 222n = 111n = 111
Demographics
Age39.00 [31.25, 45.00]42.00 [34.00, 47.00]37.00 [29.00, 43.00]0.001
Age group 0.001
20–2938 (17.1)9 (8.1)29 (26.1)
30–3977 (34.7)37 (33.3)40 (36.0)
40–4977 (34.7)46 (41.4)31 (27.9)
50–5924 (10.8)14 (12.6)10 (9.0)
60+6 (2.7)5 (4.5)1 (0.9)
BMI23.10 [21.20, 25.60]24.70 [23.00, 26.70]21.80 [20.15, 23.50]<0.001
Marital status 0.033
married109 (49.1)63 (56.8)45 (40.5)
divorced5 (2.3)1 (0.9)4 (3.6)
unmarried108 (48.6)47 (42.3)61 (55.0)
Residential area
Small town72 (32.4)38 (34.2)34 (30.6)0.667
Urban/Metropolitan area150 (67.6)73 (65.8)77 (69.4)
Depression related
PHQ-9 mean (SD)5.25 (5.97)3.74 (4.89)6.77 (6.56)<0.001
PHQ-9 median (IQR)3.5 [1.0, 8.0]2.00 [0.00, 6.00]5.00 [2.00, 10.00]<0.001
Mild Depression 90 (40.5)34 (30.6)56 (50.5)0.004
Moderate Depression ⁑48 (21.6)16 (14.4)32 (28.8)0.014
Hyperhidrosis related
Duration of disease29.0 [20.0, 34.0]30.00 [20.00, 35.00]26.00 [20.00, 33.50]0.061
Location of hyperhidrosis
Axilla111 (50.0)45 (40.5)66 (59.5)0.007
Palmar161 (72.5)76 (68.5)85 (76.6)0.229
Plantar164 (73.9)78 (70.3)86 (77.5)0.285
Facial82 (36.9)44 (39.6)38 (34.2)0.487
Multiple188 (84.7)88 (79.3)100 (90.1)0.039
Other areas42 (18.9)20 (18.0)22 (19.8)0.864
Comorbidity ⁂
Gastrointestinal diseases84 (37.8)36 (32.4)48 (43.2)0.128
Obesity62 (27.9)33 (29.7)29 (26.1)0.654
Anxiety44 (19.8)18 (16.2)26 (23.4)0.238
Depression44 (19.8)15 (13.5)29 (26.1)0.028
Hypertension27 (12.2)22 (19.8)5 (4.5)0.001
Diabetes mellitus8 (3.6)6 (5.4)2 (1.8)0.280
Neurologic disorder17 (7.7)9 (8.1)8 (7.2)1
BMI, body-mass index; SD, standard deviation; IQR, interquartile range; PHQ-9, patient health questionnaire-9. Patients with PHQ-9 score 5 or above. ⁑ Patients with PHQ-9 score 10 or above. ⁂ This is based on the patients’ self-report not previous medical records.
Table
Table 2. Predictors for PHQ-9 score, identified by multiple linear regression analysis.
Table 2. Predictors for PHQ-9 score, identified by multiple linear regression analysis.
FactorEstimateStandard Errort Valuep Value
(Intercept)8.16 (0.39 to 15.93)3.942.070.040
Age−0.08 (−0.18 to 0.02)0.05−1.670.096
BMI−0.06 (−0.31 to 0.19)0.13−0.460.640
Marital status [single or divorced]1.66 (−0.16 to 3.48)0.921.80.074
Gender [female]2.36 (0.7 to 4.03)0.842.790.006
Residential area [urban/metropolitan]−1.98 (−3.61 to −0.35)0.83−2.40.017
Axillary hyperhidrosis0.63 (−0.9 to 2.17)0.780.810.420
Facial hyperhidrosis1.87 (0.25 to 3.5)0.832.270.024
BMI, body-mass index; PHQ-9, patient health questionnaire-9.
Table
Table 3. Quality of life and patients’ experience during the pandemic.
Table 3. Quality of life and patients’ experience during the pandemic.
TotalMaleFemalep Value
n = 222n = 111n = 111
Quality of life problems
Use of public spaces, (%)102 (45.9)43 (38.7)59 (53.2)0.043
Working environments (%)37 (16.7)12 (10.8)25 (22.5)0.030
Interpersonal relationship (%)98 (44.1)38 (34.2)60 (54.1)0.004
Public speaking or presentation (%)130 (58.6)52 (46.8)78 (70.3)0.001
Digital life (%)61 (27.5)25 (22.5)36 (32.4)0.132
Intimate personal contacts (%)134 (60.4)59 (53.2)75 (67.6)0.039
Dressing (%)105 (47.3)43 (38.7)62 (55.9)0.015
Hobbies and leisure activity (%)74 (33.3)30 (27.0)44 (39.6)0.064
Academic activity (%)96 (43.2)40 (36.0)56 (50.5)0.042
Change in symptoms 0.750
Improved9 (4.1)5 (4.5)4 (3.6)
Same as usual190 (85.6)96 (86.5)94 (84.7)
Worsened23 (10.4)10 (9.0)13 (11.7)
Problems in treatments during the pandemic
No problem158 (71.2)82 (73.9)76 (68.5)0.459
Information related issues31 (14.0)15 (13.5)16 (14.4)1
Inaccurate information12 (5.4)8 (7.2)4 (3.6)0.374
Insufficient information26 (11.7)11 (9.9)15 (13.5)0.532
Visit to outpatient clinics26 (11.7)13 (11.7)13 (11.7)1
Side effects9 (4.1)4 (3.6)5 (4.5)1
Communication with physicians4 (1.8)3 (2.7)1 (0.9)0.622
Treatments received during the pandemic
No treatment105 (47.3)62 (55.9)43 (38.7)0.015
Self-medication ⁂64 (28.8)23 (20.7)41 (36.9)0.011
OPD visit to thoracic surgeons23 (10.4)10 (9.0)13 (11.7)0.660
OPD visit to dermatologist11 (5.0)5 (4.5)6 (5.4)1
Surgery3 (1.4)3 (2.7)0 (0.0)0.247
Diet therapy18 (8.1)8 (7.2)10 (9.0)0.807
Leisure activity18 (8.1)7 (6.3)11 (9.9)0.462
Herbal medicine4 (1.8)1 (0.9)3 (2.7)0.622
Mobile consultation2 (0.9)0 (0.0)2 (1.8)0.498
Health supplement15 (6.8)6 (5.4)9 (8.1)0.594
Others22 (9.9)9 (8.1)13 (11.7)0.501
OPD, outpatient department. It includes inconvenience related to the use of smartphone and electronic devices. ⁂ Over-the-counter drugs, aesthetic products, and the use of topical agents such as aluminum chloride.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Woo, W.; Oh, J.; Kim, B.J.; Won, J.; Moon, D.H.; Lee, S. The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study. J. Clin. Med. 2022, 11, 3576. https://doi.org/10.3390/jcm11133576

AMA Style

Woo W, Oh J, Kim BJ, Won J, Moon DH, Lee S. The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study. Journal of Clinical Medicine. 2022; 11(13):3576. https://doi.org/10.3390/jcm11133576

Chicago/Turabian Style

Woo, Wongi, Jooyoung Oh, Bong Jun Kim, Jongeun Won, Duk Hwan Moon, and Sungsoo Lee. 2022. "The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study" Journal of Clinical Medicine 11, no. 13: 3576. https://doi.org/10.3390/jcm11133576

APA Style

Woo, W., Oh, J., Kim, B. J., Won, J., Moon, D. H., & Lee, S. (2022). The Impact of COVID-19 on Hyperhidrosis Patients in the Mental Health and Quality of Life: A Web-Based Surveillance Study. Journal of Clinical Medicine, 11(13), 3576. https://doi.org/10.3390/jcm11133576

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop