“While a few studies have described an increased prevalence of skin infections in individuals with hyperhidrosis compared with those without the condition, it remains uncertain whether hyperhidrosis is an independent risk factor for skin infections,” explains Mattias A.S. Henning, MD. “Specifically, the study of skin infections in humid skin is important not only because it may constitute a comorbidity to hyperhidrosis, but also because it sheds light on the risk of skin infections in humid skin in general, such as in tropical conditions.”
For a paper published in the Journal of Dermatological Treatment, Dr. Henning and colleagues sought to compare the risk of skin infections in individuals with and without hyperhidrosis. “We looked at a proxy marker of skin infections, namely the usage of medications against skin infections,” Dr. Henning says. “We included otherwise healthy volunteer blood donors between 2010 and 2019 and then followed them until the end of 2019.” Through access to nationwide registries, the study team included data on all redeemed prescriptions from study inclusion to the end of follow-up.
Increased Use of Prescriptions Noted
Blood donors with hyperhidrosis had an increased use of prescriptions against bacterial and fungal skin infections compared with individuals without hyperhidrosis. “This increased consumption appears to be independent of other factors, such as demographics, smoking, and summer season,” Dr. Henning says, “implying that skin infections may be a recurrent comorbidity to hyperhidrosis, even in healthy individuals without other diseases.”
Dr. Henning adds that during the study, participants with self-reported hyperhidrosis, when compared with those without the condition, were at an increased risk of receiving and redeeming prescriptions for drugs used against bacterial skin infections, independent of other factors that can increase the risk of skin infections (Table). “We also found an increased risk of receiving and redeeming prescriptions against bacterial and fungal skin infections in participants with hospital-diagnosed hyperhidrosis compared with those without it, independent of other factors that can increase the risk of skin infections,” he says.
Based on these findings, the study team notes that physicians should be aware of skin infections as a potential hyperhidrosis comorbidity. “During the clinical consultation, physicians may need to inquire about symptoms of skin infections (ie, pain, redness, heat, swelling) and if deemed necessary, examine the patient for skin infections,” Dr. Henning notes. “Individuals with hyperhidrosis may also benefit from being informed about the potential of skin infections, to enable timely and adequate interventions, which can improve patient care.”
Diagnostic Consensus of Hyperhidrosis Needed
As hyperhidrosis remains sparsely investigated, first and foremost, there is a need for high-quality research in general that can benefit the patients, according to Dr. Henning. “To enable effective comparison of research findings across studies, it is important to reach a consensus on how to diagnose hyperhidrosis in a validated manner, both in research and clinical practice,” he adds. “Of specific areas, the etiology and pathophysiology of hyperhidrosis remain unknown and, therefore, merit additional research, which can enable the development of effective diagnostics and treatments. Moreover, research of the risk of comorbidities—somatic and psychiatric—is warranted. For hyperhidrosis treatments, there is a need for viable and long-term effective options that can improve patient care.”
Dr. Henning and colleagues concur that, regarding the risk of skin infections, research that can seek to verify whether these results are reproducible in other study populations is merited. “Rather than using the proxy prescriptions, future research that uses microbiologic examination results with or without a clinical examination would allow for characterization of what pathogens cause the skin infections and thereby, determine the most effective treatments,” he states.