Real sweating in a virtual stress environment: Investigation of the stress reactivity in people with primary focal hyperhidrosis

Abstract

Background Hyperhidrosis (excessive sweating, OMIM %114110) is a complex disorder with multifactorial causes. Emotional strains and social stress increase symptoms and lead to a vicious circle. Previously, we showed significantly higher depression scores, and normal cortisol awakening responses in patients with primary focal hyperhidrosis (PFH). Stress reactivity in response to a (virtual) Trier Social Stress Test (TSST-VR) has not been studied so far. Therefore, we measured sweat secretion, salivary cortisol and alpha amylase (sAA) concentrations, and subjective stress ratings in affected and non-affected subjects in response to a TSST-VR. Method In this pilot study, we conducted TSST-VRs and performed general linear models with repeated measurements for salivary cortisol and sAA levels, heart rate, axillary sweat and subjective stress ratings for two groups (diagnosed PFH (n = 11), healthy controls (n = 16)). Results PFH patients showed significantly heightened sweat secretion over time compared to controls (p = 0.006), with highest quantities during the TSST-VR. In both groups, sweating (p < 0.001), maximum cortisol levels (p = 0.002), feelings of stress (p < 0.001), and heart rate (p < 0.001) but not sAA (p = 0.068) increased significantly in response to the TSST-VR. However, no differences were detected in subjective ratings, cortisol concentrations and heart rate between PFH patients and controls (pall > 0.131). Conclusion Patients with diagnosed PFH showed stress-induced higher sweat secretion compared to healthy controls but did not differ in the stress reactivity with regard to endocrine or subjective markers. This pilot study is in need of replication to elucidate the role of the sympathetic nervous system as a potential pathway involved in the stress-induced emotional sweating of PFH patients.

Treatment of hyperhidrosis with Botox (onabotulinumtoxinA): Development, insights, and impact

“…[14] Although the etiology of primary hyperhidrosis is not yet known, hypotheses include the abnormal central control of emotional sweating occurring in response to stress, anxiety, and fear, triggered by sympathetic cholinergic nerves, or the dysregulation of the areas of the body that respond to emotion with sweating. [12,18,19] Nevertheless, the link between emotions and hyperhidrosis via an autonomic mechanism may be incomplete. A recent controlled study examined the relationship between subjective stress reactivity (induced via a virtual standardized stress test) and markers of biological response, including sweat secretion, salivary cortisol levels, and heart rate, in individuals with primary hyperhidrosis versus unaffected subjects.…”

“…However, whereas the primary hyperhidrosis group had secreted significantly higher quantities of sweat compared with controls, there was no significant difference between groups in subjective feelings of stress, cortisol levels, and heart rate. [19] Etiologic uncertainties aside, it is evident that hyperhidrosis has distressing and debilitating effects on individuals, which include difficulty engaging in basic, everyday social interactions and a costly need to replace sweat-stained clothing, and there are demonstrated, long-lasting benefits of treatment. [20][21][22][23] In a 2004 survey, approximately one-third of those with axillary hyperhidrosis reported that sweating was intolerable or barely tolerable, and frequently or always interfered with daily activities.…”

“…A recent controlled study examined the relationship between subjective stress reactivity (induced via a virtual standardized stress test) and markers of biological response, including sweat secretion, salivary cortisol levels, and heart rate, in individuals with primary hyperhidrosis versus unaffected subjects. [ 19 ] Both groups showed significantly increased stress-induced sweat secretion, maximum cortisol levels, feelings of stress, and heart rate. However, whereas the primary hyperhidrosis group had secreted significantly higher quantities of sweat compared with controls, there was no significant difference between groups in subjective feelings of stress, cortisol levels, and heart rate.…”

“…However, whereas the primary hyperhidrosis group had secreted significantly higher quantities of sweat compared with controls, there was no significant difference between groups in subjective feelings of stress, cortisol levels, and heart rate. [ 19 ]…”