Primary focal hyperhidrosis and autonomic symptom burden: a case-control study using the COMPASS-31 questionnaire

Area of Science:

• Neurology
• Dermatology
• Autonomic Medicine

Background:

• Primary focal hyperhidrosis (PFH) is characterized by excessive localized sweating.
• The potential link between PFH and broader autonomic nervous system dysfunction remains under-explored.

Purpose of the Study:

• To investigate the association between primary focal hyperhidrosis (PFH) and generalized autonomic dysfunction.
• To quantify autonomic symptom burden in PFH patients using a validated instrument.

Main Methods:

• A case-control study compared 132 PFH patients with 74 healthy controls.
• Autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31 (COMPASS-31).
• Propensity score matching and multivariate regression analyses were employed to minimize confounding and adjust for covariates.

Main Results:

• PFH patients exhibited significantly higher COMPASS-31 scores than controls (median 18.7 vs. 11.2, p < 0.001).
• Significant differences were noted in orthostatic, vasomotor, secretomotor, and gastrointestinal autonomic symptom domains.
• PFH status independently predicted higher autonomic symptom burden, with craniofacial and truncal hyperhidrosis showing stronger associations.

Conclusions:

• Primary focal hyperhidrosis is associated with a wider range of autonomic symptoms, indicating generalized autonomic dysfunction.
• These findings highlight the necessity of a holistic approach in the evaluation and management of individuals with PFH.