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Purpose <p>To explore the relationship between primary focal hyperhidrosis (PFH) and generalized autonomic dysfunction, we assessed autonomic symptom burden using a comprehensive and validated measure of autonomic symptoms.</p> Methods <p>In this case–control study, we compared 132 patients with PFH with 74 matched healthy controls. Autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire. Propensity score matching minimized confounding. Mann–Whitney<i> U</i>&#xa0;tests compared COMPASS-31 scores between groups. A sensitivity analysis using multivariate linear regression accounted for specific hyperhidrosis sites and demographic factors.</p> Results <p>PFH cases demonstrated significantly higher median COMPASS-31 scores compared to controls (18.7 [IQR 7.7–34.8] vs. 11.2 [IQR 3.5–19.3], <i>p</i> &lt; 0.001). Significant differences were observed in orthostatic (2.0 [0–20] vs. 0 [0–12], <i>p</i> = 0.028), vasomotor (0 [0–0] vs. 0 [0–0], <i>p</i> = 0.005; 24.2% vs. 9.5% non-zero scores, respectively), secretomotor (3.2 [2.1–8.6] vs. 0 [0–3.8], <i>p</i> &lt; 0.001), and gastrointestinal (5.4 [1.8–8] vs. 1.8 [0.9–5.4], <i>p</i> = 0.004) domains. Sensitivity analysis confirmed PFH status as a significant predictor of higher COMPASS-31 scores (additional 7.5 points on average, 95%&#xa0;CI 1.6–13.4, <i>p</i> = 0.012) after adjusting for demographic factors and hyperhidrosis sites. Craniofacial and truncal hyperhidrosis were associated with higher autonomic symptom burden.</p> Conclusion <p>PFH is associated with a broader spectrum of autonomic symptoms beyond localized sweating, establishing a link to more generalized autonomic dysfunction. These findings underscore the need for a comprehensive approach to evaluating and managing patients with PFH.</p>

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

  • 期刊论文

  • 发表日期：

    2025年12月13日

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  • Andrei Gurau,
  • Wasay Nizam,
  • Hamza Khan,
  • Nimisha Seshadri,
  • Christine Kim,
  • Suguru Yamauchi,
  • Rita de Cássia Collaço,
  • Ruilin Ma,
  • Kaitlyn Ecoff,
  • Jolien Vander Cruyssen,
  • Jeannine Forrester,
  • Kristen Rodgers,
  • Andreas S. Barth,
  • Frank Bosmans,
  • Jinny S. Ha,
  • Malcolm Brock

摘要

Purpose

To explore the relationship between primary focal hyperhidrosis (PFH) and generalized autonomic dysfunction, we assessed autonomic symptom burden using a comprehensive and validated measure of autonomic symptoms.

Methods

In this case–control study, we compared 132 patients with PFH with 74 matched healthy controls. Autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire. Propensity score matching minimized confounding. Mann–Whitney U tests compared COMPASS-31 scores between groups. A sensitivity analysis using multivariate linear regression accounted for specific hyperhidrosis sites and demographic factors.

Results

PFH cases demonstrated significantly higher median COMPASS-31 scores compared to controls (18.7 [IQR 7.7–34.8] vs. 11.2 [IQR 3.5–19.3], p < 0.001). Significant differences were observed in orthostatic (2.0 [0–20] vs. 0 [0–12], p = 0.028), vasomotor (0 [0–0] vs. 0 [0–0], p = 0.005; 24.2% vs. 9.5% non-zero scores, respectively), secretomotor (3.2 [2.1–8.6] vs. 0 [0–3.8], p < 0.001), and gastrointestinal (5.4 [1.8–8] vs. 1.8 [0.9–5.4], p = 0.004) domains. Sensitivity analysis confirmed PFH status as a significant predictor of higher COMPASS-31 scores (additional 7.5 points on average, 95% CI 1.6–13.4, p = 0.012) after adjusting for demographic factors and hyperhidrosis sites. Craniofacial and truncal hyperhidrosis were associated with higher autonomic symptom burden.

Conclusion

PFH is associated with a broader spectrum of autonomic symptoms beyond localized sweating, establishing a link to more generalized autonomic dysfunction. These findings underscore the need for a comprehensive approach to evaluating and managing patients with PFH.