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

Andrei Gurau^{1

2}, Wasay Nizam³, Hamza Khan^{1

2}, Nimisha Seshadri⁴, Christine Kim⁵, Suguru Yamauchi¹, Rita de Cássia Collaço⁶, Ruilin Ma⁷, Kaitlyn Ecoff¹, Jolien Vander Cruyssen⁶, Jeannine Forrester¹, Kristen Rodgers¹, Andreas S Barth⁸, Frank Bosmans^{6

9}, Jinny S Ha¹, Malcolm Brock¹⁰

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA.
² Valley Health System General Surgery Residency Program, 2075 East Flamingo Road, Las Vegas, NV, 89119, USA.
³ Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave NW, Room 4B-16, Washington, DC, 20060, USA.
⁴ Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
⁵ Department of Biology, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, 21218, USA.
⁶ Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, Faculty of Medicine and Public Health, University of Ghent, 9000, Ghent, Belgium.
⁷ Department of Biology, New York University, New York, NY, 10003, USA.
⁸ Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
⁹ Experimental Pharmacology Group (EFAR), Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmaceutical Sciences, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
¹⁰ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA. mabrock@jhmi.edu.

PMID: 41388201
DOI: 10.1007/s10286-025-01178-w

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

Andrei Gurau et al. Clin Auton Res. 2025.

. 2025 Dec 13.

doi: 10.1007/s10286-025-01178-w. Online ahead of print.

Authors

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA.
² Valley Health System General Surgery Residency Program, 2075 East Flamingo Road, Las Vegas, NV, 89119, USA.
³ Department of Surgery, Howard University College of Medicine, 2041 Georgia Ave NW, Room 4B-16, Washington, DC, 20060, USA.
⁴ Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
⁵ Department of Biology, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, 21218, USA.
⁶ Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, Faculty of Medicine and Public Health, University of Ghent, 9000, Ghent, Belgium.
⁷ Department of Biology, New York University, New York, NY, 10003, USA.
⁸ Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
⁹ Experimental Pharmacology Group (EFAR), Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmaceutical Sciences, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
¹⁰ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA. mabrock@jhmi.edu.

PMID: 41388201
DOI: 10.1007/s10286-025-01178-w

Abstract

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.

Keywords: Autonomic dysfunction; COMPASS-31; Case–control study; Dysautonomia; Primary focal hyperhidrosis; Sympathetic nervous system.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest.

References

1. Naumann M, Hamm H, Spalding J, Kowalski J, Lee J (2003) Comparing the quality of life effect of primary focal hyperhidrosis as assessed by the Dermatology Life Quality Index (DLQI). In: July 2003 meeting of the American Academy of Dermatology
1. Kjeldstrup Kristensen J, Grejsen D, Swartling C, Bygum A (2020) In hyperhidrosis quality of life is even worse than in acne, eczema, or psoriasis. A comparison of Skindex-16 and dermatology life quality index (DLQI). Int J Dermatol 59(11):e392–e393. https://doi.org/10.1111/ijd.15164 - DOI - PubMed
1. Cina CS, Clase CM (1999) The illness intrusiveness rating scale: a measure of severity in individuals with hyperhidrosis. Qual Life Res 8(8):693–698. https://doi.org/10.1023/a:1008968401068 - DOI - PubMed
1. Sato K, Kang WH, Saga K, Sato KT (1989) Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol 20(5 Pt 1):713–726. https://doi.org/10.1016/s0190-9622(89)70081-5 - DOI - PubMed
1. Johnson R, Spaulding J (1974) Disorders of the autonomic nervous system. Chapter 10. Sweating. Contemp Neurol Ser (11):179–98

Grants and funding

LinkOut - more resources

Full Text Sources
- Springer

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources