Investigation and analysis of personality characteristics of primary palmar hyperhidrosis patients: a cross-sectional observational study

Abstract

Background

Patients with primary palmar hyperhidrosis (PPH) may exhibit distinct personality traits that influence their perception of the condition. These traits can manifest as heightened sensitivity to physical symptoms, as well as feelings of anxiety or depression, especially in social settings.

Methods

This study is a retrospective cross-sectional observational study aimed to evaluate and analyze the personality characteristics of patients with primary palmar hyperhidrosis using the Personality Diagnostic Questionnaire—Version 4 (PDQ-4). This study explored the relationships between personality traits and various factors, including age, gender, body mass index (BMI), onset age, the age when symptoms began to impact daily life (Impact age), the choice of thoracic sympathectomy nerve segment, and postoperative satisfaction. The study enrolled primary palmar hyperhidrosis patients treated at the Thoracic Surgery Department of Beijing Haidian Hospital between 2016 and 2021, with a total of 791 patients meeting the inclusion criteria. Statistical analyses, such as the Chi-square test and Mann–Whitney U-test, were conducted using SPSS 26.0 to investigate associations between personality traits and various variables.

Results

Primary palmar hyperhidrosis patients exhibited a higher prevalence of personality disorders at 16.18% compared to the general population, which ranges from 6.1 to 9.5%. Male patients exhibited a statistically significantly higher prevalence of schizoid, narcissistic, and antisocial personality disorders compared to female patients (P < 0.05). Furthermore, postoperative satisfaction among patients with primary palmar hyperhidrosis declined over time, with a statistically significant difference (P < 0.05). Notably, primary palmar hyperhidrosis patient comorbid personality disorders experienced a more pronounced decline in satisfaction.

Conclusions

Patients with primary palmar hyperhidrosis demonstrate a relatively high prevalence of personality disorders.

Introduction

Primary palmar hyperhidrosis (PPH), a localized subtype of primary hyperhidrosis, is defined by the abnormal and excessive secretion from eccrine sweat glands, specifically on the palms. Despite considerable research efforts, the precise underlying mechanisms of PPH remain unclear. Studies have shown that the structure and number of palmar sweat glands in individuals with PPH fall within the normal range [1, 2]. The duration, severity, and frequency of PPH episodes vary and remain unaffected by seasonal changes. Factors such as anxiety, stress, and social situations can induce or exacerbate the condition [3, 4]. These factors are more significant aggravators of hyperhidrosis than heat or the summer season [4]. Notably, psychological factors have been identified as significant contributors to the onset of PPH [3, 5].

Patients with severe cases of palmar hyperhidrosis often exhibit marked physical abnormalities. Persistent moisture on the hands can lead to skin maceration, peeling, chapping, and may even result in bacterial and fungal infections [6]. Excessive sweating can make the hands slippery, impairing hand function and reducing work efficiency, as well as quality of life [7, 8]. Moreover, palmar hyperhidrosis severely impacts patients'social interactions. Confronted with uncontrollable physical symptoms and social pressures, patients are prone to developing negative emotions, particularly anxiety and depression [7, 8]. Palmar hyperhidrosis typically begins and the critical period for personality development both occur during adolescence. Consequently, these factors might exert a deep influence on an individual's health, both physical and mental, possibly causing psychological health issues and personality disorders. [9,10,11]. To our knowledge, there is currently no literature that provides an in-depth analysis of the personality traits in patients with palmar hyperhidrosis. This study, therefore, aims to employ the PDQ-4 personality survey questionnaire to perform a comprehensive analysis of the personality traits in PPH patients and to investigate the potential correlations between these traits and various factors associated with disease.

Methods

Study design and setting

This study adhered to the principles outlined in the 2013 revision of the Declaration of Helsinki. The study obtained permission from the Ethics Committees of Beijing Haidian Hospital (Beijing, P.R. China) (Approval No.: [2017028]). Informed consent was obtained individually from each patient. This study is a retrospective, observational, and cross-sectional design conducted at our single center. Between 2016 and 2021, 1112 patients with palmar hyperhidrosis were treated at Beijing Haidian Hospital. This study involved the retrospective analysis of prospectively collected questionnaire data. All patients were prospectively assessed using the administration of the Personality Diagnostic Questionnaire-4 (PDQ-4) before surgery, with the entire process facilitated by professional staff, and also filled out a specifically designed preoperative questionnaire (which covered patient demographics, basic status of sweating, Onset age and the age at which symptoms began to impact daily life (Impact age) and so on). Participants received professional guidance and assistance throughout the questionnaire completion process. For postoperative satisfaction, our study employs an assessment method made in Beijing Haidian Hospital to comprehensively evaluate postoperative satisfaction in patients. Each participant underwent systematic follow-up within 6 months (short-term) and beyond 6 months (long-term) post-surgery.

To investigate the personality traits of PPH patients. We systematically analyzed the collected data. Specifically, we assess the PDQ-4 scores and document the corresponding prevalence of personality disorders. Utilizing the PDQ-4 positive threshold score of 30 as a criterion, we stratified the patients into two distinct groups: those scoring above 30 and those scoring below 30. Subsequently, we conducted a comprehensive comparison and correlation analysis of clinical characteristics, postoperative satisfaction levels, onset age, Impact age and other pertinent factors between these two groups.

Participants

The criteria for participant inclusion included: (1) a definitive diagnosis of palmar hyperhidrosis; (2) age over 18 years; (3) no significant physical illnesses; (4) an education level above junior high school and the ability to complete the assessment without difficulty. The exclusion criteria were as follows: (1) individuals suffering from the following diseases: diabetes, hyperthyroidism, brain disorders (such as pituitary tumors), tuberculosis, and other similar conditions; (2) individuals with mental disorders who are unable to cooperate and complete the survey.

Diagnostic criteria and survey tools

The Diagnostic and Statistical Manual of Mental Disorders, IV Edition (DSM-IV) [12], is a diagnostic manual developed by the American Psychiatric Association (APA) for diagnosing and classifying mental disorders. The DSM-IV classifies personality disorders into three clusters, comprising ten specific types. Cluster A is the odd or eccentric cluster, Cluster B is the dramatic and erratic cluster, and Cluster C is the anxious cluster. The ten specific types include paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, histrionic personality disorder, narcissistic personality disorder, antisocial personality disorder, borderline personality disorder, avoidant personality disorder, dependent personality disorder, and obsessive–compulsive personality disorder.

The Personality Disorder Questionnaire-4 (PDQ-4) [13] is a 99-item, true/false, self-assessment psychological screening tool developed by Steven Hyler (USA) to assess potential personality disorders listed in the DSM-IV. The PDQ-4 is a diagnostic questionnaire for personality disorders suitable for individuals aged 18 and above. Based on the PDQ-4 diagnostic criteria for adults, the positive cutoff scores for this questionnaire in the United States range from 3 to 5 points. Specifically, the positive cutoff score for paranoid, schizoid, avoidant, and obsessive–compulsive personality disorders is set at 4 points. For schizotypal, histrionic, narcissistic, borderline, and dependent personality disorders, the positive cutoff score is set at 5 points. The positive cutoff score for antisocial personality disorder is set at 3 points. A total score of 30 or higher is considered indicative of overall personality disturbance [14].

For postoperative satisfaction, patient self-assessments focus on subjective experiences. Postoperative satisfaction levels are categorized on a scale from 0 to 5, as follows: 0 points—Very Unsatisfied; 1 point—Unsatisfied; 2 points—Slightly Unsatisfactory; 3 points—Average; 4 points—Satisfied; 5 points—Very Satisfied.

Bias and data integrity

In this study, we enrolled 791 patients in all. However, among them, 597 patients fulfilled the short-term postoperative satisfaction follow-up, and 540 patients completed both the short-term and long-term postoperative satisfaction follow-ups, yielding a response rate of 68.3% (540/791). For the assessments of onset age and impact age, data were gathered from 598 patients (75.6%) and 542 patients (68.6%), respectively. The primary reasons for data missingness include incorrect filling of content, patients losing contact, patients declining to continue participation in the study, as well as errors or incompleteness in data recording. This data missingness may introduce a certain degree of bias into our analysis results and can also affect the accuracy of statistical analysis. Given that the data missing rate exceeds 30% and the non-randomness of some data missing, the application of multiple imputation method to interpolate the missing values within the data and other methods may not accurately reflect the true distribution and characteristics of the original data. Meanwhile, considering the large sample size we have included, we proceed with analyzing the existing data as the subject of related research. To minimize such bias and error, we need to conduct a more meticulous analysis of the existing data. Simultaneously, in future studies, we should place greater emphasis on the completeness and accuracy of data to enhance the reliability and scientific rigor of our research.

Sample size calculation

Based on the prevalence rate of personality disorders in the general population, which is estimated at 9.5%, we aim to derive a two-sided 95% confidence interval with a margin of error of 0.1. The calculated initial sample size is 133, and our enrolled data satisfy this sample size requirement.

Statistical analysis

After collecting, organizing, and reviewing all the questionnaires, invalid questionnaires were excluded, and the resulting data were entered into SPSS version 26.0 (IBM SPSS Statistics for Windows, Version 26.0, Released 2019) for further statistical analysis. Patient data are presented as continuous variables or categorical variables. The Kolmogorov–Smirnov test is utilized to determine if the dataset adheres to a normal distribution. When continuous variables are normally distributed, they are depicted as the mean with standard deviation and analyzed using the t-test. In cases where continuous variables do not follow a normal distribution, the Mann–Whitney U-test is employed, with data presented as the median and interquartile range. Categorical variables are displayed as numbers and frequencies and are assessed using the Chi-square test or Fisher's exact test when appropriate. All statistical analyses are conducted as two-tailed tests, with a significance level set at P < 0.05.

Results

Clinical characteristics of PPH patients (N = 791)

In total, 791 patients fully met the inclusion criteria and accurately completed the PDQ-4 measurement. The median age was 25 years (IQR 21–29) with BMI 21.05 kg/m² (IQR 19.53–23.14). Comparisons of demographic characteristics by gender are detailed in Table 1. While no significant age difference was observed between genders (P = 0.236), males had significantly higher BMI (P < 0.001) (Table 1).

Table 1 Clinical characteristics of the total sample of PPH patients (N = 791)

The gender differences of PDQ-4 subscale scores for PPH patients (N = 791)

In the analysis of PDQ-4 subscale scores among all 791 PPH patients, gender differences were examined using the Mann–Whitney U-test to account for the non-normal distribution of data. Male patients exhibited significantly higher scores on the schizoid and narcissistic personality disorder subscales compared to female patients (p < 0.05). Conversely, male patients scored significantly lower on the histrionic and avoidant personality disorder subscales (p < 0.05). However, no significant difference was observed in the total PDQ-4 scores between male and female patients with PPH, indicating no overall difference in personality disorder traits as measured by the PDQ-4 (Table 2).

Table 2 Comparison of the PDQ-4 subscale scores between male and female PPH patients

Percentile scores and positive rate of the PDQ-4 subscales and total score for PPH patients (N = 791)

We performed percentile analysis on the scores of the 10 subscales and the total score from the PDQ-4 survey results for all 791 PPH patients. The results indicated that, apart from antisocial personality disorder, the scores of the other subscales at the 95 th percentile ranged from 4 to 6 points, exceeding the positive cutoff range of the original scale in the United States (3–5 points) (Table 3). The results suggest that individuals with palmar hyperhidrosis may score higher on personality disorder scales, indicating a potentially higher likelihood of personality disorders within this group.

Table 3 Percentile scores of the PDQ-4 subscales and total score for PPH patients (N = 791)

When calculating the positive rates based on the American positive cutoff range of 3–5 points, obsessive–compulsive personality disorder exhibited the highest positive rate among the 10 subtypes of personality disorders in patients with palmar hyperhidrosis, at 31.61%, followed by avoidant personality disorder at 25.03%, while schizotypal personality disorder had the lowest positive rate at 2.28%. Using a cutoff point of 30 points on the PDQ-4 total scale to calculate the overall positive rate, the rate of personality disorders among patients with palmar hyperhidrosis is 16.18%.

To examine gender differences in the positive detection rates of various subscales of the PDQ-4, Chi-square tests were performed for each subscale. The results showed that, among males, obsessive–compulsive personality disorder exhibited the highest positive detection rate of 34.58%, while schizotypal personality disorder had the lowest at 1.49%. Among females, obsessive–compulsive personality disorder also exhibited the highest positive detection rate of 28.53%, while dependent personality disorder recorded the lowest at 2.83%. Notably, for the three subtypes of schizoid, antisocial, and narcissistic personality disorders, the positive detection rates were significantly higher in males compared to females, with statistical significance (P < 0.05) (Table 4).

Table 4 Positive rate of the PDQ-4 subscales and total score for PPH patients

Distribution of total scores on the PDQ-4 scale among 791 PPH patients (N = 791)

Among the 791 patients with PPH, 128 individuals scored above 30 on the PDQ-4 scale. In contrast, 663 patients scored below 30 on the PDQ-4 scale. Notably, as shown in Table 5, patients with PDQ-4 scores below 30 had a median age that was 2 years older than those with scores above 30, and this difference was statistically significant (P < 0.05). Of the 791 patients, 598 completed the survey regarding the age of onset of their palmar hyperhidrosis. Of these, 83 patients scored above 30 on the PDQ-4, while 515 scored below 30. However, no significant difference in the onset age was observed between the two groups (P = 0.611). Additionally, 542 patients responded to the survey regarding the age when their palmar hyperhidrosis symptoms first began to affect their daily lives. Of these, 76 scored above 30 on the PDQ-4, while 466 scored below 30. Similarly, no significant difference was found in the age at which symptoms began to impact their lives between these two groups (P = 0.663) (Table 5).

Table 5 Clinical characteristics comparison between PPH patients based on PDQ-4 score above or below 30 (N = 791)

We conducted a survey and analyzed the reasons why some patients did not complete the survey. Some patients chose not to answer due to privacy concerns or reluctance to recall the specific circumstances of their illness onset. For some patients, their medical records were incomplete, making it impossible to accurately obtain their age of onset. Additionally, some patients found it difficult to accurately recall the exact time point when their symptoms began to affect their daily lives. A few patients may have had unclear understanding of the survey questions, resulting in their inability to provide valid information. There were also cases of recording errors, among other reasons.

Nerve segment selection in endoscopic thoracic sympathectomy (N = 791)

This study investigates the relationship between the personality traits of all 791 patients with palmar hyperhidrosis and the selection of surgical segments for endoscopic thoracic sympathectomy. Based on the conventional approach to selecting surgical segments, we used the highest segment as the grouping criterion and classified the surgical procedures into two main groups. Specifically, Group T3 includes surgical approaches with T3 as the highest segment (including T3, T3 + T4, and T3 + T4 + T5), whereas Group T4 includes surgical approaches with T4 as the highest segment (including T4 and T4 + T5). However, no significant differences in nerve segment selection were observed based on PDQ-4 scores, whether above or below 30. Furthermore, no significant differences were found between male and female patients with regard to nerve segment selection (Table 6).

Table 6 Selection of nerve segment in endoscopic thoracic sympathectomy (N = 725)

Postoperative satisfaction after endoscopic thoracic sympathectomy (540)

Of the 791 patients who underwent the procedure, 540 participants completed the systematic follow-up and long-term follow-up post-surgery. This finding indicated a significant decrease in postoperative satisfaction over time among PPH patients following endoscopic thoracic sympathectomy. Specifically, patients reported higher satisfaction scores in the short-term follow-up phase post-surgery, with a median score of 5.0 (IQR: 4.0–5.0), compared to the long-term follow-up period, which had a median score of 4.0 (IQR: 4.0–5.0). This difference was statistically significant, as indicated by a Mann–Whitney U-test (Z = − 3.686, P < 0.001) (Table 7). However, no significant differences in satisfaction were observed between PPH patients with PDQ-4 scores above and below 30 at both time points, as well as between male and female patients, suggesting that these factors do not significantly influence postoperative satisfaction levels (Table 7).

Table 7 Postoperative satisfaction after endoscopic thoracic sympathectomy (N = 540)

When examining the postoperative satisfaction levels of PPH patients with PDQ-4 scores above 30 at both the short-term and long-term follow-ups, a statistically significant decrease in satisfaction over time was observed (P < 0.05). This trend was also noted among patients with PDQ-4 scores below 30, although the decline was less pronounced. Patients with PDQ-4 scores exceeding 30 reported a median satisfaction score of 4.5 (IQR: 4.0–5.0) during the short-term follow-up period, whereas patients with PDQ-4 scores below 30 had a median score of 5.0 (IQR: 4.0–5.0) at the same stage, indicating a significantly lower median score for the former group. In the long-term follow-up period, patients with PDQ-4 scores above 30 had a median satisfaction score of 4.0 (IQR: 4.0–5.0), and those with scores below 30 maintained a median score of 4.0 (IQR: 4.0–5.0). The patient group with PDQ-4 scores above 30 consistently showed lower satisfaction levels during both the short-term and long-term follow-up period, with a continued decline observed in the long-term period. In contrast, the patient group with PDQ-4 scores below 30 experienced a less pronounced decrease. This pattern indicates a persistent difference in satisfaction levels over time between the two groups.

These findings suggest that patients with higher PDQ-4 scores, indicative of potential personality disorders, may be more likely to experience a decrease in postoperative satisfaction, which could be associated with psychological factors affecting their perception of outcomes. However, because of the issue of data missingness, this could introduce the possibility of bias within these results. The primary reasons for data missing include incorrect information filling, patients becoming unreachable, patients declining to continue participation in the study, as well as errors or incompleteness in data recording and so on.

Discussion

Current research suggests that the etiology of primary palmar hyperhidrosis remains unclear. The condition can be triggered or exacerbated by factors such as heat, emotional excitement, and stress. Under high-stress conditions, stress can induce sweating, which, in turn, exacerbates stress levels [7, 8, 15, 16]. This vicious cycle profoundly impacts patients'daily lives, academic performance, work, and social interactions. The unpredictable nature of palmar hyperhidrosis often leads to avoidance behavior, anxiety, and depression, potentially resulting in psychological disorders [7]. Personality traits are consistent and enduring patterns of thinking, feeling, reacting, and interacting with others, demonstrating stability across various contexts and time periods [17]. In contrast, personality disorders are characterized by pervasive and enduring patterns of thought, perception, and behavior that severely impair an individual's functioning or cause distress [17]. These disorders often begin in adolescence or early adulthood, remain stable over time, and lead to impairment or distress [18]. Research has shown that the prevalence of personality disorders is 7.8% (95% CI 6.1 to 9.5) [19].

Despite the high prevalence of palmar hyperhidrosis in the general population, there is a relative scarcity of research investigating its psychiatric and psychological ramifications. Research has shown that hyperhidrosis significantly affects the psychosocial and social development of pediatric patients [20,21,22]. In our study population, the average age of onset was 8.8 years, with symptoms beginning to affect daily life at 12.4 years. This period coincides with the critical phase of personality development. Uncontrollable hand sweating can cause significant distress, leading to feelings of anxiety or panic [3]. Palmar hyperhidrosis typically begins in childhood or adolescence, periods during which there is a predisposition to exhibit the development of certain psychopathologies [3]. Given adolescents'typically fragile psychological resilience, the accumulation of psychological strain may overwhelm their coping abilities, potentially leading to introversion, low self-esteem, and even severe mental health consequences like depression and anxiety. Several studies have demonstrated positive associations between impaired personality functioning and anxiety disorders [23, 24]. These emotional states may further exacerbate the symptoms of palmar hyperhidrosis, creating a vicious cycle.

Our study analyzed PDQ-4 in PPH patients, according to the American criteria for positive PDQ-4 classifications, we found that the overall positive rate for personality disorders among PPH patients was 16.18%, with a prevalence of 17.16% in males and 15.17% in females. Both figures exceed the prevalence of personality disorders reported in the general population, which ranges from 6.1 to 9.5% [19]. This highlights that the prevalence of personality disorders among PPH patients is significantly higher than in the general population. Upon analyzing the PDQ-4 subscale scores, we observed that, excluding antisocial personality disorder, the scores for the remaining subscales at the 95 th percentile ranged between 4 and 6, exceeding the positive threshold range (3–5) established by the original American version of the questionnaire. This finding suggests that individuals with hyperhidrosis may have higher scores on personality disorder scales. After examining the positive detection rates of subscale, it became clear that schizoid, antisocial, and narcissistic personality disorders were significantly higher in males than in females (P < 0.05). This finding suggests that male patients with hyperhidrosis are significantly more likely to have these three personality disorders than their female counterparts (Result 3). This observation is consistent with the findings presented in Result 2 which reveal males had higher scores on the schizoid and narcissistic subscales, whereas females had higher scores on the histrionic and avoidant subscales. These findings suggest gender differences in personality traits among PPH patients, which may be related to varying tolerance levels and coping strategies for palmar hyperhidrosis.

A comparative analysis of PDQ-4 score above 30 and below 30 individuals within the hyperhidrosis patient population revealed that the median age of the PDQ-4 score above 30 group was 2 years younger than that of the other group, with a statistically significant difference (P < 0.05). This finding suggests that, within the hyperhidrosis patient population, younger individuals may be more likely to exhibit personality disorders. Younger hyperhidrosis patients, whose personality, psychological, and physiological development may not yet be fully matured. Palmar hyperhidrosis exerts a profound impact on multiple dimensions of younger patients’ lives, surpassing their psychological resilience and significantly increasing the risk of mental health disorders. Therefore, younger patients require more detailed attention and care during the course of treatment. No significant differences were observed between the two groups in terms of BMI, age of hyperhidrosis onset, age at which hyperhidrosis symptoms began affecting daily life, or the type of surgical procedure selected.

Regarding postoperative satisfaction, our study revealed a gradual decline in overall satisfaction among PPH patients over time. From the personality perspective, we analyzed postoperative satisfaction in patients with PDQ-4 scores above and below 30 and found a significant decline in satisfaction among those with scores above 30. Those with both conditions tend to experience a greater decline in postoperative satisfaction. This suggests a potential correlation between high or low scores on the personality scale and corresponding levels of postoperative satisfaction. This may be associated with patients’ psychological factors, such as expectations, perceptions of surgical outcomes, and changes in quality of life. In general, the interplay between hyperhidrosis and personality disorders significantly affects the lives of PPH patients. PPH patients already carry a considerable psychological burden, and the coexistence of a personality disorder further exacerbates this strain. This combined adversity may not only heighten patients’ aversion to treatment and diminish satisfaction levels, but also create a gap between the heightened expectations of patients with personality disorders and attainable treatment outcomes, further influencing their perception of therapeutic efficacy. However, individuals with personality disorders may find it difficult to maintain a stable commitment to treatment and sustain a constructive attitude due to pronounced emotional instability or impatience. This, in turn, disrupts the smooth progression of the treatment regimen and ultimately undermines both treatment success and patient satisfaction. Consequently, it is essential to carefully consider patients’ mental and emotional states during treatment and implement comprehensive intervention strategies [7]. These strategies should aim to alleviate physical symptoms while simultaneously addressing and improving psychological well-being, thereby enhancing treatment outcomes and improving patients'quality of life.

Our systematic literature review has identified a gap in the research concerning the personality traits associated with PPH patients. Although some studies mentioned the potential influence of PPH on patients'personalities, this relationship has yet to be comprehensively explored. The physiological and psychological impacts of palmar hyperhidrosis on patients'daily lives, work, and social interactions are multifaceted and extensively. Gross KM et al. found that patients with hyperhidrosis are more probable to experience depressive symptoms compared to a control group with normal sweating patterns. These depressive symptoms stem from feelings of embarrassment and lack of self-confidence [25]. This highlights the significant impact hyperhidrosis can have on social and professional activities, as well as causing considerable emotional distress. Hasimoto EN et al. found that the quality of life in PPH patients is comparable to that in individuals with other chronic conditions, such as psoriasis, eczema, renal failure, and rheumatoid arthritis [26]. An analysis of the Skindex-16 dermatology-specific quality of life instrument, conducted by Kristensen et al., showed that the adverse effects of hyperhidrosis on patients'daily lives surpass those of other chronic skin conditions, including psoriasis, eczema, and acne [27]. These findings highlight the significant impact of hyperhidrosis on patients, comparable to that of severe chronic skin diseases. However, it is often underrecognized and overlooked due to its less overt presentation. A survey of 1958 patients, conducted by Glaser et al. found that a significant proportion (48.9%) sought treatment only after a decade or more since the onset of hyperhidrosis [28]. Another study found that 51% of hyperhidrosis patients had discussed their symptom with healthcare providers, but 60% were unaware it was a medical condition, and 47% believed it to be incurable [11]. Furthermore, Heiskanen et al. found that 36.8% of patients experienced a diagnostic delay of more than 10 years [29]. Initially, many individuals attempt to adapt by altering their lifestyle or addressing the issue independently. However, as the effects of hyperhidrosis on their daily lives worsen over time, changes in both their physical and mental well-being become evident. Only then do they seek medical assistance. Multiple studies have shown that treatment for hyperhidrosis can effectively reduce sweating and alleviate psychosocial symptoms. Additionally, sympathectomy has been shown to enhance patients'social self-esteem. de Campos et al. found improvements in the quality of life and emotional well-being of patients undergoing hyperhidrosis treatment [30]. These findings suggest that managing palmar hyperhidrosis not only alleviates local symptoms, but also reduces the psychological burden on patients, thereby improving their overall quality of life.

Previous studies have confirmed that hyperhidrosis is a profoundly impactful and distressing condition. It significantly affects various aspects of patients'lives, with mental and psychological repercussions being particularly significant. Our study confirms the high prevalence of personality disorders among patients with palmar hyperhidrosis. However, the current exploration of the psychosocial and personality dimensions of palmar hyperhidrosis remains under-researched. This is primarily due to an inadequate understanding of the psychological and personality implications of the disease among both healthcare providers and patients. Consequently, it is essential not only to raise healthcare providers’ awareness of the psychosocial and personality aspects of hyperhidrosis, but also to prioritize patient education through scientific communication, considering it a crucial factor in achieving successful treatment outcomes.

Strengths and limitations

The strengths of the study were as follows: firstly, this study included a sufficient number of PPH patients, which enhances the representativeness and statistical significance of the research results. Secondly, this study collected extensive and comprehensive data, aiding in a thorough understanding of the actual situations of PPH patients.

The limitations of the study were as follows: firstly, as an observational study, it is susceptible to information bias, and the control of all potential confounding factors was not feasible, which constrains the ability to draw definitive causal conclusions. Secondly, the single-center nature of our investigation limits the generalizability of the results; therefore, future studies should employ a multi-center design to validate our findings. Thirdly, missing data. This data absence may arise from multiple sources, including but not limited to incomplete recording, data entry errors, or loss to follow-up of study subjects. These missing data have had a non-negligible impact on our research findings, potentially introducing bias into our conclusions. This has made us realize the necessity for implementing more rigorous and holistic strategies in future research endeavors to mitigate data loss.

Conclusions

Patients with PPH exhibit a relatively high prevalence of personality disorders. Understanding these associations can facilitate the provision of more comprehensive and individualized psycho-spiritual support to PPH patients.