{"doi":"10.1111/ijd.17490","title":"A case–control study of bacterial, fungal, and viral skin infections in 9,143 adults with hyperhidrosis","abstract":"Hyperhidrosis (HH) is characterized by excessive sweating beyond regulating body temperature, affecting ~5% of the US population.1, 2 HH significantly impacts quality of life, causing physical discomfort and emotional distress. Persistent moisture and skin breakdown are hypothesized to promote bacterial and fungal invasion and growth,3 thereby driving skin infection. However, the association of infection and HH across diverse racial and ethnic groups is poorly characterized. Therefore, we aimed to investigate infection risks in generalized hyperhidrosis (GHH, excessive sweating of the entire body typically secondary to an underlying condition) and primary focal hyperhidrosis (PHH, excessive sweating localized to specific areas, and idiopathic) using a national sample. We conducted a nested case–control study using the All of Us v7 database (~45% racial/ethnic minority patients). Adult cases of GHH and PHH were identified using Systematized Nomenclature of Medicine codes 274673004 and 427794001, respectively. Cases were selectively matched to four controls using nearest-neighbor propensity scores based on gender, age, and race/ethnicity. Patient characteristics were compared using Fisher's exact test (categorical) and unpaired t-test (continuous). Associations between HH and infection types were tested by univariable and multivariable logistic regression, with significance P < 0.05. A total of 8,210 GHH and 933 PHH cases were identified, with mean ages 59.4 years (standard deviation [SD] 15.7 years) and 49.9 years (16.2 years), with Black/Hispanic patients comprising 27.4 and 27.7%, and females 62.8 and 70.9%, respectively. Type 2 diabetes, HIV infection, tuberculosis, chronic kidney disease, and alcohol use disorder, which are associated with immune dysregulation, were more prevalent in the GHH cohort (Table 1). The most common infection types in subjects with both HH types were cellulitis, dermatophytosis, and verruca vulgaris. Unadjusted analysis showed that GHH and PHH patients had increased odds of impetigo, verruca vulgaris, verruca plantaris, cutaneous herpes simplex virus, mucocutaneous candidiasis, cutaneous abscess, dermatophytosis, bacterial folliculitis, and cellulitis compared with matched controls (P < 0.001) (Table 2). Patients with GHH had the greatest odds of developing mucocutaneous candidiasis (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 2.40–3.79), while patients with PHH had the greatest odds of developing verruca plantaris (OR: 6.69, 95% CI: 4.30–10.56) compared to controls. All associations remained significant after adjusting for demographics and comorbidities. In a race/ethnicity sub-analysis, White, Black, and Hispanic patients had increased infection risks in the GHH cohort (OR range: 2.59–2.86), and Hispanics had greater skin infection risk in the PHH cohort (OR: 7.38; 95% CI: 4.2–13.0) (Table 2). We observed that GHH and PHH correlated with increased odds of a broad range of infections, consistent with a study of Danish blood donors (2010–2019) reporting that HH correlated with increased antibiotic and topical antifungal use (respectively, adjusted hazard ratio = 1.33, 95% CI: 1.03–1.68, P = 0.028; adjusted hazard ratio = 1.43, 95% CI: 1.04–1.97, P = 0.027) (N = 437).4 Similarly, a retrospective case–control study of 387 PHH patients (1993–2005) found a significant risk of contracting a bacterial (OR: 2.6; 95% CI: 1.2–5.7), fungal (OR: 5.0; 95% CI 2.6–9.8), or viral skin infection (OR: 1.9; 95% CI: 1.2–3.0).5 These findings suggest that proactive and effective management of HH, generalized or focal, may reduce secondary skin infection risks and subsequently associated healthcare utilization and costs. Limitations include potential inaccuracies and inconsistencies in assigned procedural codes and missing information. We were also unable to interpret causality, and temporality was not established. Hygiene and the anatomic region affected could not be assessed. Although our multivariable model","journal":"International Journal of Dermatology","year":2024,"id":504602,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9649,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1085192,"name":"Zaim Haq","orcid":null,"position":1,"is_corresponding":false},{"id":1084604,"name":"Parsa Abdi","orcid":"0000-0001-8724-3969","position":2,"is_corresponding":false},{"id":1355456,"name":"Jasmine Tran","orcid":null,"position":3,"is_corresponding":false},{"id":1180157,"name":"Dang Nguyen","orcid":"0000-0002-9622-8370","position":4,"is_corresponding":false},{"id":1355033,"name":"Kiran Motaparthi","orcid":"0000-0003-0562-0826","position":5,"is_corresponding":false},{"id":979996,"name":"Shari R. Lipner","orcid":"0000-0001-5913-9304","position":6,"is_corresponding":false},{"id":425695,"name":"Michael J. Diaz","orcid":"0000-0003-2291-8122","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T02:10:39.578471Z","pmid":"39392397","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}