The KOBE study is a multicenter cross-sectional questionnaire survey in Japan that investigated factors associated with primary focal hyperhidrosis (PFH), a condition with excessive sweating in localized areas regardless of temperature or stress. The study included 3617 patients aged 5–64 years who visited 24 dermatology institutions from April to July 2024. The prevalence of PFH was 15.0% (544 of 3617 participants). Factors associated with a higher risk of PFH included axillary osmidrosis (OR=5.440), psoriasis (OR=1.830), moist earwax (OR=1.780), HADS-A anxiety score (OR=1.460 for questionable score), and smoking (OR=1.450). The optimal cut-off value for the suspicion of PFH was a HADS-A score of 6 according to ROC curve analysis. The findings may help identify untreated patients in clinical practice and support interventions to improve quality of life.