Unmet Needs in Hyperhidrosis

Dee Anna Glaser, MD: What are the unmet needs that we’re facing? Can you speak to this? What are some of the challenges that we need to address at this point?

Adam Friedman, MD, FAAD: I think first and foremost are misperceptions. We have numbers in terms of how many people this affects in the United States and worldwide. I would argue those are probably undershooting it, because many people don’t recognize it. And what’s so tough here is this disease is just an increase in physiologic behavior. We need to sweat. It is part of our natural air conditioning system. Where do you draw the line, when it’s too much and it’s not appropriate? We, as physicians, can figure that out. The consumer cannot.

It’s really about dispelling a lot of misperceptions that not only prevent people from seeking care but also ostracize them. This is not their fault. It’s not because they’re unhealthy. It’s not because they drink. It’s not because they smoke. From an early age, safety is huge, but even just development and developing social interactions, holding hands, that touch, is very important to developing relationships later on in life. So, I think dispelling a lot of the myths related to hyperhidrosis, that is a huge unmet need. I think we certainly need more therapies. There are some coming out, but looking across the spectrum of dermatology, we need more options, affordable and safe options. We’re getting them, but it does take some time to get them as well.

And then, we also need to coordinate better with our partners across the aisle in other specialties of medicine. While we can take care of it, there are more of them than there are of us. In the recent paper looking at the burden of skin disease, one of the conclusions was that we need 20,000 more dermatologists right now to address the number of skin diseases. That’s not going to happen. It’s not feasible. We need to rely on other physicians to help manage our patients. And so, we need to educate them, first and foremost.

Dee Anna Glaser, MD: Yes, I agree. And for you?

Adelaide Hebert, MD: I think that we need to make sure that our patients feel comfortable coming in. I think we really will have to work with the dermatologists that we have to embrace caring for this. For patients with excessive sweating, perhaps this isn’t at the top of the list of the patients who come in that we manage. In my hyperhidrosis clinic, the adult patients cry, and not just the pediatric patients, because it’s so emotional. They finally find someone with an interest. It’s really overwhelming to them. But my hope is that with the education, and with new opportunities for therapeutic intervention, our dermatology colleagues and our colleagues across the house of medicine will embrace a willingness to really care for these patients. They will not have a more grateful population than this population when we successfully intercede and make them better. Give them their life back. That’s really what happens.

Dee Anna Glaser, MD: Yes, I agree. For me, it’s frustrating. I’ll be treating somebody and they’ll go see their family practitioner or their internist. That doctor will say, “You don’t need to do all of that. You’re not going to die from this.” They’re getting these mixed messages, which I think is really the worst. Almost no message would be better than these mixed messages, and it’s very hard to overcome. Personally, I send a letter to every physician or provider who is seeing the patient that I’m taking care of, trying to help educate them on what we’re doing and why we’re doing it. Adam, you really touched on something important—making our lives a little bit easier and making our time more efficient with the patient.

We have high-volume practices. We’re trying to get through the patients and take care of them. In our office, when a new patient calls to make their first appointment to see us for hyperhidrosis, we actually give them the website and ask that they go and look at it prior to coming into the office. They’ve heard of the word “iontophoresis.” They’ve heard the word “anticholinergic.” They know what these are. And what we’ve also asked, which patients are not always quite as good at doing, is that they call up their insurance company and find out if hyperhidrosis is excluded or not excluded from their plan. That gives us a ground framework that we can start from. If it’s excluded, we start to think of some different paths: trying to prescribe botulinum toxin every 6 months, with the cost that it has versus microwave thermolysis.

This has been very helpful for us, but it really is a challenge, and it has been a challenge in educating the payer side, the insurance plans, that this really does have an impact. I know they have their constraints. They’re not really looking at the years ahead, the next 50 years of the kid who never raised their hand in class and how that impacts their ability to serve society. I understand that, but I do think that programs like this are so important to educate the insurance companies, the payers, and the stakeholders at all levels.

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