Welcome

Lisa J. PierettiExecutive Director

International Hyperhidrosis Society

The Know Sweat! Campaign

• To raise awareness of devastating condition• To encourage people who sweat excessively to visit a

dermatologist • To let people know that they are not alone!• Consists of public relations efforts and physician education• Also, partnership with college health programs (e.g., University of

Miami, University of Texas, American University)

An Introduction to Hyperhidrosis

David M. Pariser, M.D.

President, International Hyperhidrosis SocietySecretary/Treasurer, American Academy of Dermatology

Senior Physician, Pariser Dermatology Associates

What is Hyperhidrosis?

• A physiological, medical condition characterized by excessive or unexpected sweating– Sweat exceeds normal amount

required to maintain consistent body temperature

– Patients often produce up to four times the average volume of sweat

– Occurs regardless of environmental surroundings

What Causes Hyperhidrosis?

• Exact mechanism unknown• Overproduction of neurotransmitter in sympathetic nervous

system OR• Sweat glands overreact to normal levels of

neurotransmitter

How Prevalent is Hyperhidrosis?

• Nearly 8 million people in the U.S. have hyperhidrosis• Over 28 million people in the world• Three percent of global population suffers• Compared to 4.5 million adults in the US have psoriasis

Barriers to Diagnosis• Widespread lack of awareness

– More than half of people who sweat excessively never diagnosed or treated

• Medical community inadequately informed, condition is often misdiagnosed

• Sufferers think nothing can be done – Think their sweating is normal– Can’t imagine there is treatment for sweating beyond

regular deodorant– Often too embarrassed to talk about it

How to Know if Sweating is “Normal” or Excessive

• There are questions people can ask themselves to determine whether they sweat too much, e.g.:– How much time per day spent dealing with sweat?– Do you carry “supplies” to help manage your sweat?– How many times per day do you change clothes?– Do you ever change your social plans due to excessive sweating

or fear of it?– Does sweating in public cause distress?– Have you lost friends or a job due to excessive sweating?

Primary Focal Hyperhidrosis

• Excessive sweating not caused by another medical condition or medication

• Occurs symmetrically on armpits, hands, feet, or face• Often begins in childhood or adolescence• Does not occur while sleeping• May be inherited

Secondary Generalized Hyperhidrosis

• Can occur over large areas of the body• May be a symptom of other medical conditions or as a side

effect of some medications– Anxiety disorders, cancer, diabetes, thyroid malfunction, menopause,

TB

• Important to see a doctor as soon as possible to find underlying condition

• Occurs even while sleeping

Lifestyle Implications

• Huge psychological and emotional impact can be devastating to sufferer

• Makes simple daily activities challenging• Impacts relationships, career choices, mental well-being,

self-image• Can lead to social isolation, anxiety disorders, depression

Treatment Options

• Existing treatment options can be highly effective– Antiperspirants– Iontophoresis– Botox® injections– Oral medications– Surgery

Reimbursement

• Not understood as legitimate medical condition by some insurance companies

• Quality of Life impact message not heard• Lobbying & education efforts ongoing

Know Sweat! Survey Results

David M. Pariser, M.D.

President, International Hyperhidrosis SocietySecretary/Treasurer, American Academy of Dermatology

Senior Physician, Pariser Dermatology Associates

Harris Interactive Survey

• Surveyed over 1,000 Americans in general population• Objectives:

– Determine people’s “sweatiest” moments– Determine people’s attitudes towards sweat and people who

sweat excessively– Determine level of general awareness about hyperhidrosis and

treatment options

International Hyperhidrosis Society Patient Survey

• Survey sent to IHHS patient database; over 750 responded• Objectives:

– To highlight differences in attitudes towards sweating between hyperhidrosis patients and those in general population

– To compare levels of awareness of hyperhidrosis and treatment options

America’s “Sweatiest” Moments• Sweatiest moments are job related – 63 percent of people

said on-the-job issues make them sweat (Harris survey):– Running late (32 percent)– Making a presentation (26 percent)– Going on a job interview (21 percent)– Asking for a raise or promotion (nine percent)– Preparing to resign (six percent)– Opening an acceptance or rejection letter (two percent)

Excessive Sweating

• Twelve percent of Harris respondents said they sweat all the time…

• Yet 83 percent of them had not seen a doctor about their sweating, citing common reasons:– I don’t think I have a problem (57 percent)– I don’t think anything can be done about it (28 percent)– I haven’t had the time (14 percent)– I am too embarrassed (two percent)

Others’ Perceptions Matter

• A full 88 percent of IHHS patients have experienced a negative reaction from others towards their sweating, versus nine percent of Harris respondents

• Harris population’s impressions of someone sweating are mixed:– Nervous (66 percent)– Overweight/Out-of-Shape (49 percent)– Hard-working (42 percent)– Excited (29 percent)– Sick or unhealthy (25 percent)

Coping with Sweating• People who sweat excessively cope with it in different ways:

– Wear or avoid certain clothing (74 percent)– Avoid certain situations (47 percent)– Keep a towel accessible (37 percent)– Hold tissue in hands to avoid sweat (44 percent)

• 97 percent of people do something to reduce or prevent their sweating, versus 86 percent of Harris respondents

What Do Results Tell Us?• Hyperhidrosis may be more prevalent than we think, but

people are not seeing their doctor about it• People who DO go to doctors may not be getting diagnosed

appropriately• Excessive sweating is a burden that can result in ridicule

and embarrassment• There is a huge need to raise awareness of this

condition among the general population and the medical community!

What Can We Do?

• Create community and support for people who are suffering and let them know that they are not alone and that treatment options exist

• Educate physicians about how to appropriately diagnose and treat excessive sweating

• Raise public awareness of hyperhidrosis (88 percent of Harris respondents had never even heard of the term) so that people know – that it is a true medical condition and– that can be treated

Hyperhidrosis and Ethnic Considerations

Flor Mayoral, M.D.Department of Dermatology and Cutaneous Surgery

University of Miami

Differences Between Ethnic Groups

• Income gap• Attitudes towards healthcare• Minority stereotypes

Race/gender Earnings Wage ratio White men $41,211 100.0%Black men $32,241 78.2White women $31,169 75.6Black women $26,965 65.4Hispanic men $26,083 63.3Hispanic women $22,363 54.3

All men $40,668All women $30,724 

Wage gap 75.5%NOTE: Includes full-time, year-round workers ages 15 and above. “White” and “Black” exclude those who reported more than one race category. “Hispanic” includes all those who so identified, regardless of race..

2003 Median Annual Earnings by Race and Sex

Income Gap

• Creates differences in treatment availability– May live in neighborhoods where information on healthcare may

not be available– Lack of information on hyperhidrosis in Spanish

• Creates differences in medical insurance coverage– Does equal insurance coverage guarantee equal treatment?

Attitudes Towards Healthcare

• Attitudes are barrier to getting appropriate treatment– Less likely to see a doctor because of lack of information– More likely to think that hyperhidrosis may be a “normal”

condition in them– More likely to be isolated within their own community– Less likely to discuss something as embarrassing as excessive

sweating with their doctor

Minority Stereotyping

• Ethnic stereotyping further affects an individual with hyperhidrosis

• Negative minority stereotypes can be reinforced with negative attitudes towards sweaty people

The Psychological Effects of Hyperhidrosis

Kathryn Connor, M.D.Research Director, Anxiety and Traumatic Stress Program

Department of Psychiatry and Behavioral SciencesDuke University

Quality of Life Issues

• Daily activities impacted, e.g.– Worrying about clothes (bringing several sets to work, wearing

dark clothes only– School/work papers ruined– Sports and recreation choices are severely limited

• Sufferers are constantly adjusting behavior to account for sweating, all day, every day

Quality of Life Issues

• Constant fear of embarrassment– Avoiding certain situations– Fear of raising arms– Fear of touching others (shaking hands, hugging, being intimate)– Fear of what people will think—shutting down

• Can lead to extreme self-image problems

Social/Psychological Issues

• Excessive sweating can lead to more serious issues such as:– Social isolation

• Sufferers feel different/isolated from family and friends, which leads to damaged relationships

• Since they are ashamed to talk about their sweating, loved ones don’t know and can’t understand

– Social anxiety• Sometimes it can be too much to even leave the house

Social/Psychological Issues

– Paranoia• The extreme self-consciousness can be completely

debilitating• Self-image issues turn into total paranoia

– Depression• Can even lead to clinical depression, which has further

ramifications

Testimonial

Sophia Parente

Testimonial

Frances Rivers

Questions and Answers

International Hyperhidrosis Society

• A resource for people who sweat excessively but may not have found the support/information they need

• Physician education is a top priority• SweatSolutions – a monthly newsletter of hope, support and resources• www.SweatHelp.org

– Online support community– Physician Finder– Self assessment tool– Up-to-date treatment information– Insurance coverage tools

Thank you.