Improving Hyperhidrosis Treatment: The Role of IHhS

David M. Pariser, MD, FACP, FAAD

In recognition of November’s Hyperhidrosis Awareness Month, David M. Pariser, MD, FACP, FAAD, met with Dermatology Times to discuss the undertreatment of hyperhidrosis as well as the misconceptions commonly associated with the disease. He also shared the vast array of advanced research and treatment options for patients. Pariser is one of the founders of the International Hyperhidrosis Society (IHhS), which brings further awareness to the condition’s impact on clinical practice and works to improve patients’ quality of life.

Pariser is also a professor with the Department of Dermatology at Eastern Virginia Medical School in Norfolk, Virginia, and senior physician with Pariser Dermatology Specialists, Ltd. Additionally, he serves as president and principal investigator for Virginia Clinical Research, Inc., and is a former president of the American Academy of Dermatology as well as the American Dermatological Association.

Dermatology Times: What do you think dermatology clinicians should know about hyperhidrosis?

David M. Pariser, MD, FACP, FAAD: This is an impactful medical condition that is still often under-diagnosed and under-treated. Approximately 4.8% of the population has hyperhidrosis—that’s more than 16 million people in the US alone.

Yet, many patients continue to be hesitant to discuss it because there can be a level of embarrassment and shame and perhaps a history of having their concerns diminished.

Many people also do not realize the number of treatment options that are now available. But there are so many ways dermatology clinicians can now help improve hyperhidrosis patients’ quality of life. We have so many treatment options to offer as well as a nuanced understanding of the benefits of combinations of treatments.

Dermatology Times: What’s new in hyperhidrosis research and treatment?

David M. Pariser, MD, FACP, FAAD: There have been a few exciting additions to our treatment arsenal recently. Sofpironium (Sofdra, Botanix Pharmaceuticals) is a new prescription topical anticholinergic. It was FDA-approved this summer (2024) to treat primary axillary hyperhidrosis in adults and children 9 years of age and older. Using a special applicator, sofpironium should be applied to the underarms once per day before bed.

In April 2023, Brella SweatControl Patch from Candesant Biomedical was cleared by the FDA as a medical device for the treatment of underarm hyperhidrosis in patients 18 years and older. Brella is a patch applied to the underarms by a healthcare provider for approximately 3 minutes per underarm. When the patch is applied, there’s an interaction between the water in sweat and the sodium in the patch to generate a targeted amount of heat, causing microthermal injury to the sweat glands that inactivates those glands and decreases sweat production for about 3-4 months.

Glycopyrronium (Qbrexza, Journey Medical Corporation)is another relatively new treatment for axillary hyperhidrosis. It is a topical anticholinergic applied to the underarms as a wipe or cloth once per day. It is FDA-approved for patients 9 years and older.

There’s also miraDry, which is a handheld medical device utilized by a clinician in their office. With the device’s microwave technology, sweat glands are inactivated through thermolysis and these effects are permanent (Bonus: Odor-producing glands and underarm hair are also permanently eliminated.)

Of course, each of these treatments is FDA-approved (or cleared) for the underarms only. And we know that hyperhidrosis can also impact patients severely on the hands, feet, scalp, face, and in the groin and many combinations of these focal areas (as well as other localized areas - like on the back). So, botulinum toxin injections, iontophoresis, antiperspirants, systemic medications, combinations of treatments, and off-label use of treatments all continue to play critical roles in helping us to treat our patients.

We are hopeful to have data in the future about potential off-label uses of current treatments for non-underarm areas. And there’s hope for improvements to our oral medication options to limit side effects, such as dry mouth and dry eyes.

A very interesting area of study is also how to help amputees who often deal with extreme sweating at the site of their prosthesis - to a degree that limits their ability to use their prosthetic limb and of course that limits functionality and has ripple effects throughout their lives.

Dermatology Times: What special challenges does this condition present to clinicians?

David M. Pariser, MD, FACP, FAAD: Hyperhidrosis is a nuanced condition that impacts patients and their families in many different ways and often very severely. Those effects depend on the focal areas (and often combination of focal areas) involved, the age and occupation of the patient, and the degree of sweating. Risks for depression and anxiety are both higher among those with hyperhidrosis. Patients often change their lives, their clothing choices, their habits, their recreation and social pursuits, their career aspirations, and so much more because they need to cope with their sweating and the embarrassment and extreme discomfort of it. Patients may have been struggling with this condition for years and years before I see them. They may have felt that their condition is their fault, or that it’s not a real medical problem, or that there is nothing to be done. As with so many dermatological conditions, skin health, self-image, and emotional wellness can be very much intertwined so caring for the whole person is very important.

Thankfully, as a clinician, there is so much room for us to help and make a truly remarkable difference in a person’s life. And that is exciting. But there is no one treatment for hyperhidrosis that is right for every patient. Often combinations of treatments provide the most efficacy, and sometimes there is some trial and error and adjustments involved and that’s to be expected.

Dermatology Times: What inspired you to get involved with IHhS?

David M. Pariser, MD, FACP, FAAD: I have patients with hyperhidrosis who have tried everything. They have tried hypnosis. They have tried acupuncture. They have tried to restrict their diets, their fluid intake. They are so desperate to get relief from their disease. These are remarkable patients, and you can remarkably change their lives with good, effective treatment.

One of the reasons I helped found the International Hyperhidrosis Society is because dermatologists can improve the quality of life of patients with hyperhidrosis often more than they can improve quality of life of patients with nearly any other problem, including severe psoriasis, eczema, and acne. Research has shown that hyperhidrosis is the No. 1 dermatological disease in terms of negatively affecting a person's quality of life and is also No. 1 in having the most dramatically positive impact when treated. But I’m just one clinician. To really have an impact, I wanted to help not only my patients but patients all over the world. Raising awareness and knowledge-sharing through IHhS has helped me to do that.

IHhS was founded in 2003 by a team of physician experts in hyperhidrosis research. Since that time, the International Hyperhidrosis Society remains the only independent, nonprofit, global organization working to improve the quality of life for those affected by the disease via advocacy, support, and information-sharing.

Our mission is to reduce the symptoms, anxiety, and social stigma associated with hyperhidrosis. As part of our mission, we promote research, educate healthcare professionals in optimal diagnosis and management, raise awareness about the condition's emotional, economic, and life impacts, and advocate for improved patient access to effective treatments.

A big part of our campaign to increase awareness is Hyperhidrosis Awareness Month in November. As part of this initiative, we educate the public as well as clinicians about the importance of recognizing and treating excessive sweating. 

Dermatology Times: How does the organization support dermatology clinicians?

David M. Pariser, MD, FACP, FAAD: The International Hyperhidrosis Society has so much to offer dermatology clinicians in terms of up-to-date, comprehensive content, practice tools, and information to ensure clinicians feel empowered to leverage the latest and best practices in hyperhidrosis care. The website is so rich with content, and the last estimate I heard was that our site has more than 900 pages of information. I actually request that all of my hyperhidrosis patients spend some time on the website prior to our initial appointment.

IHhS resources can also be found through other organizations. This year, we began a collaboration with the World Health Organization (WHO) wherein 2 of our continuing education courses were made available for global access at no cost through the OpenWHO platform. Eastern Virginia Medical School’s continuing education portal hosts these courses as well.