Welcome

2. Welcome Lisa J. Pieretti Executive Director International Hyperhidrosis Society

3. 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)

4. An Introduction to Hyperhidrosis David M. Pariser, M.D. President, International Hyperhidrosis Society Secretary/Treasurer, American Academy of Dermatology Senior Physician, Pariser Dermatology Associates

5. 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

6. What Causes Hyperhidrosis? • Exact mechanism unknown • Overproduction of neurotransmitter in sympathetic nervous system OR • Sweat glands overreact to normal levels of neurotransmitter

7. 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

8. 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

9. 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?

10. 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

11. 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

12. 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

13. Treatment Options • Existing treatment options can be highly effective • Antiperspirants • Iontophoresis • Botox® injections • Oral medications • Surgery

14. Reimbursement • Not understood as legitimate medical condition by some insurance companies • Quality of Life impact message not heard • Lobbying & education efforts ongoing

15. Know Sweat! Survey Results David M. Pariser, M.D. President, International Hyperhidrosis Society Secretary/Treasurer, American Academy of Dermatology Senior Physician, Pariser Dermatology Associates

16. 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

17. 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

18. 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)

19. 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)

20. 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)

21. 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

22. 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!

23. 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

24. Hyperhidrosis and Ethnic Considerations Flor Mayoral, M.D. Department of Dermatology and Cutaneous Surgery University of Miami

25. Differences Between Ethnic Groups • Income gap • Attitudes towards healthcare • Minority stereotypes

26. 2003 Median Annual Earnings by Race and Sex Race/gender Earnings Wage ratio White men $41,211 100.0% Black men $32,241 78.2 White women $31,169 75.6 Black women $26,965 65.4 Hispanic men $26,083 63.3 Hispanic women $22,363 54.3 All men $40,668 All 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..

27. 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?

28. 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

29. Minority Stereotyping • Ethnic stereotyping further affects an individual with hyperhidrosis • Negative minority stereotypes can be reinforced with negative attitudes towards sweaty people

30. The Psychological Effects of Hyperhidrosis Kathryn Connor, M.D. Research Director, Anxiety and Traumatic Stress Program Department of Psychiatry and Behavioral Sciences Duke University

31. 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

32. 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

33. 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

34. 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

35. Testimonial Sophia Parente

36. Testimonial Frances Rivers

37. Questions and Answers

38. 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

39. Thank you.