PracticalDermatology

Although hyperhidrosis is estimated to affect three percent of the population, the International Hyperhidrosis Society maintains that roughly half of those affected are not formally diagnosed. Whether or not they have received a diagnosis of hyperhidrosis, patients affected by excessive sweating have had few treatment options that offer lasting efficacy. This has been disappointing for both the patients and providers, as the effects of excessive sweating can be seen in social, professional, and other areas of life.

A novel treatment for hyperhidrosis, the miraDry System (Miramar Labs) delivers precisely controlled microwave energy non-invasively to sweat glands where accumulated energy results in thermolysis of the glands. The handpiece includes a continuous hydro-ceramic cooling system that protects the superficial dermis and keeps heat at the level of the sweat glands. Treatment results in permanent damage to sweat glands and long-term reduction in sweating.

When I heard about the miraDry technology at the American Society for Dermatologic Surgery Annual Meeting in November 2011, I thought it was a great option for people who suffer from hyperhidrosis. It offers a convenient and effective treatment for a relatively common patient concern. In studies reported by the company, patients reported an 82 percent reduction in sweat after a round of two treatments. Data show that damaged sweat glands do not regenerate, making microwave therapy a long-term solution to hyperhidrosis. We introduced the procedure into the practice in early 2012 and have seen good results and steadily increasing demand since then.

A Welcomed Option

Previously existing options for the treatment of hyperhidrosis include iontophoresis and botulinum toxin injections. Iontophoresis generally cannot be applied to the underarms, and results are typically short-term, requiring ongoing treatment for the patient. Botulinum toxin injections can be provided to the underarms as well as to the hands and feet, and they provide a reduction in sweating for up to several months. Effects are not permanent, however, and patients will inevitably require retreatment. Continuous treatments can become costly and potentially inconvenient. Before offering miraDry, botulinum toxin was the only treatment for axillary hyperhidrosis we offered in our practice.

Over the past year, we have been pleased with the consistency in treatment outcomes. Results achieved with the miraDry system for axillary hyperhidrosis have been what we expected. We inform patients that they will need two to three treatments to achieve optimal results. The majority of our patients have had marked sweat reduction after two treatments; only two or three patients have required a third treatment.

Patient response to treatment has been positive to date, with patients expressing satisfaction with the results of treatment. In fact, some patients have described treatment as “life-changing.”

Marketing Considerations

There tends to be a stigma associated with hyperhidrosis. Patients may be reluctant to discuss the problem, especially if they don’t know that treatment options exist. Therefore, marketing and patient education are important. At the same time, however, we have found that many patients with hyperhidrosis are researching the condition online and are aware of new treatment options; it’s important to market so that such patients are aware that you offer treatment.

We have promoted miraDry on our website, in our eand print newsletters, at our annual open house, and at seminars. For seminars, we typically incorporate discussion of hyperhidrosis and miraDry within presentations on other topics. Promoting a seminar solely for excessive sweating did not or will not attract people with this condition, due to the stigma associated with it. We are currently trying our first billboard advertisement.

With our current strategies in place, the volume of procedures has steadily increased since introduction. We are doing on average one procedure per day.

Practical Considerations

Beyond potential patient interest/demand and the evidence associated with miraDry, another attractive feature of the system is its compact size and portability. The machine can roll from room to room so we keep it in a storage room when we are not using it. The lone consumable is the sterile, disposable BioTip.

We have had very few logistical challenges in incorporating miraDry into our practice. The time it takes to do the procedure is very consistent from patient to patient so scheduling is easy.

From a practical standpoint, we have found it beneficial to have patients pay up-front for the two procedures. This way, the patient becomes mentally committed to undergoing treatment twice and therefore achieving optimal response. They don’t have unrealistic expectations, expecting resolution of sweating from a single treatment.

A Novel Approach to a Widespread Need

The population of patients dealing with excessive sweating may be large and underserved. While hyperhidrosis is a medical condition, it’s important to note that excessive sweating can negatively influence an individual’s quality of life with social, professional, and aesthetic ramifications. Certainly miraDry fits well into a general dermatology practice because we frequently see hyperhidrosis patients. At the same time, cosmetic practices are used to using technology like lasers and other energy-using devices, so this procedure also fits well in an aesthetic practice.

Suzanne Bruce, MD founded her practice in Houston in 1997. She is a former Vice President of the Texas Dermatological Society and a former President of the Houston Dermatological Society.