How To Treat Excessive Sweating: In Conversation with Dr. Raj Singh, MD
Hyperhidrosis Interview with Dr. Raj Singh, MD
"In the past, I was not very comfortable with iontophoresis because the devices were clunky, bulky with huge trays, and not very reliable. But with improvements in technology, iontophoresis devices, like Dermadry—they're so compact and so easy to manage. So, I think it's a very good option for treatment of hyperhidrosis. You can do it at home, it's way more affordable, and provides really amazing results. If compliance is good, actually sometimes a hundred percent of hyperhidrosis symptoms go away."
We spoke with Dr. Raj Singh MD, FACP, FASN, about his experience with hyperhidrosis, and his thoughts on iontophoresis as a treatment for excessive sweating!
Watch our full Dermadry Segments interview on the Dermadry YouTube channel below!
Amanda: Hi, everyone, welcome to Dermadry Segments. I'm Amanda and we have Raj Singh with us today. Say hi to everyone and thank you very much, Dr. Raj for having us today, we're really happy that you're on board.
Dr. Raj Singh: Thank you so much for having me on the segment, Amanda.
Amanda: You're very welcome. So now the viewers and I would love to know a little bit of what you do, if you could explain it to us a bit about hyperhidrosis, so we're gonna go through a series of questions. The first one is, tell us a little bit about yourself in the field of work.
Dr Raj Singh: So you already kind of covered my name, it’s Dr. Raj Singh. People always ask me, is that your real name because it's a little shorter for like most Indians, but it is, so medicine physician, but I've also specialized in w as well.
I like to travel all over the US. Teaching is my passion, so I speak at a lot of medical conferences. I'm also assistant professor at the local university. I got involved in a little bit of social media and recently got the YouTube bug. So I've been working on promoting my YouTube channel also a little bit.
So I've been in practice for about 12 plus years now.
Amanda: Wow. And how did you first become interested in this field of medicine?
Dr Raj Singh: So I wish I had a more interesting or motivational story like a lot of doctors do. I don't, I was, I always wanted to be a mechanical engineer. However, my sister was in dental school and my dad told me you're going to med school.
So pack my bags, and at age 17, I went to med school in India. Of course, later moved to the United States, went for a residency in internal medicine. And later on a nephrology fellowship at University of Kansas. So that being said, I'm a relatively young guy at age 41, and although I wanted to be a mechanical engineer, I love what I do every single day and the pleasure it brings, of course, taking care of our patients. But I always wish I had a very inspiring motivational story, but I don't.
Amanda: Well, that's still a wonderful story. So there's plenty of viewers, asking about hyperhidrosis and now speaking, especially that you are in Las Vegas, what was your first experience dealing with hyperhidrosis patients in your area?
Dr Raj Singh: So when we started our practice, uh, initially a few years back, we were like seeing maybe one to two patients per month.
But as the word is spreading, we're more having more patients come in. That being said, my first experience, I remember this, there was this very young girl, probably like 20 years old, she was very uncomfortable having this conversation with me and would not make eye contact, always kept looking down at the floor.
So it took a while for her to kind of get comfortable and actually start addressing some of the issues. So she was very embarrassed about the https://www.sweathelp.org/home/understanding-hyperhidrosis.html. She also had some issues with some body odor. So that was sort of my first experience. And I realized that, you know, how uncomfortable it can be for patients to kind of come to our medical office and actually discuss this because they feel like it is, it's such a taboo topic, although it is a medical disease.
I think we are such a judgmental society, that the pressure to look perfect and be perfect. It makes it equally hard. So that was my first experience that kind of left a mark on me about how distressed these patients are when they suffer from it.
Amanda: And that's something that we're also dealing with and the ones that come to us sometimes we get to have that open conversation with them and they're very kind of unsure if they're comfortable with speaking about it, and then we're saying, listen, this is a safe space. And we're happy that slowly but surely there's more advocacy coming in. So we're really excited to hear that people are open to speak about it.
And when it comes to now age groups, do you find that there is a specific age group that has more hyperhidrosis, if you want to say, versus for example, teens and adults, and does hormones come into play?
Dr Raj Singh: So we are an internal medicine practice. We only deal with clients that are 18 and older, so I don't have any experience in the pediatric side of things.
Most of our clients are young females, typically the age group of about 20 to 28, although the condition is equally common in men and women. But we see more females as our clients because women are more likely to seek care than men. And I think part of that is because I think it's more acceptable to be a male and sweaty than it is for a woman. So there is a little bit of gender bias there. So a lot of my clients are women and they're in their late twenties.
Amanda: When it comes to the outgrowing of hyperhidrosis, do you think that they might outgrow it when they're in their young adult years?
Dr Raj Singh: Unfortunately not. Once you are diagnosed with hyperhidrosis, it is a genetic disease, it has a familial component. So once you have it, unfortunately, it stays with you for the rest of your life. That being said, once we identify it and as time goes by, our clients become more comfortable in managing that hyperhidrosis. So it's much more distressing when you're young, because you don't really know what to do with this, but as you learn more about it, as you educate yourself, educate those around you, I think it becomes easier to handle and easier to manage as we become older. But yes, the disease does stay with us till we die.
Amanda: And now do you find that there's a difference when it comes to which area that they're suffering from hyperhidrosis?
Dr Raj Singh: If we're talking about primary focal hyperhidrosis, most of the symptoms initially would be on the palms under the arms, so axilla, and also the soles.
So that's the most common presenting symptoms. Most of the clients, initially, at least in their childhood, they tend to have more palmar hyperhidrosis than any other area. There are rare varieties, you know, some craniofacial hyperhidrosis is also where we sweat on the face and on the scalp. But the most common presentations tend to be in the palms, the soles and the armpits.
Amanda: And now we know that there's multiple different treatments when it comes to hyperhidrosis. So what are your thoughts on tap water iontophoresis, like Dermadry, as a treatment option for hyperhidrosis?
Dr Raj Singh: So tap water iontophoresis works well. Now, this is not a new treatment. I mean, it has been around since the fifties. So that being said in the past, I was not very comfortable with iontophoresis because you know, the devices were kind of clunky, they were bulky with huge trays, and not very reliable. But with improvements in technology, iontophoresis devices, like Dermadry, they're so compact, so easy to manage. So I think it's a very good option for treatment of hyperhidrosis. You can do it at home, it's way more affordable, and provides really amazing results. If compliance is good, actually sometimes a hundred percent of symptoms go away for hyperhidrosis by maintaining a good regimen. So not everyone benefits from iontophoresis because you need to maintain a schedule and you need to be following the routine, so it's not for everyone. For those who use it properly, it can be very, very helpful.
Amanda: And as you were saying, and it has been around for years, and we know that there's so many clinical studies, are there any clinical studies that you're familiar with when it comes to iontophoresis? Just, that's a question that comes up a lot from the viewers.
Dr Raj Singh: Oh, yeah. I mean, like I said, the device has been around since the fifties, so there is a ton of clinical data and there's a lot of randomized, double controlled trials out. So those are the best studies we like to look at is a randomized control trial.
And I mean, there's new data coming out every single year. I look at so many different studies. The success rate for iontophoresis can be upwards of like 90%. And some studies actually show that it was up to 98 to actually a hundred percent effective. So it's a very good treatment and I highly recommend it to our clients. Like I said, not everyone is a candidate for iontophoresis because there are certain conditions we look at, but it works for a majority of people who suffer from primary focal hyperhidrosis.
Amanda: So the device itself is recommended and it is safe to use. However, when do you specifically recommend using iontophoresis treatment, like Dermadry, for example, to your patients?
Dr Raj SIngh: So, Dermadry tap water iontophoresis is effective for anywhere from mild to moderate, to severe hyperhidrosis, but they need to have primary focal hyperhidrosis. So there is general hyperhidrosis also, which is the body sweating all over, so it does not work for those.
Of course it will not work for someone who has craniofacial hyperhidrosis, because there's no electrodes that you can put on your face or the scalp. So for those, we use more topical treatment. For everyone else, this treatment works really, really, really well. And we, during our medical consultation, of course, we look at the symptoms when they got started, we look at what they do for work.
So I'm in Las Vegas. So I have some patients who are frequent travelers, so they're taking the flight from here to there, so they're traveling constantly. So for those days they say, I prefer that I come to you once every couple of months and just get the treatments in your office, that works better for my life schedule, but that's just a minority of our clients, majority of our clients, 90 percent or higher
They prefer to do the treatments at home because it doesn't take that much time. You could be watching TV and doing this. And it's also something to do in the privacy of my home, I think it's just much more comfortable and the results are really good. Again, following a regimen, following the instructions of how to use the tap water iontophoresis, I think is very important.
So I see a lot of people will actually use bottled water because it’s their own drinking, bottled water, so they think I can put that there. I tell them no, you cannot do that it needs minerals for this to work. So if you don't have access to tap water,, or you’re thinking “tap water is not good for my drinking, so how can I?”. So there’s an education part that still needs to go in there, but overall, I think it's a really good treatment. We recommend it highly during our medical consultation procedures.
Amanda: And that's actually a very great tip. I was speaking to someone from Hong Kong actually, and she was saying that the water was kind of, it wasn't working with no minerals in it, wasn't working at all. So he told her to maybe add a pinch of salt and the treatment started working perfectly fine. So it's good to give them also tips and tricks depending on where they are located.
Dr. Raj Singh: Absolutely. Yeah. I mean, if, if they're not using the device properly, they're not going to see results. And I think that's one of the common mistakes I see, is adding bottled water instead of adding the tap water.
Amanda: Thank you very much for that point and moving forward now, what should your patients expect when it comes to the treatment of iontophoresis?
Dr. Raj Singh: So like any other, any new treatment that we introduce into our life, it has a little bit of a learning curve. So first it does take a while to kind of get used to adding this to your regimen at home. So I would say like, you know, don't be distressed or stressed, but it's easy to do.
And once you follow the proper instructions now, initially there is a protocol that you have to follow a couple times two to three times a week. Depending again, on whether you have mild to moderate, to severe hyperhidrosis. Afterwards, the frequency of treatment goes down. But initially yes, you will have to do more frequent treatments to get the desired results.
That's my advice. So just stick with it all, like on a regular basis and you will see results and it's so much easier to add it to the schedule once you get comfortable using it. And it's such a small kit to actually, even if you're traveling occasionally, it's okay to just put it in a suit briefcase and just take it with you.
So it works really well. But, like I said, there is a little bit of learning curve and a lot of our clients, you know, like I said, they are young. So I was pretty stupid when I was in my twenties. And I didn't want to do any of those things. When we’re teenagers we're just less compliant, we have too many things going on. The compliance can be an issue, but if you follow it on a regular basis, yes, the side effects are minimal. There is a little learning curve. You feel like a little feather kind of touching the palms, but otherwise very comfortable treatment to do at home.
Amanda: Also, what's very important is that, like you said, there are little tingling sensations.
It's very important to note that everyone’s sensibility is different. So it's also very important to keep that in mind when doing the treatment. There was a question coming up from the viewers and they were asking, for example, if they're treating one area. Does that necessarily mean that they're going to be sweating from another area?
Dr Raj SIngh: No, it does not work like that. So there will not be increase in sweating in other areas just because we are blocking the release of sweat from these glands in the palms or the underarms. So there is no compensatory increase in sweating. So I think that's just a myth and that's not scientific based. So there will not be an increase in sweating anywhere else, just because you're using this.
Amanda: So another question comes up, they ask, how do I know if iontophoresis treatment is the right one for you? What are your thoughts on that?
Dr Raj Singh: So I think we determine that based on our consultation. So although it has a genetic component there are certain things that can make it worse. For example, you know, a lot of these patients can have anxiety or sometimes increased sympathetic tone.So we kind of look at, you know, their age group, what they do at home, how comfortable they are going to be managing something like this at their home. So that's all part of the consultation process and that determines, whether they are, but the majority of patients are good candidates for tap water iontophoresis for instance.
So I don't see any obvious contraindications unless you've got pacemakers and all those things, but those are not really common in the younger age group. I would say that everyone in my book is a candidate for iontophoresis, e'd recommend it.
But if they feel like they cannot follow this or they have some other issues, then yes, there are other alternative treatments also. But we generally do recommend this as one of the good options for that can be done at home.
Amanda: Now we know that Dermadry is not really prescribed, you don't really need it to be prescribed in other countries. However, in the United States, we do need a prescription. So we know that we do have Dermadry on your website and available at your clinic, so what is the procedure for someone that would be interested in buying a device through you?
Dr. Raj Singh: So like you mentioned, in the United States, you do require a prescription. It can be reimbursed by your insurance also to some extent, but we do require a consultation. The consultation can be virtual so we can do it over telemedicine or it can be at our office. And then a prescription is given and sent to the manufacturer. So if someone has to buy it from our website, they can do that, but before a device is sent to them, we have to do a consultation. And the parts being, one of the reasons behind acquiring a prescription is we want to make sure that they are good candidates for iontophoresis, and that it is going to work for them.
And it is going to match their expectations. And so a lot of education sort of goes into this as well. So that's why I think it is important that they set up consultation. It can be partial or it can be in our office. And then once we feel that they are a good candidate for this, we can send them a prescription.
They're going to do that, buy a device from our website or from any of the places to acquire it. But a consultation is required in the United States.
Amanda: Thank you very much for that. What do you wish the public understood more about iontophoresis treatment, such as Dermadry, as a treatment option for hyperhidrosis?
So I think education is the key. The most important part, I think initially, is educating the public about actually hyperhidrosis, that it is a medical condition and removing some of the taboo and things around hyperhidrosis. So once they understand once we educate the public about hyperhidrosis and the treatment options, I think a public education campaign that says “Hey, hyperhidrosis is very common, it can occur in up to 5% of the population and there are very effective treatments”. Maybe some TV ads, some educational components, education, I think is the key for successfully managing hyperhidrosis and also the treatment options, like Dermadry, because I'll be honest, with a lot of patients, although we live in a social media environment. A lot of my clients actually have never heard of options like Dermadry or iontophoresis. All they have been using is, you know, some antiperspirants, but this is such an effective treatment. And they had no idea that something like this exists. So I'm happy to see that, actually, I see a lot of YouTubers and some social media campaigns going on more and more people are learning about it. So education, I think, would be the key component, having some public education campaign. Better education in our medical schools and doing our trainings that we got. So I'll be honest with you, I learned nothing about hyperhidrosis during my residency or during my training. I had to learn everything after that, attending some medical conferences, doing my own little research and from my clinical experience. So I wish this was taught better in medical schools, but it is just not.
And that's something that we're trying to advocate, especially those that do suffer from hyperhidrosis. We want to create a community that it's safe for them to speak about it, know that we're here to listen. One of the founders, for example, of Dermadry has hyperhidrosis, and that's how the device did come about.
And like you said, I think it's the education part of it is very important. And that's why we love speaking to medical experts like yourself and get your opinions and your thoughts and trying to push hyperhidrosis treatments out there. So thank you very much for that. That's a very, very good point.
Moving forward now, there is a question that came in from a viewer asking how effective is Dermadry. So we want to know from your experience with your patients that have used this type of treatment, what would you respond to them?
Dr Raj Singh: It is a really effective treatment. And from my experience, I can tell you that the clients, or my patients, who use it properly have amazing results. But again, like I said, using it properly, that means following the regimen recommended by the manufacturer and using it on a regular basis is the key. So compliance, I think is the most important, but I've seen success rates, I would say close to a hundred percent at least in our practice, but even if you are not using it as prescribed and you know, we are all human, so we don't like to do these things, right. So even if you miss a treatment in between, still, I would say like close to 95% success rate in improvement of hyperhidrosis. For a lot of patients, the sweating issue completely goes away for a lot of others, it becomes much more manageable. So that means instead of changing their socks five times a day, they might only have to do it once a day.
But again, if you are following it much more rigorously, like based on the recommendation of the manufacturer, actually, some studies show actually 100% improvement, and I can attest to that. So our patients have a really amazing response. Yes, sometimes if they miss their schedule, in between some of the sweating can return. So it's not an issue with the device or the iontophoresis, it's just more of an operator issue. If you're not following the instructions and using it on a regular basis, like you're supposed to. We all get lazy.
Amanda: Yeah, that's something that we're also trying to let them understand that there are two phases.
We do have the [initial] treatment schedule and then the maintenance schedule, depending, like you said, on your hyperhidrosis, if you have a mild hyperhidrosis, you might not really tend to need the maintenance as much as somebody that has severe. So yeah, that's something very important. There were also questions that came in speaking about the subtype of side effects.
What are your thoughts on that? Even though they're kind of temporary. What would you answer to that question?
Dr Raj Singh: Hyperhidrosis is such a distressing condition. So to me, a little bit of minor side effects or some skin irritation, which can happen sometimes, it's not a big concern.
Most of our clients have no problem. It is just more getting comfortable with that feeling when you have the hands and you have the trays or the feet, the little tingling sensation, and a little sensation after the treatment, especially if you have very severe hyperhidrosis. So you'll be doing more frequent treatments initially.
You might see that the skin has a little bit of dryness. You might see some cracking in the skin, but all of that kind of gets better, but just by applying a little bit of moisturizer after the treatment. So I have not really seen anyone come in and say, “okay, this is not working for me and I'm having a ton of side effects” because there just aren't that many, it's just a little bit of skin redness as electric current is traveling.
So that's a normal response. It is going to happen, but they're very, very minor. Very manageable. It does not happen in every case, so someone who has mild hyperhidrosis, who is using the device on a less frequent basis, they’ll feel just fine. If you have very, very severe hyperhidrosis, initially, you might notice more, but as you keep using the device, those minimal side effects, they actually tend to go away or you don't even notice them. Skin dryness, a little bit of redness is the most common one, applying a little moisturizer takes care of that after the treatment.
Amanda: Yeah, and we also do recommend that, if somebody feels that there is a bit of redness, what we always recommend is maybe stop the treatment for that week or two, just to give them a bit of a break and then go back.
We just want to make sure that everyone is safe on that side as well, even though they are temporary. But that question has come up a few times. So thank you very much for that. Moving forward now, you did give a few tips and tricks, like for example, the socks. Do you have any other tips and tricks for those who do suffer from hyperhidrosis?
Dr Raj Singh: So hyperhidrosis sometimes can be associated with bromhidrosis, which is excessive body odor. Once we sweat a lot more we're not changing clothes more frequently. You can have some bacteria overgrowth, which can cause excessive body odor in addition to excessive sweating. So avoiding certain foods, you know, like garlic, honey, and a lot of curries because they can sort of cause the sweat to be more odorous.
So having some modifications in diet helps. Some clients may also have an increase in sympathetic response. So they might have a little bit more anxiety, a little bit more heart palpitations or tachycardia, just because it has some anxiety component as well. So yoga, meditation, all these things are going to bring down that sympathetic response. Being more calm, more comfortable, I think helps a lot. Having a good social support structure, I think, is one of the most important things. I don't need 500 friends on Facebook, I only need five who understand what I have. They have my back, they understand what I'm going through. And I think that is so, so important as well. Other than that, avoiding living in a hot and humid climate, if possible, move away to much cooler places, dressing in layers, cotton is king it wicks the moisture away unlike white plastic clothing and things like that. Avoid too much makeup, because that can clog the pores also. So those are some of the things that can also really, really help a lot.
Amanda: Thank you very much for those tips. And there's so many more, and I think that perfect aspect when you’re talking about even the social support at home or social support through friends or doctors, even. I think that's very, very important. Like you said, it is a taboo topic. People are afraid of it, and sometimes you'll get too anxious to speak about it and that causes a ripple effect of other issues. So I think that's a very, very great point to bring up. Another question now, um, we would love to know what are your hopes and thoughts for the future when it comes to hyperhidrosis treatments? In terms of research.
Dr Raj Singh: So, we have way more treatment options for hyperhidrosis that we had, let’s say, 20 years back, the iontophoresis devices like Dermadry, I mean, have improved so much in technology, we have a better understanding of the disease. Public has a little bit better understanding of the disease, the clients who are patients who suffer from this and all that, they have more options than they did 10 years back.
So I think evolving the research, putting more funding into something like this, having much more and bigger clinical trials, educating the public, seeing way more treatment options, and improvement in devices. So it's an ongoing process. And I think we are seeing, at least my understanding of learning about this is improving. I treat more clients, and adding more education in medical school, that's something I would like to see, you know, so the doctors are more trained in managing something like this.
We are educating the public, but we also need to educate our medical professionals who actually take care of this. So that's something I would like to see, more money, spent into research trials, educating more of the physicians who are coming out from the pipeline.
Amanda: And before we do end off, do you have any questions or thoughts, or any unique experience that you would love to share with the viewers out there?
Dr Raj Singh: I have a lot, but as it relates to hyperhidrosis, what I would like to end off with is that, you know, we're not perfect. None of us are, at least I'm not, you know, I have plenty of flaws. So consider hyperhidrosis also is the same way, you know, it's a medical disease and there's not something we can do about it.
So you have it. So the first thing is acceptance, so accepting that yes, you have this issue is the first step. And then understanding how to manage it would be the next one. Finding a provider who is not dismissive and who actually has experience managing hyperhidrosis will be very, very important, because they can be really a partner who can kind of educate you and guide you on how to better manage your disease.
Having a support structure. I think that's very, very important. I think acceptance, once you accept that there is something and I have a medical disease lowers the anxiety level down significantly. So that's what I would say. None of us are perfect, so we don't have to pretend to be. Acceptance is the key.
Amanda: Thank you very much.