Interview with Dr. Leona Yip, MD
Dermadry Segments: Dr. Leona Yip, MD
Dermadry spoke to Dr. Leona Yip, MD to learn more about her first-hand experience diagnosing and treating her hyperhidrosis patients.
In this interview, Dr. Yip guides us through her experience as a dermatologist, what she sees in her hyperhidrosis patients, and the various treatments she prescribes to her patients dealing with excessive sweating.
Read our full interview with her below! Thank you to Dr.Yip for taking the time to speak with us and help us raise awareness of hyperhidrosis, and available treatment options!
About Dr. Leona Yip, MD
Dr Leona Yip is a dermatologist based in Brisbane, Australia. Dr Yip is a Fellow of The Australasian College of Dermatologists (FACD).
She is committed to dermatology research and academia and has published numerous publications and commissioned articles either as first or senior author in peer-reviewed medical journals and medical websites.
Dr Yip is passionate about skin health advocacy especially in her role as Advocate for The Australasian College of Dermatologists where she regularly interacts with stakeholders including patient support groups, skin health organisations and various media outlets to improve skin health literacy.
As an advocate of skin health, can you tell us what sparked your interest in the field of dermatology?
Dermatology was very scarcely taught in medical school so it was always an elusive specialty. As a junior doctor, I rotated through different medical specialties but none really made me feel it was my calling. One day, I saw a dermatologist doing a ward round on her own and I’m not sure what made me talk to her but the conversation led to me observing in a few of her dermatology clinics and becoming a mentor for me to and was fascinated with the myriad of skin conditions that dermatologists are able to diagnose relatively effortlessly, whereas to untrained eyes, everything was “a rash” through the kind mentoring of a few dermatologists who nurtured my growing interest in the specialty, I quickly decided that dermatology was for life!
I enjoy the fast-paced nature of dermatology which offers excellent work variety ranging from medical dermatology, surgery, laser and aesthetics. It is incredibly gratifying when patients with chronic skin conditions tell me their treatment has been life-changing, which makes it all worthwhile as I am making a difference. With dermatology, I am also fortunate to have a good work-life balance, and one that uniquely allows me to use my voice across different platforms to advocate for better skin health.
Do you remember your first hyperhidrosis patient, or the first time you were introduced to hyperhidrosis (perhaps in med school or your dermatology training)? Can you please tell us about this?
I became aware of hyperhidrosis as a condition during dermatology training, and how distressing it can be. One of the most memorable patients was a lady with severe underarm hyperhidrosis who could not leave the house without bringing a spare change of clothes in case of sweat stains on clothing, and she was struggling to cope psychologically and with the increasing expenses of dealing with hyperhidrosis treatments. She successfully campaigned for a medical treatment (neurotoxin injections) for underarm hyperhidrosis to be a government-subsidised treatment in Australia.
Another patient was a 9-year-old girl who could not hold pencils properly at school because of severe palmar hyperhidrosis. She would not participate in school sports as she was always concerned about clothing sweat stains and difficulties gripping sports equipment with sweaty palms. Her mum was also visibly distressed with how hyperhidrosis was affecting her child. These cases were truly reflections of how much negative impact hyperhidrosis can have in affected children and adults alike.
What is the average age of your hyperhidrosis patients? Have you noticed it to be more common in a certain age group?
Primary hyperhidrosis tends to start in younger age groups, including in children and teenagers. In my patient cohort, the average age ranges between ages 20-40s when they present for treatment. Many of them would have put up with hyperhidrosis for years before seeking treatment, due to lack of awareness of available treatments and where to seek help.
Primary hyperhidrosis is localized to certain areas of the body. Do treatments differ based on the area of the body that is affected?
Yes, treatments generally differ based on where hyperhidrosis is localised mainly due to logistical factors. For example, iontophoresis is usually used for treatment of hand and feet hyperhidrosis as many machines do not have pad attachments for the underarms to be treated. Neurotoxin injections, on the other hand, is commonly used for underarm hyperhidrosis but less so on hands and feet due to higher costs for treatment of these larger skin areas, and significantly more painful injections that usually require nerve blocks.
When a patient comes in seeking treatment for hyperhidrosis, what do you recommend at first?
I would firstly assess which areas are affected and explore previous treatments before recommending the next step. My treatment recommendation is often tailored to individual expectations and needs to be effective, safe, work quickly and be affordable. The commonest treatment options I recommend are iontophoresis (with tap water or with an anticholinergic), neurotoxin injections, and oral anticholinergics.
If a patient doesn’t experience success with a certain treatment, how do you proceed?
Exploring expectations of treatment with the patient is incredibly important – this will help me decide if further localised treatments or progressing to oral cholinergics are more appropriate. In some patients, I would use combination treatments for better results. If these fail, the last resort is to refer to a surgeon for consideration of a procedure called endoscopic sympathectomy where the sympathetic nerves that supply sweat glands in the affected areas are destroyed to reduce sweat production.
How do you decide what hyperhidrosis treatment is best suited for a particular patient?
I often firstly tell them which treatment I recommend as first choice and why, and also give them a second choice alternative and discuss the treatments’ mode of action, when to expect results, side effects, costs and treatment maintenance schedules. Sometimes, what I recommend as the “best” treatment option may not be what the patient’s prefer. It is best to work together to find a treatment that the patient is most comfortable with to ensure they follow through with it to achieve desirable results in the long-term.
When do you recommend iontophoresis treatment to your patients?
I regularly recommend this as first line specialist treatment for hand and feet hyperhidrosis in all age groups as it is effective in many people and has a good safety profile. Depending on the severity of hyperhidrosis, I would commence treatment either using tap water or with an anti-cholinergic medication in the first few weeks for more effect before switching to tap water treatments for maintenance.
What are your general thoughts on iontophoresis treatment for hyperhidrosis?
It is an effective treatment for many people with hand and feet hyperhidrosis, and generally has a good safety profile. It can be used in both children and adults, and tap water treatments are a good drug-free option for those who are concerned about medication side effects. It is also easy to administer from the comfort of home, or if preferred, can be done in the clinic under supervision. The costs of iontophoresis machines have also come down in recent years, making it more affordable.
Hyperhidrosis can be a very embarrassing problem to deal with. Do you have any tips or suggestions for those living with it?
Do not be afraid to tell people about it – there is still so much lack of awareness of this condition. Until we can educate more people about it, we won’t see enough affected individuals coming forward for treatment or others offering support for individuals suffering from this debilitating condition. Seek medical help promptly from your GP, dermatologist or neurologist who can help you decide on treatments that are often life-changing.
Are there any permanent or long-lasting solutions for hyperhidrosis?
Hyperhidrosis is a life-long condition that requires long-term maintenance treatment. The only expectation of a cure would be with surgery (often a last resort treatment) where sympathetic nerve trunks that supply sweat glands in the affected area are destroyed. However, this procedure commonly results in permanent compensatory sweating in previously unaffected areas in approximately 30% of people, which is an undesirable side effect.
How often do you have patients who come in for hyperhidrosis diagnosis or treatment? How does it compare to other dermatologic conditions you treat?
As a dermatologist with interest in treating hyperhidrosis, I see affected people seeking treatment very regularly, almost on a weekly basis. I also end up treating many people with incidental hyperhidrosis who come in for treatment of other skin conditions, as their skin conditions e.g. eczema, seborrhoeic dermatitis, skin infections etc would usually improve if their hyperhidrosis is better controlled.
Hyperhidrosis is not amongst the top few commonest conditions that present to me unlike eczema, psoriasis, acne, skin cancers etc. I think I would be seeing more patients seeking treatment for hyperhidrosis if there is more awareness in the community about this debilitating condition.
Staying on the topic of comparison, how do the effects of hyperhidrosis differ from other dermatologic conditions? Research has shown that it has an even greater negative impact on quality of life and wellbeing than conditions such as psoriasis. Do you have any thoughts you can share on this based on your extensive experience?
Studies show that people with hyperhidrosis have similar impairment in quality of life compared to rheumatoid arthritis, psoriasis and other chronic diseases. However, most delay seeking treatment for years, one study reported up to 10 years, as they are unaware of available treatments or where to seek help. Hyperhidrosis, in my experience, is one of the most understated debilitating conditions that I treat. Other people don’t tend to see how stressful this condition can be and how much it negatively affects personal lives, work and social interactions.
Do you believe there is a lack of awareness and/or understanding of hyperhidrosis in general? What about in the medical sphere?
Yes, definitely. Even amongst medical professionals, there is lack of awareness about the condition and treatment options. This results in delayed diagnosis and treatments, and in many cases, referral for specialist treatments. It is great to see patient support groups for hyperhidrosis advocating more support for affected people and awareness of this condition.
Are there any hyperhidrosis treatments you would advise against?
I would be cautious recommending surgery (endoscopic sympathectomy) where sympathetic nerve trunks that supply sweat glands in the affected areas are destroyed. This is usually a last resort treatment if all else fails. This procedure commonly results in permanent compensatory sweating in previously unaffected areas in approximately 30% of people, which is an undesirable side effect. Other possible side effects include extreme low blood pressure, irregular heart rhythms and heat intolerance.
Is it necessary for someone suffering from hyperhidrosis to come in for a medical diagnosis?
Primary hyperhidrosis is usually caused by a genetic predisposition to this condition and affected individuals are otherwise healthy. Primary hyperhidrosis usually affects focal areas, commonly the underarms, hands, feet, and scalp. In some people, primary hyperhidrosis can be generalised. Generalised hyperhidrosis can also be secondary to underlying medical issues e.g. thyroid, diabetes, infections, medications etc. Blood investigations may be needed to exclude underlying secondary causes. It is therefore advisable for people with both focal and generalised hyperhidrosis to seek medical advice for guidance towards appropriate treatments and for exclusion of underlying causes.
What are the most common complaints you receive from your hyperhidrosis patients (i.e. social life, mental health-related)?
Commonly social disruptions that affect personal relationships and work e.g. too embarrassed to hold or shake hands, avoidance of meeting people and public speaking for fear of looking drenched with sweat, need to change drenched clothes every few hours throughout the day. Psychological effects are also very common e.g. lack of self-confidence, anxiety and depression. Ongoing high costs of replacing damaged clothing is another very common complaint. Lastly, functional issues e.g. inability to hold pens/pencils properly, unable to grip sports equipment, increased skin infections e.g. fungal, warts, bacteria.
As someone who remains committed to dermatology research and academia, do you have any particular hopes for the future in terms of research & development for hyperhidrosis treatments?
I think there are already great treatments available for underarm, hand and feet hyperhidrosis e.g. iontophoresis and neurotoxin injections. However, we still need more effective treatments developed for treatment of more difficult areas e.g. scalp, face, groin and for generalised hyperhidrosis. I think energy-based devices e.g. ultrasound, radiofrequency, laser etc may be the way into the future for hyperhidrosis treatments. The constantly evolving technology would ideally enable small and larger skin areas to be treated with targeted destruction of sweat glands aiming for a cure without the need for long-term maintenance treatments.
Are there any additional thoughts you would like to share with us?
People with hyperhidrosis are at higher risk of skin infections e.g. bacterial, fungal and warts; as well as worsening of skin conditions e.g. eczema, seborrheic dermatitis, acne etc. Treating hyperhidrosis often helps improve treatment outcomes of these skin issues.