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Who Chooses the Appropriate Treatment for Hyperhidrosis—Physician and Patient, or Insurer?–Reply–I

      We appreciate the points made by Dr Reisfeld. We attempted to describe current therapies without insinuations of superiority or bias because of the heterogeneity of hyperhidrosis and, more importantly, because the evidence comparing specific therapies is currently insufficient. Treatment progresses in order of invasiveness, risk-to-benefit, and cost. We wholly agree with the seriousness of insurers requiring multiple steps in the treatment approach that are off-label and unproved, particularly for palmar hyperhidrosis. In our experience, treatment of palmar hyperhidrosis with botulinum toxin has been presented as an option—not a requirement—by patient insurers. If botulinum injection for palmar hyperhidrosis is indeed less effective, less satisfying, and more costly than endoscopic sympathectomy surgery, physicians, patients, and insurers will adjust accordingly. Debate between repeated medical therapy and permanent surgical therapy is certainly not unique to this disorder and will require prospective trials to promulgate evidence-based medicine instead of opinion.

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      • Who Chooses the Appropriate Treatment for Hyperhidrosis—Physician and Patient, or Insurer?
        Mayo Clinic ProceedingsVol. 81Issue 2
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          To the Editor: Hyperhidrosis (excessive sweating beyond that required for body temperature regulation) has become a more familiar term to the public because of increased awareness of this problem as a “real” entity and the availability of information on the Internet. In the May 2005 issue of Mayo Clinic Proceedings, Eisenach et al1 reviewed therapies for this problem. They discussed conservative methods to deal with palmar hyperhidrosis, including botulinum toxin, but noted that in severe cases these treatments often fail or have only short-term effects.
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