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In this interview, Dr. Mitchell guides us through her educational background, what led her to pursue a career in dermatology, and whether her first introduction to hyperhidrosis was during her time in medical school. She reflects on why excessive sweating (hyperhidrosis) is a highly stigmatized medical condition and the common symptoms she sees in her hyperhidrosis patients. She opens up on the obstacles and challenges that her hyperhidrosis patients face in their daily life, activities, and routines, as well as the social, emotional, and occupational challenges of the condition.
Listen to her discuss her hopes regarding the future of hyperhidrosis research, tips and tricks for those suffering from hyperhidrosis, and the future of telemedicine in light of the ongoing COVID-19 pandemic.
Watch the full video (or read the transcription) to hear her treatment recommendations, the pros and cons of iontophoresis treatment, and her thoughts on Dermadry's iontophoresis machine.
Dr. Hope Mitchell is an Ohio and Michigan board-certified medical and cosmetic dermatologist and the founder & CEO of Mitchell Dermatology. With over 25 years of experience in the medical field, she is an accomplished, highly qualified dermatologist and entrepreneur. She is an advocate for mentorship, education, entrepreneurship, and diversity in medicine and dermatology.
Amanda: Hello, my name is Amanda Colapelle, welcome to Dermadry Segments! For the episode today, I'm joined by Dr. Hope Mitchell, thank you very much for having us today!
Dr. Mitchell: Thank you for having me!
Amanda: So just to go into a few of the questions, we founded Dermadry because it was our desire to help people. What was your motivation to enter the field of dermatology?
Dr. Mitchell: Well, you know, my motivation was very similar. I am the product of a nurse. My mother was a nurse and from a very young age, I watched her help many people. And I remember her asking me, “what do you think you want to be when you grow up?”. I was about 12 or 13 and I had no idea, but I knew that I loved to read and to study, and I was a very independent student. She said to me: “I think you have what it takes to be a doctor. You know, I think that you can help many, you love to read, you love to research. You're very inquisitive. You're always asking questions and I think that's what you're going to be, you're going to be a doctor.” and the rest was history. Ever since then, I have advocated for my patients through reading and learning and educating them about every condition that they come to see me about.
Amanda: Wow, that's awesome. When you were studying to be a dermatologist, did you learn specifically about hyperhidrosis in school?
Dr. Mitchell: I did, we absolutely learned about it. As you know, in dermatology training, there are over 3000 conditions of the hair, skin, and nails that we have to learn about. And we actually go through all of the material every year. So it's like we're preparing every year, times three years of residency, to do what we do. And what I found with hyperhidrosis is that it actually was more common than people led us to believe. And even back then, and still today with hyperhidrosis, a lot of the diagnosis is made kind of incidentally. What I find in my practice is that people come in for one thing, and I'm the one that notices that they have hyperhidrosis, you know, they may come in for acne or a full body skin exam and the table exam paper has been moistened when they get up. And so it was common back then, but I didn't see nearly the number of people that I see coming in to talk to me about it today. So back then, I really didn't have anyone coming in and that being the main reason why they scheduled an appointment to see me.
Amanda: That's really interesting. Why do you think the reason is that a lot of people have hyperhidrosis or why is it such a taboo?
Dr. Mitchell: You know, it's really hard to say, but I do know that there are still many people that don't know that it's a medical condition. A lot of people suffer in silence. I know that there may be adolescents that may say something to their parents, but their mom or dad may say “your body is changing” or “that's normal, that will go away”. I also know that although it runs in families, it's not discussed—it's a condition that I think a lot of people live with in silence, unfortunately. I know that it can be embarrassing, I know that it can be dismissed and maybe some people until luckily today we have a lot of information online. I think more and more people are figuring it out. But I'm not quite sure why we still don't get a number of people coming in to seek treatment for this condition.
Amanda: Exactly. Speaking about that, what is the typical hyperhidrosis patient? When they come in, what do they typically have as symptoms?
Dr. Mitchell: I think, you know, when they come in, they talk about the social or the emotional anxiety that surrounds the condition. I think that's what drives them is the fact that they're avoiding social gatherings, you know what I mean? There may be parents that bring in children and talk about the fact that they have body odor, and are not quite sure why they have that odor and not really thinking, or making the connection to the fact that it could be a condition that's doing it. But really thinking more so that they're not cleaning themselves well, or they're not showering enough. We also have people that suffer from stress and anxiety and depression about it. And I think that one way or the other, they come to the understanding “Look, I have to figure out what's going on and I have to find a way to get past this because it's becoming disabling. It's impacting my ability to even date or to go out with people, to be in public, to do the work that I've been employed to do, presentations, all of that.” I think it's just all of that comes together and it finally drives these patients into the office.
Amanda: Yeah, there's a lot of research that was done, psychological-based, and those were exactly the reasons that came out—a lot of patients were anxious, had anxieties, and then that develops into another condition. So they are linked together and there's been a lot of studies that have shown that. So, it's interesting to also see your view on how they're brought in together. I believe it is a taboo and that's also why at Dermadry, we're trying our best to spread the word and also allow people to understand that it's okay to talk about it and also make them feel comfortable that there's a product out there to help them as well.
Dr. Mitchell: Exactly and that's so needed, it's really needed. That’s what's impressive about research. A lot of studies that I look at that have been most impactful for me have been those survey type studies, or those retrospectives where people are given surveys. The amount of information that you can get from those surveys, that people have been living in silence with the condition, some for 10 years, before they've decided to seek treatment. And then when they did reach out for treatment, they may have seen some of my primary care colleagues, who really didn't know much about it either. And so that may have been discouraging for them in terms of continuing that journey to find treatment. And then the quality of life questions that are asked are just amazing. The responses from how hyperhidrosis can affect quality of life, it can be debilitating.
Amanda: How do you think hyperhidrosis and wellness routines fit into women's wellness? Do women sweat more or is it males that sweat more? Is there research that you've seen that could go into that?
Dr. Mitchell: Well, you know, for some reason, I don't know what it is. It's like men can sweat and it's not as huge of a deal as it is for women. I think in terms of the wellness of women, I think that once you know you have hyperhidrosis, we know that there's no cure for it but you can live with hyperhidrosis with a quality of life that is acceptable. And what I educate my patients about is just always be kind to yourself, figure out what you can do that can help promote wellness in your life and your lifestyle. So for example, if you know, cleaning your home brings out a sweat in you, and that bothers you then maybe consider hiring a cleaning service. Think about moisture-wicking clothing that will allow you to have better rest at night. We all need rest and to not be able to get that because you're breaking out in a sweat, you’re moist and you're uncomfortable, it’s not a good thing. Don’t not exercise because you're embarrassed about being in the gym. Maybe consider working out at home, maybe bringing in someone that can train you or a friend that you can work out with. So I think in terms of wellness, I think once, you know, you have this condition, I think that there are different tiers of things that you need to do to address it. Obviously we’re going to talk about treatment, but we have to talk about wellness. We have to talk about “what can I do to be well with this condition?”, “it’s not acceptable for me to ruin all of my clothes”, “it's not acceptable for me to not be able to sleep at night or not be able to be around people”. Thinking about things in that aspect will help alleviate some of the stress and anxiety that may surround wellness.
Amanda: Without giving any names, could you give examples of what obstacles your patients with hyperhidrosis have lived or gone through? Have you encountered any stories in some way?
Dr. Mitchell: In terms of obstacles, the biggest one that I hear about when I ask people, because I do ask my patients “tell me how this has impacted your life” “give me an example”, because there are times when I need to advocate for my patients and I need to be able to if I have to send off a prior authorization or documentation, I want it to be from the source, the patient's perspective. Well, I think the most common would be intimacy and relationships with others, dating, being afraid to hold hands with your partner. Especially when you're first meeting people, it has greatly impacted teenagers with wanting to go out and be around other people. And as I had indicated, I get a lot, a lot of patients that come in concerned about body odor and what can I do about that, that tends to be some of the most common stories that I hear. The others would be just work, ability to perform at work, you know, no one wants to break out in a sweat all over their forehead or wants to have sweat stains on their clothing. I have had several people that have come in and have talked with me about that.
Amanda: When it comes to clothing, what do you recommend to stay away from, and what do you recommend to stay with?
Dr. Mitchell: I think cotton clothing would be best. I always recommend lighter clothing in color and in weight. I think that that's really important. I think layering is important, you know, as we switch seasons, it could be quite difficult trying to figure out what to wear, especially when it's going from spring to summer or fall to winter, when it's colder in the morning, you know, how do you dress? And so I do quite a bit of education about layering, and the ability to be able to remove a top layer very quickly, when you feel that warmth start.
Amanda: That's a really good point. I feel like especially now that we're going to the winter season it's really important to. Because now let's say if people are taking public transportation, you know, it gets warmer, then they have to take off their coat and there's so many layers, so it's really important and something we need to take an understanding of.
Dr. Mitchell: Exactly, it's all about being proactive right?
Dr. Mitchell: I think the education that we provide is critical. I mean, that's part of the consultation. When people come into the office we start out by hearing them out, showing compassion. Ask “You know, how does this impact your daily living and wellbeing?”. And once we receive that information, in my practice we talk about ways to approach different facets of their concerns.
Amanda: That’s a good aspect, and a good approach to that. What are your thoughts on tap water iontophoresis, such as Dermadry, as a treatment option for hyperhidrosis?
Dr. Mitchell: I think it's a fantastic option. I love iontophoresis for my patients who have palmar and plantar hyperhidrosis, especially. It works well for axillary, but let's be honest, the palms and soles can be difficult to treat with perhaps conventional treatment. And so it actually is my number one recommendation for palmar and plantar hyperhidrosis. I think that it can be effective, I think we have to talk our patients through the consistency in the beginning, you know, sticking with it and letting them know that if they do stick with it, you do start to receive results depending upon severity. You know, it can be anywhere from two weeks to three weeks or four weeks in, but you do get to a point where you can continue the treatment on a maintenance schedule. It's very easy to use, and I always tell my patients, when you're doing the 15 or 20 minute treatments, you can do it in front of a TV, watch a movie, or read on your computer! I mean, we're doing everything on our devices right now, and I think our mindset is let's get in front of a device anyway. So, I like it.
Amanda: We're so happy to hear that, and that's exactly what we see as well. There's a lot of patients that come up to us and say, “Oh, we could watch television while using it.”, and they love that it's an at-home treatment as well. So. It works on both ends, right?
Dr Mitchell: Yes. It's an at-home medical treatment that is FDA cleared in the United States now and in a lot of countries and so people love to hear that they feel like it's a safe treatment, when they hear it's been cleared.
Amanda: What patients is iontophoresis fit for, or when is a treatment prescribed for hyperhidrosis patients?
Dr. Mitchell: Well, we do have to take a medical history when we see patients, of course, that's part of the evaluation. And so patients that may have a pacemaker, patients that may have underlying conditions like seizures or cardiac arrhythmias are not going to be suitable for this treatment. However, just about everyone else, especially those with moderate to severe hyperhidrosis are a great fit for this treatment. What I find is that even if I have patients that have palmar hyperhidrosis, I always check the feet. I take a look at the feet and I talk to the patient about the fact that it can occur there. And so any of my patients that even have it there, they have an infection on their feet, we always treat that first, of course, but it doesn't stop them from being a candidate. Patients that may have athlete's foot or open skin or anything like that, we would address that first, and once we get past that, then those patients would be suitable to start the treatment. So outside of any of those medical conditions, just about anyone would be a candidate for Dermadry iontophoresis.
Amanda: That's an aspect in our approach as well. And what you're saying, it really matches our values as well, when we look for a candidate we've really made sure that both ends match. When it comes to misconceptions, what are the largest misconceptions about iontophoresis?
Dr. Mitchell: I don't want to be funny, but I think people think of it like “is that electrocution”, you know, “is that electrical, like electricity for water? Is that safe?”. I get that question a lot, and of course, I have to reassure them that it is low energy from the power source, it’s safe. That's probably my biggest question and then followed by, “will I have persistent numbness” and “is that going to alter my ability to have sensation in that area?”. I have to reassure them about that. Other than that, I don't get a lot of questions, but those are probably my most common comments or questions about the treatment.
Amanda: Yeah, sometimes there's also redness that comes from the palms, however it also depends on how mild the hyperhidrosis is. But, a lot of people tend to have these misconceptions, however it's super easy and safe to use. And this redness, it really depends also on how fair your skin is or how sensitive you may be, but the percentage is very slim as well.
Dr. Mitchell: Yeah, agree with you, the redness, there may be blisters, small, very tiny, rare, and that are transient, meaning that they go away. Maybe some mild discomfort that goes away, but I've never had anyone tell me that they wanted to discontinue treatment because it was uncomfortable. Very rarely will I hear that, it’s not that common.
Amanda: What do you hope to see in the future in terms of developments in treatments and research for hyperhidrosis?
Dr. Mitchell: I still want people to know this is a medical condition. We can rely on research for treatments to show us that they're safe and all of that, but we still have a lot of patients that are not aware that hyperhidrosis is a medical condition, and that there are safe treatments. I also would love to see there be ways to get adolescents treated. I have seen even children with palmar hyperhidrosis, it can happen. It can start in childhood and a lot of the devices—I know Dermadry is approved for 13 and up [21+ in USA]—but, we know that this condition starts even younger. So, I would love to see more for that category, for the children. But overall, I would say more education, getting the word out, and studies that show that this is safe and effective treatment— We can never have enough of that. You know, we can't have too much of that, so I'd love to see more studies.
Amanda: In your past 20 years, were there any recommendations or tips that you would recommend to all the patients when it comes to hyperhidrosis? Was it always focused more on the clothing, or also giving them tips and tricks also about anxiety. What have you done over the past 20 years to help them and give them little tips and tricks?
Dr. Mitchell: When I first started, we didn't have much in our treatment algorithm. And so what I find is that, I completed dermatology residency in 1998, and at that time we had antiperspirants, as an option and iontophoresis was an option that I did recommend back then. As we move forward, It's very exciting to know that we have more information and I can educate my patients in terms of lifestyle changes, in terms of combining treatments, there are times when we use more than one treatment. So, I don't think there's anything wrong with using iontophoresis in combination with antiperspirants. I do have patients where I combine those treatments and I think that it's very beneficial. I think empowering patients in terms of building their confidence through the fact that you can be treated. And telling them “you're not alone”, there are societies that are strong and provide support. And so, I often recommend that my patients also join the hyperhidrosis society, and that's very exciting, to have people be able to join platforms like that. I think overall, to me, what's most important is not only to provide safe and effective treatment, like what Dermadry provides, but to educate and empower our patients so that they know that they can achieve dryness, and they can be confident being who they are.
Amanda: That’s the most important thing, when it comes to making them feel confident again—that's also a great aspect that you bring in your practice. You always try your best to understand the patient and help them to get where they want to be and make them feel comfortable again and that's great from your practice. Now when it comes to COVID-19, is it difficult when it comes to meeting with patients, or speaking about hyperhidrosis? Also in general about your day to day life, has that affected anything?
Dr. Mitchell: Well, initially yes, we all had difficulties, right? We all had to pivot. I think we all had to sit down, have a moment, and pivot, and telemedicine, in my opinion, has been a lifesaver. Even us meeting today through the way that we're meeting is a lifesaver. And I think that it provides us with the opportunity to still stay engaged with our patients and still be able to help them. In terms of a diagnosis like hyperhidrosis, we don't have to see patients in person. I mean, we understand, we can see it. And even if it's not to the extreme at the visit, if it impacts the patient, we still get to receive the history from the patient, and so it hasn't stopped me from being able to treat my patients, which is what we want to do. We started out by saying, we want to help people, and so telemedicine has been fantastic. It has been phenomenal in terms of being able to connect with people all over the country and not even in the country. I've had meetings where I've talked with people that are not in the country, and so I think that, for me, it has been a great tool; a great resource in allowing me to stay connected.
Amanda: That's amazing. I feel like especially now, this is where we all need humanity the most. And that's something that we want to bring up with everyone, with work employees, with clients, with dermatologists and doctors that we work with. We really want to make sure that everyone, especially during this time is going with that. And we're able to check in with each other and not just speak about the treatment, but also on how you're doing physically, emotionally—we feel like that's really important.
Dr. Mitchell: I agree. Absolutely.
Amanda: Thank you very much for meeting us today, it was a pleasure to go through some questions with you. We’re really excited that you like Dermadry and that you've recommended us to your patients. We're really happy to have spoken to you today.
Dr. Mitchell: Thank you so much for having me!
Amanda: Have a great one.
Dr. Michell: You too!