The Role of Insurers in Hyperhidrosis Treatment: A Critical Perspective by Dr. Rafael Reisfeld

In the ongoing discourse surrounding hyperhidrosis treatment, a compelling letter by Dr. Rafael Reisfeld highlights the often overlooked yet critical role insurers play in determining the course of treatment. This letter, published in the Mayo Clinic Proceedings, sheds light on the tensions between medical professionals, patients, and insurance carriers regarding managing severe hyperhidrosis. 

Hyperhidrosis and Treatment Options

Hyperhidrosis, characterized by excessive sweating beyond what is necessary for body temperature regulation, has gained more visibility in recent years. Awareness has been driven by online resources and increased public recognition of the condition. Dr. Reisfeld points out that while conservative treatments, such as botulinum toxin (commonly known as Botox), can be effective for some, they often fall short for patients with severe cases. Endoscopic Thoracic Sympathectomy (ETS) has become the preferred solution for these individuals. ETS boasts a remarkable success rate, stopping palmar sweating in at least 98% of patients, with a meager recurrence rate of 1-2%.

Insurer Influence on Treatment Decisions

Despite the proven efficacy of ETS, insurance companies frequently require patients to undergo Botox treatments before authorizing surgery. This policy persists even though Botox is not FDA-approved for palmar hyperhidrosis and can cause significant discomfort and pain, particularly when injected into the densely innervated skin of the palms. Moreover, Botox treatments need to be repeated every few months, making it a costly and less permanent solution compared to ETS.

Observations and Implications

Dr. Reisfeld's frustration is palpable as he discusses the undue burden placed on patients due to insurer mandates. He argues that requiring patients to try conservative methods for extended periods can prolong their suffering and feelings of futility. The financial burden also increases, as repeated Botox treatments often end up being more expensive than a one-time ETS procedure.

Impact on Children and Families

For parents of children with hyperhidrosis, this discussion is particularly relevant. Children suffering from this condition can experience severe emotional and social distress. Adequate and prompt treatment is crucial in improving their quality of life. When insurers mandate less effective treatments, it can delay relief and exacerbate the child's discomfort and anxiety. Dr. Reisfeld's call for a more rational approach to treatment authorization is a plea for allowing medical professionals and patients to make informed decisions without unnecessary insurance interference.

"To allow the insurance industry to decide that patients must first try an unapproved (by the Food and Drug Administration) and unproven treatment for palmar hyperhidrosis before undergoing treatment that has been shown to be effective, that is in widespread use, and for which results have been published on thousands of patients should be unacceptable to the medical profession" (Reisfeld).

Conclusion

The debate over who should decide the appropriate treatment for hyperhidrosis—physicians, patients, or insurers—is far from settled. Dr. Reisfeld's insights underscore the need for insurance policies prioritizing patient well-being and clinical efficacy over cost-cutting measures. As parents and guardians navigate treatment options for their children, understanding these dynamics can empower them to advocate more effectively for the best possible care.

Rafael Reisfeld, "Who Chooses the Appropriate Treatment for Hyperhidrosis—Physician and Patient, or Insurer?" Mayo Clinic Proceedings, Volume 81, Issue 2, 2006, Page 262, ISSN 0025-6196<br>