U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Wade R, Rice S, Llewellyn A, et al. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Southampton (UK): NIHR Journals Library; 2017 Dec. (Health Technology Assessment, No. 21.80.)

Cover of Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis.

Show details

Appendix 5Survey of UK dermatologists

Introduction

The purpose of the survey was to obtain information on current clinical practice to help inform the economic modelling assumptions. The survey was conducted by means of an online survey tool: ‘Qualtrics’ version 2016 (Provo, UT, USA). It was circulated to > 1000 dermatologists in various NHS units across the UK. The questionnaire dealt with treatments typically administered, effectiveness of treatments, adverse events related to treatments and resource use associated with each individual treatment.

Forty-five respondents from 42 different dermatology units completed the survey at least partially (i.e. not all respondents answered every question and, therefore, most of the questions had different response rates).

Methods

Each type of treatment (medication, Botox, iontophoresis, curettage and alternative minor non-invasive surgery) was assigned a separate section in the survey. It was assumed that all dermatologists prescribe medication, including aluminium chloride, for hyperhidrosis and so respondents were asked to list all prescribed medications, their dosages and recommended frequencies. For all other treatments, a filter question was included whereby respondents were simply asked to choose ‘yes’ or ‘no’ depending on the availability of that treatment at their individual unit. If they chose ‘yes’, they were asked to answer further questions on the effectiveness of, and resource use associated with, that treatment. If they chose ‘no’, respondents were asked to move to the next section. The full survey can be seen at the end of Appendix 5.

NB, questions about ETS were not included in the survey as sufficient evidence for the model had already been obtained.

Results

Treatment availability

Medications

When asked what medications were available at their units, 42 dermatologists (93% of the total sample) mentioned at least one type of medication. The total number of responses, or medications listed (n = 114), was greater than the total number of respondents (n = 42), as the majority of clinicians (83%) listed more than one type of medication. Seventy-one per cent of these included oxybutynin and 55% included propantheline bromide.

Table 64 shows the medications prescribed by dermatologists and the percentage delivering each type of medication.

TABLE 64

TABLE 64

Available medications

In terms of combinations of the medications outlined in Table 64, 22 different combinations were reported by the 42 respondents. This suggests that there is no unique combination of medications that is prescribed. However, 19 out of the 22 combinations (86%) included oxybutynin and/or propantheline bromide. Use of these two medications only combined was also notably more frequent than use of any other combination (reported by 19% of respondents). All medication combinations are presented in Table 65.

TABLE 65

TABLE 65

Combinations of prescribed medications

Other treatments

Regarding the availability of other treatments (Botox, iontophoresis, curettage and alternative minor non-invasive surgery), all 45 dermatologists (100%) indicated the availability of one or more procedures. Responses are summarised in Table 66.

TABLE 66

TABLE 66

Availability of other treatments

As shown in Table 66, the vast majority of respondents (84%) indicated that iontophoresis (tap water) was available at their dermatology unit, and over half of the sample (58%) stated that their unit offered Botox, but no respondents indicated that alternative minor non-invasive surgery procedures were available.

In terms of combinations of the available treatments, the most commonly offered combination was Botox and iontophoresis (tap water) – reported by 33% of the sample. Slightly fewer dermatologists (22%) indicated iontophoresis (tap water) only. The remaining combinations of treatments varied across the sample, but most included Botox and/or iontophoresis (tap water). All combinations of other treatments can be seen in Table 67.

TABLE 67

TABLE 67

Combinations of other treatments

It can be concluded that there are a variety of medications and other treatments available for hyperhidrosis from dermatologists in the UK. The most prevalent medications are oxybutynin and propantheline bromide and the most common clinical procedures are Botox injections and iontophoresis (tap water), according to the survey results. No respondents indicated availability of the alternative minor non-invasive surgery procedures, suggesting that they are not yet available on the NHS.

Resource use associated with treatments

The survey respondents were asked to provide additional information about available treatments. For medications, they were asked to indicate dosage, frequency and details about follow-up visits. For other treatments, they were asked to indicate duration of the procedure, job title of the treatment provider and details about monitoring visits. Dermatologists that provided iontophoresis (tap water) were additionally asked to indicate the type of machine that would be used in the clinic, the type of machine that would be used at home and the proportion of patients that would continue this treatment at home.

Medications

Nineteen out of 30 dermatologists who prescribe oxybutynin indicated the dose. Responses ranged from 2.5 to 30 mg daily, but the most common minimum and maximum values were 5 mg and 15 mg daily, indicated by eight and six respondents respectively. This is largely consistent with the British National Formulary recommendation, which is, on average, 12.5 mg per day. For propantheline bromide, 21 out of 23 respondents indicated the dose. Responses ranged from 15 to 125 mg daily. The most frequently indicated value was 45 mg daily, which is lower than the British National Formulary recommendation of 75 mg daily. Only 6 out of 12 respondents indicated the dose for glycopyrronium bromide, out of which the most common recommendation was 1–4 mg daily and four indicated the dose for propranolol (120 mg per day).

Thirty-three dermatologists out of 42 who prescribe medication specified the frequency of, length of and the title of health professional present at monitoring visits. More than a third of them (n = 12) stated that follow-up visits take place every 3 months, over a half of them (n = 18) said it would last for 10 minutes and the majority of respondents (n = 25) indicated that it would be led by a consultant dermatologist. According to four clinicians, there are no follow-up visits; patients would be discharged back to their GP.

Botox

According to 13 out of 26 dermatologists who indicated that Botox was available at their unit, the procedure is delivered by a consultant dermatologist. The other half responded that it would be carried out by specialist nurse. In terms of duration of the procedure, 22 out of 24 dermatologists who responded to this question stated values of < 1 hour (mostly 30 minutes). Only 5 of the 26 respondents who indicated that they provide the procedure reported frequency of follow-up visits. In the majority of cases (four), these were every 6 months.

Iontophoresis (tap water)

The treatment details for iontophoresis (tap water) are summarised in Table 68 (the most frequent responses are shown), based on the responses from the 35 dermatologists who indicated that they provide this treatment.

TABLE 68

TABLE 68

Most frequent responses on resource use associated with iontophoresis (tap water)

The results presented in Table 68 highlight the uncertainty and variability in responses among dermatologists in relation to iontophoresis (tap water) treatment. This could potentially be explained by the fact that the survey was completed by dermatologists, whereas the procedure is normally carried out by a nurse.

Iontophoresis (glycopyrrolate)

Eight of the 10 respondents that indicated that they provide iontophoresis (glycopyrrolate) reported the job title of the health professional. According to all eight, the procedure is delivered by a specialist nurse. Six of the 10 clinicians stated that the procedure could be done at home. Five of the six respondents who reported the length of the procedure said that the procedure would last for up to 1 hour (varied between 15 and 60 minutes).

Curettage

Only one dermatologist provided treatment details about curettage surgery. According to the respondent, the procedure would last for 30 minutes, it would be delivered by a consultant dermatologist and there would be one follow-up visit that would last for 5 minutes.

Adverse events and treatment effectiveness

Dropout rates due to adverse events and lack of effectiveness

The survey respondents were asked to indicate the dropout rates for each type of treatment due to both lack of effectiveness and adverse events. The percentage of who drop out, according to the respondents, was recorded. Results are presented in Tables 69 and 70.

TABLE 69

TABLE 69

Dropout rates due to lack of effectiveness

TABLE 70

TABLE 70

Dropout rates due to adverse events

In the case of aluminium chloride and iontophoresis (tap water and glycopyrrolate), dropout rates due to lack of effectiveness were higher than dropout rates due to side effects. For medications, the dropout rates were similar in both categories. Overall, the dropout rates are relatively high for both of the reasons.

Time to effectiveness

As sufficient clinical advice on time to effectiveness had already been obtained for all types of treatment except for medications, data were only collected for medications. The responses varied significantly, from ‘immediate’ to ‘up to 3 months’. The most common response was ‘variable’ (stated by 8 out of 38 respondents).

Survey questions

  1. What is the name of the town/city to which your responses relate?
  2. What is the name of the hospital trust(s) to which your responses relate?
  3. What medications, and with what dose and frequency, do you prescribe to hyperhidrosis patients?
  4. What is the time to effectiveness of medication for hyperhidrosis?
  5. If a hyperhidrosis patient is on medication:
    1. How frequently would a monitoring visit (follow-up visit following the prescription of medication) be required?
    2. What is the duration of one monitoring visit? (In minutes.)
    3. Job title of the health professional(s) that is present at the monitoring visit.
  6. Is there an ongoing risk of dropout due to adverse events related to medication use beyond 1 month?
  7. Is Botox procedure available at your dermatology unit?
  8. What is the job title of the health professional(s) that delivers the procedure?
  9. What is the duration of the procedure (in minutes)?
  10. How many monitoring visits following Botox treatment and how often do they occur?
  11. Is curettage surgery (for hyperhidrosis) available at your dermatology unit?
  12. What is the duration of the surgery? (In minutes.)
  13. What is the job title of the health professional(s) that delivers the procedure?
  14. What is the duration of monitoring visits? (In minutes.)
  15. What is the frequency of monitoring visits?
  16. What are the side effects?
  17. What are the treatments of side effects?
  18. Is laser surgery available at your dermatology unit?
  19. What is the duration of the surgery? (In minutes.)
  20. What is the job title of the health professional(s) that delivers the procedure?
  21. What is the duration of monitoring visits? (In minutes.)
  22. What is the frequency of monitoring visits?
  23. What are the side effects?
  24. What are the treatments of side effects?
  25. Is microwave surgery available at your dermatology unit?
  26. What is the duration of the surgery? (In minutes.)
  27. What is the job title of the health professional(s) that delivers the procedure?
  28. What is the duration of monitoring visits? (In minutes.)
  29. What is the frequency of monitoring visits?
  30. What are the side effects?
  31. What are the treatments of side effects?
  32. Is ultrasound treatment of hyperhidrosis available in your unit/hospital?
  33. What is the duration of the surgery? (In minutes.)
  34. What is the job title of the health professional(s) that delivers the procedure?
  35. What is the duration of monitoring visits? (In minutes.)
  36. What is the frequency of monitoring visits?
  37. What are the side effects?
  38. What are the treatments of side effects?
  39. Is radiofrequency treatment of hyperhidrosis available in your unit/hospital?
  40. What is the duration of the surgery? (In minutes.)
  41. What is the job title of the health professional(s) that delivers the procedure?
  42. What is the duration of monitoring visits? (In minutes.)
  43. What is the frequency of monitoring visits?
  44. What are the side effects?
  45. What are the treatments of side effects?
  46. Is iontophoresis (with tap water) available at your dermatology unit?
  47. What is the model of the iontophoresis machine used at the hospital?
  48. Approximately, what is the proportion (%) of patients who would carry on with the treatment at home?
  49. What is the model of the iontophoresis machine recommended for home use?
  50. What are the side effects?
  51. What are the treatments of the side effects?
  52. Is iontophoresis (with glycopyrrolate) available at your dermatology unit?
  53. What is the job title of the health professional(s) that delivers the procedure?
  54. What is the duration of the procedure? (In minutes.)
  55. What are the side effects?
  56. What are the treatments of the side effects?
  57. Can the patient have the procedure at home?
  58. Approximately what proportion of patients (%) would carry on with the treatment at home?
  59. Approximately, please indicate the dropout rates (%) due to lack of effectiveness for the following treatments:
    1. antiperspirants
    2. medication
    3. iontophoresis (tap water)
    4. iontophoresis (glycopyrrolate).
  60. Approximately, please indicate the dropout rates (%) due to side effects for the following treatments:
    1. antiperspirants
    2. medication
    3. iontophoresis (tap water)
    4. iontophoresis (glycopyrrolate).
Copyright © Queen’s Printer and Controller of HMSO 2017. This work was produced by Wade et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Bookshelf ID: NBK470639
Contents

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (2.9M)

In this Page

Other titles in this collection

Recent Activity

ClearTurn OffTurn On

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...