INTRODUCTION
• Hyperhidrosis is a chronic medical condition characterized by excess sweat production beyond 

that which is necessary to maintain thermal homeostasis, affecting an estimated 4.8% of the 
United States (US) population1 

• The condition has reportedly been associated with impacts on health‑related quality of life, 
social and emotional stress, and a relatively high risk of concomitant depression and anxiety2‑5

• Real‑world observational data are limited in patients with hyperhidrosis, suggesting that 
additional research is warranted

OBJECTIVES
• To describe clinical characteristics and treatment patterns of patients with hyperhidrosis

• To determine the prevalence of depression and anxiety among patients with hyperhidrosis 
relative to patients in a control cohort

• To examine health care resource utilization (HCRU) and costs associated with concomitant 
depression and/or anxiety in patients with hyperhidrosis

METHODS
Patient Selection
• Patients were identified from January 2010 through November 2017 from the Optum Research 

Database, a de‑identified database that contains medical and pharmacy information for 
commercial and Medicare Advantage claims 

• Inclusion criteria for patients newly diagnosed with hyperhidrosis were 

 – Commercial health plan members with continuous enrollment with medical and pharmacy 
coverage for 12 months before (the baseline or pre‑index period) and ≥12 months after the 
index date (follow‑up period) 

 – ≥2 hyperhidrosis diagnosis codes and/or prescription claims for extra‑ or prescription‑strength 
antiperspirant; the index date was the first observed claim indicating hyperhidrosis

 – No claims for medical procedures (botulinum toxin A, microwave thermolysis, suction 
curettage, iontophoresis, endoscopic thoracic sympathectomy) with codes specific to 
hyperhidrosis treatment during the baseline period

 – No claims for the above medical procedures or pharmacy claims for oral systemic therapies 
not specific to hyperhidrosis treatment within 7 days of the index date

• Patients in the hyperhidrosis cohort were followed for a variable period of ≥12 months

• A control cohort (CC) was constructed with comparable index year, age, gender, and health plan 
region to the hyperhidrosis cohort, and had the following key inclusion criteria

 – No evidence of hyperhidrosis based on medical claims or pharmacy claims for 
prescription‑strength antiperspirants

 – Continuous enrollment criteria identical to that of the hyperhidrosis cohort

• The index date for control cohort patients was selected as a random date of health care 
resource utilization during the identification period, such as an office visit, inpatient admission, 
or a prescription claim; patients were followed for a fixed 12‑month period beginning on 
the index date

Outcomes
• Outcome variables were

 – Index year, age, gender, and geographic region

 – Baseline comorbid conditions, defined using indicator variables for specific disease 
conditions based on International Classification of Disease (ICD)‑9‑CM and ICD‑10 
diagnoses employed by the Clinical Classifications Software, managed by the Agency for 
Healthcare Research and Quality

 – Hyperhidrosis treatments (hyperhidrosis cohort only, variable follow‑up period)

• These were determined by claims made during a variable follow‑up period for 
prescription‑strength antiperspirants, botulinum toxin A injections, oral systemic 
therapies, microwave thermolysis, suction curettage, iontophoresis, endoscopic thoracic 
sympathectomy, and/or glycopyrronium cloth

 – Proportion of days covered (PDC), a measure of adherence to chronic medications 
(hyperhidrosis cohort only)

• PDC was calculated for the first 12 months of follow‑up by dividing the number of days 
on which medication was available based on filled prescriptions by the number of days 
between the earliest prescription claim in the observation period through the end of the 
observation period (i.e., twelve months of follow‑up)

 – Depression and/or anxiety claims (hyperhidrosis and control cohort, 12‑month follow‑up 
period)

• Depression was defined as ≥1 medical claim with a diagnosis code for depression in 
any position and/or ≥1 pharmacy claim for a medication indicated specifically as an 
antidepressant

• Anxiety was defined as ≥1 medical claim with a diagnosis code for anxiety in any position 
and/or ≥1 pharmacy claim for a medication indicated specifically as an anxiolytic 

• Depression and/or anxiety was defined as above while also including patients without a 
diagnosis code for depression or anxiety but with ≥1 pharmacy claim for a medication 
indicated for the treatment of both depression and anxiety

• Second indicator variables identified patients with new depression, anxiety, and depression 
and/or anxiety (claims that were not identified during the pre‑index period)

 – All‑cause HCRU within the hyperhidrosis cohort; patients with ≥1 ambulatory visit, 
≥1 emergency department (ER visit), or ≥1 inpatient stay during follow‑up were identified, and 
each type of encounter was counted

 – All‑cause health care costs within the hyperhidrosis cohort, calculated as combined health 
plan and patient paid amounts; costs were inflation‑adjusted to 2018 dollars using the annual 
medical care component of the Consumer Price Index

Analysis

• All variables were analyzed descriptively

• The occurrence, counts, and time until treatments were summarized; to account for variable 
follow‑up, binary indicators of treatments and counts of the number of treatments were also 
presented as incidence rates, with rates per person‑year, the number of events (i.e., patients 
who had the treatment), and the number of person‑years; a Kaplan‑Meier analysis of the time 
until the first use of each treatment (the “event”) for all patients as a function of time was also 
performed

• A multivariable logistic regression model examined the presence of depression/anxiety in 
the patient cohort while controlling for patient characteristics including gender, age, and 
geographic region, any post‑index hyperhidrosis treatment, and five common comorbidities 
(respiratory infections, other lower respiratory infections, other upper respiratory infections, 
other gastrointestinal disorders, and other skin conditions) identified by the AHRQ software6 in 
this sample

• Comparisons between cohorts were performed with t‑tests or chi‑square statistics, as 
appropriate

• P values were computed with clustering to account for dependence between subjects due to 
matching; Z‑tests using robust standard errors in an Ordinary Least Squares regression were 
used for continuous measures, and Rao‑Scott tests were used for binary measures

• Depression and anxiety claims were summarized for the baseline period, the total follow‑up 
period, and new claims made only during the follow‑up period

RESULTS
Sample Selection

• Of 309,709 individuals identified with at least 1 claim for a prescription‑strength antiperspirant 
or an ICD code for hyperhidrosis, 44,484 patients met selection criteria for inclusion in the 
hyperhidrosis cohort; the control cohort was comprised of 137,451 patients 

Patient Characteristics 

• Patients in the hyperhidrosis cohort were a mean age of 36.5 ± 16.5 years (CC=40.2 ± 16.9); 
83.5% were ≥18 years of age (CC=87.8%), and 58.5% were female (CC=56.0%) 

• The baseline comorbid conditions that showed the greatest difference in frequency between the 
hyperhidrosis and control cohorts were respiratory infections (39.0% hyperhidrosis vs. 30.7% 
control) and other skin disorders (30.9% hyperhidrosis vs 20.5% control) (Table 1)

 – Acne (9%), rash and other non‑specific skin eruption (3%), and actinic keratosis (3%) were 
the most common comorbid skin disorders in the hyperhidrosis cohort (CC= 6%, 3%, and 
3%, respectively)

Table 1. Common Patient Comorbidities at Baseline

AHRQ comorbidities  

Hyperhidrosis
Cohort

(N=44,484)

Control
Cohort

(N=137,451)

Respiratory infections
n 17,330 42,227

% 38.96 30.72

Other skin disorders
n 13,734 28,187

% 30.87 20.51

Other connective tissue disease
n 12,745 33,509

% 28.65 24.38

Disorders of lipid metabolism
n 8,929 29,148

% 20.07 21.21

Non‑traumatic joint disorders 
n 10,623 29,874 

% 23.88 21.73 

Spondylosis; intervertebral disc 
disorders; other back problems 

n 10,338 27,537 

% 23.24 20.03 

Diseases of female genital organs
n 9,685 25,605 

% 21.77 18.63 

Eye disorders 
n 9,179 26,153 

% 20.63 19.03 

Other lower respiratory disease
n 8,840 20,785

% 19.87 15.12

Hypertension
n 8,220 27,769

% 18.48 20.20

All comorbid conditions listed were significantly higher in the hyperhidrosis vs control cohort (P<0.001) except disorders of lipid 
metabolism and hypertension, which were significantly higher in the control cohort (P<0.001)  
As sample sizes were large, statistical significance was easily achieved due to overpowering.
P values were computed with clustering; Rao‑Scott test was used for binary measures 
Comorbidities were identified by Clinical Classification Software for ICD‑9‑CM/ICD‑10‑CM codes from the AHRQ 
AHRQ, Agency for Healthcare Research and Quality; ICD, International Classification of Disease

Treatment Patterns

• A slight majority of patients in the hyperhidrosis cohort (51.6%) received treatment with 
prescription antiperspirants, while 13.1% had prescription fills for oral systemic therapies; a very 
small percentage of the hyperhidrosis sample received procedures for hyperhidrosis treatment, 
including botulinum toxin A (Figure 1) 

• Prescription antiperspirants were the earliest initiated therapies in the hyperhidrosis cohort 
during the variable follow‑up period, with a mean ± SD time to first prescription fill of 1.4 ± 6.3 
months (Table 2); this is consistent with the International Hyperhidrosis Society (IHhS) clinical 
treatment algorithm, which generally recommends antiperspirants as a first line of therapy for 
hyperhidrosis

 – While glycopyrronium cloth is also recommended by the IHhS as a first line treatment for 
primary axillary hyperhidrosis, the therapy was not available in the US until October 2018; 
since the study included data through November 2018, there were very few prescriptions 
made for glycopyrronium cloth (n=6) in this dataset, precluding meaningful analysis of the 
treatment option 

• On average, other treatments were not initiated until over a year after the index date, including 
oral systemic therapies, which had a mean time to initiation of 16.9 ± 19.1 months (Table 2)

 – These results were confirmed with Kaplan‑Meier analyses of adjusted time to treatments and 
procedures (Figure 2)

• The incidence rate shows the average frequency of treatment for patients in a given year; 
incidence rates adjusted for the variable follow‑up period ranged from 0.29 (endoscopic thoracic 
sympathectomy) to 1.80 (oral systemic therapies) per person years (Table 2)

• Adherence to prescription medications was low over 12 months, with mean ± SD PDC of only 
0.13 ± 0.09 for prescription antiperspirants and 0.30 ± 0.28 for oral systemic therapies (Table 2)

Figure 1. Treatments in the Hyperhidrosis Cohort

51.60

13.09

2.48
0.13 0.16 1.04 0.19

0

10

20

30

40

50

60

P
er

ce
nt

ag
e 

of
 P

at
ie

nt
s 

R
ec

ei
vi

ng
 T

h
er

ap
y

ES/PS
Antiperspirants

(n=22,954)

Oral Systemic
Therapies
(n=5,823)

Botulinum
Toxin A

(n=1,104)

Microwave
Thermolysis

(n=58)

Suction
Curettage

(n=70)

Iontophoresis
(n=463)

Endoscopic
thoracic

sympathectomy
(n=85)

ES; extra strength; PS, prescription strength
Treatment categories are not mutually exclusive; percentages do not account for variable follow‑up period

Table 2. Hyperhidrosis Cohort (n=44,484) Therapies and Procedures

Therapy or Procedure

Time to
First

Occurrence
 of Therapy
/Procedure
(Months),

Mean (SD)a

Incidence Rates 
Proportion

of Days 
Covered 
(PDC)b ,

Mean (SD)Events
Person
Years

Rate per
Person
 Years

Prescription‑Strength 
Antiperspirants
(n=22,954)

1.4 (6.3) 57,756 83,472 0.69 0.13 (0.09)

Oral Systemic Therapies 
(n=5,823) 16.9 (19.1) 40,965 22,709 1.80 0.30 (0.28)

Botulinum Toxin A
(n=1,104) 15.1 (19.5) 3,683 4,530 0.81

Microwave Thermolysis
(n=58) 19.9 (17.8) 379 239 1.59

Suction Curettage
(n=70) 19.7 (18.2) 105 279 0.38

Iontophoresis
(n=463) 22.9 (20.8) 1,733 2,097 0.83

Endoscopic Thoracic 
Sympathectomy
(n=85)

15.0 (21.8) 98 338 0.29

aTimes do not account for variable follow‑up period within sample
bProportion of days covered (PDC) was calculated for prescription medications and/or prescription‑strength antiperspirants only

F igure 2. Kaplan‑Meier Analysis of Adjusted Time to Treatments and 
Procedures 

40%

50%

60%

70%

80%

90%

100%

0 6 12 24 36 48 60 72 84 96

P
ro

p
or

ti
on

 o
f P

at
ie

nt
s 

U
nt

re
at

ed

 Endoscopic thoracic sympathectomy  Iontophoresis
 Botulinum Toxin A Injection  Oral Systemic Therapies
 Extra- or Prescription-Strength Antiperspirant

Time to Treatment (Months)

Glycopyrronium cloth, microwave thermolysis, and suction curettage were also measured; very few patients had these treatments and 
their trend lines are therefore not shown
Log‑rank test was used for assessing equality of survival distributions

Emotional Health Characteristics
• The percentage of patients with depression or anxiety (Figure 3) during the 12‑month baseline 

(pre‑index) period was 35% in the hyperhidrosis cohort (CC=26%, P<0.001)

• This percentage increased during the 12‑month follow‑up period, with a significantly higher 
percentage of patients in the hyperhidrosis cohort with reports of depression or anxiety than in 
the control group (41.1% vs 28.2%, P<0.001), as well as with newly diagnosed depression or 
anxiety (18.2%  vs 10.6%, P<0.001)

• Patients in the hyperhidrosis cohort had nearly 1.8 times higher odds of depression or anxiety 
than those in the control cohort while controlling for other variables (odds ratio=1.76, 95% 
confidence interval 1.7‑1.8, P<0.001; Table 3) 

• Older patients, females, and subjects with comorbid conditions, particularly gastrointestinal 
disorders, were more likely to experience depression or anxiety (Table 3)

Figure 3. Patients with Depression and/or Anxiety During Pre‑Index and 
Follow‑Up Periods

0.0

10.0

20.0

30.0

40.0

50.0

P
er

ce
nt

ag
e 

of
 P

at
ie

nt
s

Depression Anxiety Depression or Anxiety

18.4

13.0

* 21.6

14.3

*
27.8

17.4

*

35.2

26.0

*
41.1

28.2

*

22.4

15.9

*

12-mo follow-upPre-index 12-mo follow-upPre-index 12-mo follow-upPre-index 

Hyperhidrosis
Control

*P<0.001
P values were computed with clustering; Rao‑Scott test was used for binary measures

Table 3. Logistic Regression Model of 12‑month Post‑Index  
Depression or Anxiety

Independent Variables

Post‑Index Depression or Anxiety

Odds 
Ratio

Lower 
95% CI

Upper 
95% CI P value

Hyperhidrosis cohort 1.756 1.715 1.798 <0.001

AHRQ Comorbidities

 Respiratory infections 1.278 1.249 1.308 <0.001

 Other lower respiratory infections 1.434 1.395 1.475 <0.001

 Other upper respiratory infections 1.242 1.207 1.279 <0.001

 Other gastrointestinal disorders 1.824 1.767 1.882 <0.001

 Other skin conditions 1.197 1.168 1.226 <0.001

Gender

 Female 1.751 1.714 1.789 <0.001

 Male ref. – – –

Age

 <9 0.160 0.136 0.189 <0.001

 9‑17 0.368 0.355 0.382 <0.001

 18‑24 0.643 0.621 0.665 <0.001

 25‑34 0.781 0.758 0.804 <0.001

 35+ ref. – – –

Observations read = 181,935, Observations used= 181,935
AHRQ, Agency for Healthcare Research and Quality; CI, confidence interval

Depression, Anxiety, Health Care Costs, and Utilization among Patients with 
Hyperhidrosis in a Real‑World Database Analysis
M. Hull,1* K.K. Gillard,2 J. Peterson‑Brandt,1 S.Z. Klein3
1OptumInsight Life Sciences, Eden Prairie, MN, USA; 2Dermira, Inc., a wholly‑owned subsidiary of Eli Lilly and Company, Menlo Park, CA, USA; 3University of Utah Hospital, Salt Lake City, UT, USA
*Michael Hull was an employee of Optum at the time the study was conducted

Poster presented virtually at the Fall Clinical Dermatology Conference • October 29 ‑ November 1, 2020

Healthcare Costs and HCRU

• While the distribution pattern of costs within the hyperhidrosis cohort was similar between 
patients with depression/anxiety and those without, patients with depression/anxiety had 
significantly higher mean [median] all‑cause total costs ($1905 [$636] vs $673 [$197]; P<0.001, 
and all‑cause medical costs ($1598 [$412] vs $544 [$127]; P<0.001) than those without 
depression/anxiety (Figure 4A)

 – On average, ambulatory costs were the source of highest medical expense for patients both 
with and without depression/anxiety (Figure 4B)

Figure 4. Follow‑up Health Care Costs within the Hyperhidrosis Cohort 

A. Overall Medical and Pharmacy Costs

$636.24

$412.26

$99.74
$197.17

$126.89
$24.73

0

400

800

1200

1600

2000

Total Costs (Medical + Pharmacy) Medical Costs Pharmacy Costs

M
ed

ia
n 

C
os

t 
(I

Q
R

) 
U

S
 $

Depression/
Anxiety 

(N=18,266)

Non-
Depression/

Anxiety 
(N=26,218)

Depression/
Anxiety

(N=18,266)

Non-
Depression/

Anxiety
(N=26,218)

Depression/
Anxiety (N=18,266)

Non-
Depression/

Anxiety (N=26,218)

Mean $1,905.39 $672.91 $1,598.12 $543.92 $307.28 $128.99

SD $5,050.82 $2,202.78 $4,865.60 $2,015.12 $739.93 $633.40

Depression/Anxiety Patients (N=18,266)
Non-Depression/Anxiety Patients (N=26,218)

P<0.001 for all comparisons between patients with and without depression/anxiety based on mean values
IQR, interquartile range 

B. Medical Costs by Encounter

$0 $0 $15.62

$319.10

$105.87 

$0 $0 $3.73 
$0.00

$400.00

$800.00

Ambulatory Costs Emergency Room Costs Inpatient Costs Other Medical Costs

M
ed

ia
n 

C
os

t 
(I

Q
R

) 
U

S
 $

Depression/
Anxiety

(N=18,266)

Non -
Depression/

Anxiety
(N=26,218)

Depression/
Anxiety

(N=18,266)

Non -
Depression/

Anxiety 
(N=26,218)

Depression/
Anxiety

(N=18,266)

Non-
Depression/

Anxiety
(N=26,218)

Depression/
Anxiety

(N=18,266)

Non-
Depression/

Anxiety
(N=26,218)

Mean $940.41 $360.40 $39.29 $13.26 $481.20 $122.69 $137.22 $47.58

SD $2,411.34 $1,219.50 $222.33 $62.64 $3,057.61 $1,060.43 $789.99 $539.02

Depression/Anxiety Patients (N=18,266)
Non-Depression/Anxiety Patients (N=26,218)

$0 $0 $15.62

$319.10

$105.87 

$0 $0 $3.73 
$0.00

$400.00

$800.00

Ambulatory Costs Emergency Room Costs Inpatient Costs Other Medical Costs

M
ed

ia
n 

C
os

t 
(I

Q
R

) 
U

S
 $

Depression/
Anxiety

(N=18,266)

Non -
Depression/

Anxiety
(N=26,218)

Depression/
Anxiety

(N=18,266)

Non -
Depression/

Anxiety 
(N=26,218)

Depression/
Anxiety

(N=18,266)

Non-
Depression/

Anxiety
(N=26,218)

Depression/
Anxiety

(N=18,266)

Non-
Depression/

Anxiety
(N=26,218)

Mean $940.41 $360.40 $39.29 $13.26 $481.20 $122.69 $137.22 $47.58

SD $2,411.34 $1,219.50 $222.33 $62.64 $3,057.61 $1,060.43 $789.99 $539.02

Depression/Anxiety Patients (N=18,266)
Non-Depression/Anxiety Patients (N=26,218)

P<0.001 for all comparisons between patients with and without depression/anxiety based on mean values; IQR, interquartile range

• A significantly higher percentage of patients with depression/anxiety had an inpatient stay 
(12.9% vs 4.8%; P<0.001) and emergency room visit (43.3% vs 26.0%; P<0.001) when 
compared with patients who did not have depression/anxiety (Figure 5)

Figure 5. Follow‑up Health Care Resource Utilization within the 
Hyperhidrosis Cohort

99.8 98.6

43.3

26.0

12.9

4.8

0

20

40

60

80

100

120

Ambulatory visit Emergency room visit Inpatient visit

Depression/Anxiety Patients (N=18,266)
Non-Depression/Anxiety Patients (N=26,218)

P
er

ce
nt

ag
e 

of
 P

at
ie

nt
s

All patient comparisons were significant at P<0.001

Limitations
• Acknowledging that errors may occur with diagnosis codes and claims, the risk of misidentifying 

hyperhidrosis was mitigated by the requirement of at least two claims indicating the condition for 
patient study inclusion; identification of depression or anxiety required a single claim 

• Codes for procedures and oral systemic therapies were generally not specific to the treatment 
of hyperhidrosis; this was addressed by excluding patients with non‑specific codes for these 
procedures or pharmacy codes for oral systemic therapies within seven days before or after the 
index date

 – However, all instances of these procedures and medications (codes for botulinum 
toxin A, microwave thermolysis, suction curettage, iontophoresis, endoscopic thoracic 
sympathectomy, and pharmacy codes for oral systemic therapies) were counted in the 
follow‑up period, which may have led to an overestimation of the frequency of the procedures 
used for hyperhidrosis treatment

• Results and conclusions are limited to patients enrolled in managed care plans accessible from 
the Optum Research Database and may not be generalizable to other commercially insured 
populations in the US 

• Prescriptions filled outside the pharmacy benefit (out‑of‑pocket), drug samples, and 
over‑the‑counter medications were not captured, which could potentially overestimate the 
proportion of untreated patients; this is of particular note since over‑the‑counter antiperspirants 
may be appropriate for some hyperhidrosis patients 

• Counts and percentages of treatments and procedures used, as well as mean time to first 
receipt of treatments do not account for censoring; incidence rates, along with Kaplan‑Meier 
analyses of adjusted time to treatment were included to address the variable follow‑up period

• The potential relationship between treatment of hyperhidrosis and a diagnosis of depression 
and/or anxiety was not assessed, and the observational study design precludes causal 
assessment of the relationship between hyperhidrosis and anxiety and/or depression

• There may be confounding variables other than the presence of anxiety and depression that 
could have driven the differences in HCRU and costs; multivariable regression analysis was 
not conducted, and the relationship between depression or anxiety and outcomes is further 
confounded because depression/anxiety cohort assignment was based on follow‑up diagnoses

CONCLUSIONS
• This real‑world observational data analysis shows that substantial comorbid depression 

and anxiety exist among patients in a hyperhidrosis cohort relative to a control group, 
both prior to and following diagnosis of hyperhidrosis or following a prescription for 
excessive sweating

 – Other comorbidities at baseline (eg, respiratory conditions and other skin conditions) 
were more common in the hyperhidrosis cohort, which may underlie some differential 
patterns of healthcare resource utilization relative to the control cohort

• Adherence (defined by proportion of days covered) to prescription antiperspirants and 
oral systemic therapies was poor, suggesting that tolerability and efficacy may be limiting 
factors to effective treatment of hyperhidrosis

• In patients with hyperhidrosis, all‑cause health care costs and HCRU were significantly 
higher in those who experienced depression/anxiety when compared to those without 
depression/anxiety

• These results demonstrate higher overall health care burden for the hyperhidrosis patient 
population

• Further research and provider attention are needed to elucidate the emotional burden 
experienced by patients following a diagnosis of hyperhidrosis

REFERENCES
1. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. 

Arch Dermatol Res 2016; 308(10):743‑749.

2. Smith CC, Pariser D. Primary focal hyperhidrosis. Up‑to‑date 2018: https://www.uptodate.com/contents/
primary‑focal‑hyperhidrosis?search=hyperhidrosis&source=search_ result&selectedTitle=1~150&usage_ 
type=default&display_rank=1.

3. Bahar R, Zhou P, Liu Y, Huang Y, et al. The prevalence of anxiety and depression in patients with or without 
hyperhidrosis (HH). J Am Acad Dermatol. 2016;75:1126‑1133.

4. Braganca GM, Lima SO, Pinto Neto AF, et al. Evaluation of anxiety and depression prevalence in patients with primary 
severe hyperhidrosis. An Bras Dermatol. 2014;89(2):230‑235.

5. Kamudoni P, Mueller B, Halford J, Schouveller A, Stacey B, Salek MS. The impact of hyperhidrosis on patients’ daily 
life and quality of life: a qualitative investigation. Health Qual Life Outcomes. 2017;15(1):121.

6. Clinical Classification Software (CCS) for ICD‑9‑CM/ICD‑10‑CM. Agency for Healthcare Research and Quality, 
Rockville, MD. www.hcup‑us.ahrq.gov/toolssoftware/ccs/ccs.jsp

ACKNOWLEDGEMENTS
This study and all costs associated with development of this poster were funded by Dermira, Inc., a wholly‑owned 
subsidiary of Eli Lilly and Company. Medical writing support was provided by Prescott Medical Communications Group 
(Chicago, IL). 

DISCLOSURES
SZK: employed by Dermira as a consultant; KKG: employee of Dermira, Inc., a wholly‑owned subsidiary of Eli Lilly and 
Company; MH: employee of Optum at the time study was conducted, which received funding for this research; JPB: 
employee of Optum, which received funding for this research