Iontophoresis for Palmar and Plantar Hyperhidrosis




Iontophoresis is a safe, efficacious, and cost-effective primary treatment of palmar and plantar hyperhidrosis. Decades of clinical experience and research show significant reduction in palmoplantar excessive sweating with minimal side effects. To get the best results from iontophoresis, health care professionals need to provide education on the mechanism of action and benefits, evidence of its use, and creation of a future patient-specific plan of care for continued treatments at home or in the physician’s office. Iontophoresis may be combined with other hyperhidrosis treatments, such as topical antiperspirants and botulinum toxin injections.


Key points







  • •

    Iontophoresis has a long history of safe and effective use.


  • •

    Once a home device is obtained and the patient has received adequate education and training, the maintenance cost and effort are minimal for the patient and health care provider, alike.


  • •

    Iontophoresis should not be overlooked as a primary treatment of palmar and plantar hyperhidrosis.




Iontophoresis has been used to treat palmar hyperhidrosis ( Fig. 1 ) and plantar hyperhidrosis ( Fig. 2 ) for more than 70 years. Although its mechanism of action is still not entirely understood, iontophoresis has proved to provide reliable, effective treatment when practiced with appropriate technique, timing, and tweaks (as necessary). Patients who prefer to manage their excessive sweating treatment at home may find that, after they have learned the treatment process from a health care professional, iontophoresis is a particularly attractive option. In addition, many health insurance programs consider treatment with iontophoresis for hyperhidrosis medically necessary when antiperspirants have been ineffective or have resulted in a skin irritation.




Fig. 1


Severe palmar hyperhidrosis for treatment by iontophoresis.

( Courtesy of Albert Ganss, International Hyperhidrosis Society, Quakertown, PA; with permission.)



Fig. 2


Severe plantar hyperhidrosis for treatment by iontophoresis.

( Courtesy of Albert Ganss, International Hyperhidrosis Society, Quakertown, PA; and Adelaide Hebert, MD, University of Texas, Houston, TX; with permission.)


Iontophoresis is the passing of an ionized substance through intact skin by the application of a direct electrical current. In most cases, simple tap water and an iontophoresis medical device are all that is required to achieve sweat relief, and many dermatologists consider the treatment to be first line to address primary focal palmar or plantar hyperhidrosis. In some situations, adjustments to the regimen may be necessary (eg, adding baking soda or an anticholinergic to the water); these are discussed later. Three iontophoresis devices are available in the United States, and registered with the US Food and Drug Administration for the treatment of hyperhidrosis. These devices are the R.A. Fischer (both MD-1a and MD-2 models) and the Drionic.


As mentioned earlier, studies have not yet fully explained the provenance of the efficacy of ontophoresis. However, there are several theories, including the plugging of sweat glands as a result of ion deposition, a blocking of sympathetic nerve transmission, or a decrease in pH as a result of accumulation of hydrogen ions.




Efficacy


Regardless of why it works, studies have shown that iontophoresis does provide relief from excessive sweating symptoms for many patients. For instance, an early (1952) observational study of iontophoresis in 113 patients with palmoplantar hyperhidrosis reported a response rate of 91% and showed that adding ionizable agents to the water did not improve the results.


In a study published in 1987, 18 patients with palmar hyperhidrosis were treated with iontophoresis for 1 hand, and the other hand served as the control. These patients were treated with 12 to 20 mA for 20 minutes, 3 times a week, for 3 weeks. The results showed that 15 of 18 participants had markedly reduced sweat production in their treated hands.


In addition, a 1989 controlled trial with 11 patients randomized to actual or sham procedures reported 81% reduction in sweat production measured by gravimeter after a median of 10 treatments. The symptom improvement was thereafter maintained with treatment every other week. Similarly, a 2002 controlled trial of 112 patients diagnosed with palmar hyperhidrosis showed that, after 8 treatments, sweating was reduced 81.2% from baseline. This reduction was seen 20 days after the eighth treatment, with the mean return of symptoms occurring at 35 days.

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Feb 12, 2018 | Posted by in Dermatology | Comments Off on Iontophoresis for Palmar and Plantar Hyperhidrosis

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