Iontophoresis for Palmar and Plantar Hyperhidrosis

Iontophoresis is one of the many treatment options available for people trying to manage hyperhidrosis with a doctor. It is a treatment modality that uses a machine to pass a current through a patients hands or feet in order to reduce the amount of sweat the produce. It may sound scary, but it is painless and quite effective.
Iontophoresis for Palmar and Plantar Hyperhidrosis

Iontophoresis is one of the many treatment options available for people trying to manage hyperhidrosis with a doctor. The process of iontophoresis involves passing an ionized substance through the skin with the use of a direct current.[1] Iontophoresis is most effective for the treatment of treating sweaty hands and feet, these are also known as palmar and plantar hyperhidrosis respectively. Once a patient becomes comfortable with the iontophoresis process, a machine can also be purchased by patients and used to manage their hyperhidrosis at home.

It is usually considered to be a third line treatment and is typically used after both topical treatments for hyperhidrosis and oral medications have been tried, and deemed unsuccessful at alleviating symptoms.[2] Interestingly, iontophoresis is a treatment that has been available for the past 70 years and is considered to be very effective although it is not well understood.[1]

How does iontophoresis work?

Iontophoresis essentially works by delivering an ionized substance, usually tap water or a medication when necessary, into a patient’s eccrine (sweat) glands, through the use of an electrical current. As the current travels across the patient’s skin, the ionized tap water or medication is able to affect sweat glands in such a way that it reduces their ability to produce sweat. The mechanism behind this effect is not well understood. Most of the time iontophoresis only requires tap water to be used, but if that is not working there are ways to make iontophoresis more effective. Doctors can add medication, usually an anticholinergic like glycopyrrolate or oxybutynin, to the tap water to make iontophoresis more effective for patients who are not getting satisfactory results. Skin is semi-permeable and therefore only allows a small amount of any drug to cross into a patient’s body. Iontophoresis aids the body’s absorption of the drug because the electric current drives the medication through the barrier of the skin. This is especially important for the absorption of ionized drugs because they cannot otherwise pass through the skin.

Although it may sound unpleasant, iontophoresis is considered to be safe and noninvasive. It is not a painful treatment, and it is actually less painful than other comparable treatment options like botox for palmar and plantar hyperhidrosis.[3]

There are three types of iontophoresis machines available in the United States that are currently approved by the FDA.[1] When using an iontophoresis machine a patient will most likely have two electrodes (these can be trays of water) attached to the affected area, one passive and one active, which will also be connected with wires to a voltage delivery system. Once turned on, the current passes through the water and moves it through the skin via the current. A patient undergoing treatment must repeat the iontophoresis process multiple times over a period of time to see results.[3]

There are several theories about why iontophoresis works so well, but the truth is that no one is sure why it is so effective. Some of the proposed theories suggest that iontophoresis may work because ion deposition plugs the sweat glands, or because it decreases the pH of skin. Another theory asserts that iontophoresis blocks sympathetic nerve transmission. Despite the fact that science has yet to fully explain the phenomenon, it is agreed that iontophoresis is able to slow overactive sweat glands and shows measurable benefits to those with palmar and plantar hyperhidrosis.[1]

Efficacy of Iontophoresis

It is accepted in the medical community that iontophoresis really works as a treatment for palmar hyperhidrosis and plantar hyperhidrosis, especially considering that is it less invasive than some of the other treatments available. A number of studies have shown significant improvement in participants, although the reason for improvement is not well understood.[1] A study of 112 patients with hyperhidrosis done in 2002 found that they had an 81.2% reduction of symptoms from their original baseline and these findings are concurrent with findings from other similar studies.[1]

Advantages of Iontophoresis

The main advantage of iontophoresis is that it is a noninvasive treatment that can give patients measurable results. Another benefit of iontophoresis is that it treat hyperhidrosis locally. Unlike oral medications, which can have systemic effects on the body, iontophoresis only affects the areas of the body where is it applied. Iontophoresis also doesn't come with as many possible complications or side effects as other available treatments.[3] It is a mode of treatment that can be used when first line treatments fail, but before considering more invasive and possibly dangerous treatments like endoscopic thoracic sympathectomy. Iontophoresis can be used in a patient’s home and is a relatively inexpensive and low-risk therapy. The cost of hyperhidrosis can be high, so finding a treatment that is inexpensive over time can be a significant benefit.

Adverse Effects and Possible Drawbacks

Typically, adverse effects from iontophoresis are mild and it is not necessary for patients to stop treatment, even if they experience some of them. Possible negative reactions can include mild shocks, scratches or cuts on the treated area, vesiculation (similar to blistering), and redness of the skin. All of these are minor effects and tend to resolve on their own. It is not recommended as a treatment for pregnant women, those with pacemakers, or people with large amounts of metal in their body.[1]

In conclusion, iontophoresis is a safe and effective treatment for palmar and plantar hyperhidrosis that has been around for decades. It may seem a little unorthodox, but it has the potential to be an important tool for dealing with a frustrating and debilitating disorder. Iontophoresis can also be used as a medical treatment for children with hyperhidrosis, which is significant as children can't use many of the other potential treatments available for the disorder. Along with other treatment modalities, iontophoresis can be part of a comprehensive treatment plan that can help those with hyperhidrosis to live a fuller life free of constant perspiration. Lastly, if used in conjunction with alternative methods to manage hyperhidrosis and creative ways to manage hyperhidrosis at home, it can possibly prevent patients from having to use invasive treatments and medications.

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved
  2. Walling, H. W., & Swick, B. L. (2011). Treatment Options for Hyperhidrosis. American Journal of Clinical Dermatology, 12(5), 285-295. Retrieved July 25, 2018, from http://ke2nk8za8p.search.serialssolutions.com
  3. Rai, R., & Srinivas, C. (2005). Iontophoresis in dermatology. Indian Journal of Dermatology, Venereology and Leprology, 71(4), 236-241. Retrieved July 25, 2018, from https://search-proquest-com.ezproxy.wakegov.com/docview/195074488?pq-origsite=summon.
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