Dermatology Online Journal

The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime
Tee Wei Siah MBChB, Philip J Hampton PhD
Dermatology Online Journal 19 (3): 14

MBChB Royal Victoria Infirmary Newcastle upon Tyne, Tyne and Wear United Kingdom

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Abstract

Primary focal hyperhidrosis is a benign condition of unknown etiology. Tap water iontophoresis has long been known to inhibit sweat production. The mechanism of reduced hyperhidrosis by iontophoresis is not completely clear. For operational convenience, our patients received their treatments at different intervals to those recommended by the manufacturer of the iontophoresis unit. We performed a retrospective audit to evaluate the effectiveness of tap water iontophoresis using this regimen. This new treatment regimen was effective at controlling palmoplantar hyperhidrosis. Minimal undesirable effects such as mild skin irritation and erythema were noted but none were severe enough to necessitate discontinuation of treatment. In conclusion, tap water iontophoresis is a safe and effective treatment of palmar and plantar hyperhidrosis when used on Monday, Wednesday, and Friday for 4 weeks. Continued treatment is needed to maintain the effect and many patients go on to purchase their own machines. This technique should be considered prior to systemic or aggressive surgical intervention.

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Introduction

Primary focal hyperhidrosis is a benign condition of unknown etiology and occurs in otherwise healthy people. It is estimated that 2.8 percent of the population suffers from this problem [1]. Primary hyperhidrosis is a socially distressing condition, which can have major impact on professional and daily activities of patients. A variety of medical and surgical treatments have been used to control or reduce excessive sweating with variable success. Tap water iontophoresis has long been known to inhibit sweat production [2]. The mechanism of reduced hyperhidrosis by iontophoresis is not completely clear. It has been suggested that tap water iontophoresis selectively targets areas with high levels of electrolytes because of enhanced current flow. A local electro-chemical coagulation of proteins occurs in these areas and subsequently disrupts eccrine gland function [3]. Another theory hypothesizes iontophoresis causes interrupted stimulus-secretion-coupling that leads to a functional disturbance of sweat secretion [4]. Several studies have demonstrated the efficacy of iontophoresis in the treatment of hyperhidrosis [5]. Very limited published data on successful treatment protocols is available [6]. For operational convenience, our patients received their treatments at different intervals to those recommended by the manufacturer of the iontophoresis unit. We performed a retrospective audit to evaluate the effectiveness of tap water iontophoresis using this regimen.

Twenty-three patients who had been treated with tap water iontophoresis for focal hyperhidrosis of the palms and soles were identified (7 male, 16 female). They did not have significant co-morbidities and their ages ranged from 14 to 52 years (mean 26.5). As part of the standard treatment protocol, prior to each treatment, patients were asked to self assess the severity of their hyperhidrosis. A scale of 1-10 with 1 being dry and 10 being extreme sweating was employed. Treatments were applied to palms and/or soles using the Iomax 4 (STD Pharmaceuticals) iontophoresis machine. Treatment sites (21 palms, 16 soles) were exposed to controlled electric current (15-20 mA) for 20 minutes on Monday, Wednesday and Friday for four weeks. This regimen used the same time but a more convenient dosing method compared with the manufacturer’s regimen of day 1, 2, 4, 7, 10, 15, and day 22.

Figure 1
Figure 1. The subjective scores progressively decreased during the four-week treatment period for all the patients.

This new treatment regimen was effective at controlling palmoplantar hyperhidrosis. The mean starting scores were 7.6 and 8.47 for palms (Figure 1) and soles, respectively. The subjective scores progressively decreased during the four-week treatment period for all the patients with mean end treatment scores of 1.9 for palms and 3.0 for soles. Minimal undesirable effects such as mild skin irritation and erythema were noted but none were severe enough to necessitate discontinuation of treatment.

In conclusion, tap water iontophoresis is a safe and effective treatment for palmar and plantar hyperhidrosis when used on Monday, Wednesday and Friday for 4 weeks. Continued treatment is needed to maintain the effect and many patients go on to purchase their own machines. This technique should be considered prior to systemic or aggressive surgical intervention.

References

1. Strutton DR, Kowalski JW, Glaser DA et al. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: result from a national survey. J Am Acad Dermatol 2004; 51:241-248. [PubMed]

2. Levit F. Treatment of hyperhidrosis by tap water iontophoresis. Cutis. 1980; 26:192-194. [PubMed]

3. Midtgaard K. A new device for the treatment of hyperhidrosis by iontophoresis. Br. J. Dermatol. 1986; 114:485-8. [PubMed]

4. Reinaurer S, Neusser A, Schauf G, Holzle E. Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. Br. J. Dermatol. 1993; 129: 166-9. [PubMed]

5. Chan LY, Tang WYM, Lo KK et al. Treatment of palmar hyperhidrosis using tap water iontophoresis: local experience. Hong Kong Med J. 1999 Jun;5(2):191-194. [PubMed]

6. Hőlzle E, Hund M, Lommel K et al. Recommendations for tap water iotophoresis. J Dtsch Dermatol Ges. 2010 May;8(5):379-83. Epub 2009 Aug 28. [PubMed]

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