Treatment of excessive sweating of the hands and feet with iontophoresis has been practiced since the 1940s. It is particularly useful for people who've tried prescription or clinical strength antiperspirants, but find that they need a stronger treatment. For people with hyperhidrosis of the hands and/or feet, iontophoresis treatments typically result in dramatically decreased sweating with a very high success rate—over 80%, according to the American Academy of Dermatology. (Treating underarm hyperhidrosis with iontophoresis is not typically recommended, although people can have success with it.)
Iontophoresis uses water to conduct a mild electrical current through the skin's surface. While it's not entirely understood how or why iontophoresis works, it is thought that the electric current and mineral particles in the water act together to microscopically thicken the outer layer of the skin, thereby blocking the flow of sweat to the skin's surface. Once this sweat output is blocked or interrupted, sweat production in the treated areas stops.
Iontophoresis has no significant or serious side effects and the drying results do not decrease in effectiveness with long-term use.
Patients can purchase iontophoresis devices for in-home use and they can sometimes be found at doctors' offices. For mild to moderate hyperhidrosis, the battery-operated Drionic device may suffice. But more often, the US physicians of the International Hyperhidrosis Society suggest plug-in devices instead of the battery-powered machines. Usually the more powerful, plug-in devices require a doctor's prescription. Patients outside the US have an additional option in a battery-operated iontophoresis device made by i2M called Idrostar that the manufacturer claims is as powerful as plug-in models. You can find physicians familiar with iontophoresis by using our Physician Finder and searching with the additional option "Attended IHHS education and training sessions".
Instructions for using iontophoresis devices will vary by manufacturer, but in general, patients sit with both hands or both feet, or one hand and one foot, immersed in shallow trays filled with tap water for a short period of time (20 to 40 minutes) while the device sends a mild electrical current through the water. The process is normally repeated every two to three days for ten sessions. Once the desired dryness has been achieved, patients are switched to a maintenance schedule, usually once per week to once every other week, depending on the individual. To maintain dryness, iontophoresis treatments should be conducted before sweating begins to return, or the process may need to be started all over again to obtain the desired dryness. By all means, discuss the technique of performing iontophoresis with your doctor and follow the manufacturer's recommendations for your particular device.
Sometimes, tap water in certain geographic locations may be too "soft" for iontophoresis to work. That is, it doesn't contain many minerals or electrolytes (tiny particles that help the electric current travel through the water and into the skin). Adding about a teaspoon of baking soda to the trays of water will take care of this. Further, if iontophoresis with plain tap water or tap water with baking soda doesn't produce the desired dryness, a prescription medicine for hyperhidrosis called an anticholinergic (for example, Robinul; generic name, glycopyrrolate) may be crushed and added to the water. In the majority of cases this works and makes the iontophoresis therapy effective. Dee Anna Glaser, MD, President and founding board member of the International Hyperhidrosis Society, offers this guideline: "I generally start with 2 mg [of anticholinergic] per tray, but will adjust the dose based on efficacy or side effects. In the majority of cases, this is effective and results in dramatically drier hands and/or feet."
Recently, there have been some reported cases of patients adding Botox to their water. While there have been no conclusive studies for this method, it strikes us as an impractical approach to iontophoresis therapy, given the high cost of Botox--and the significant amount of Botox needed to fill the water trays--versus the low cost and high effectiveness of iontophoresis treatments with water. If you are interested in Botox treatments for hyperhidrosis, you have plenty of information here.
On first glance, iontophoresis devices may seem pricey, but the upfront expense is small when you realize that the devices last for years (if not decades), you can self-manage your treatments, and the devices could conceivably be shared among family members who have hyperhidrosis (which is often the case). R.A.Fischer, for example, has two models available. The original analog model (MD-1a) with water bath trays is $675. There is also a newer digital model (MD-2) available with more features. The cost for this model is $975. Either model can be shared by multiple people in the same family. And both of the Fischer models are available in either 110 volt for the North America market, or 220-240-volt versions for international customers.
R.A. Fischer also has an option to rent iontophoresis devices so people can try out their device before purchasing. This is especially useful for parents who are trying the device for children. The cost to rent the MD-1a or MD-2 models is $100/$150 per month, respectively, with $600/$900 deposit check requirements. Shipping is an additional $23. Half of the first month's rental fee will be applied toward the purchase price of a device for at-home use. This makes a lot of sense and is easy on the wallet too! Contact Bill Schuler at R.A. Fischer Company at (800) 525-3467 to discuss this option.
Speaking of costs, other, less expensive, homemade devices some have tried have been found to yield unsatisfactory results. So while it may appear that you are saving money, if you don't get the results you need, then it really was money wasted.
Successful iontophoresis treatment will depend on the patient. Dr. David Pariser, International Hyperhidrosis Society founding board member and 2009 President of the American Academy of Dermatology, says this: "The ideal candidate for this treatment is a motivated patient who is having good results. Treatments can continue indefinitely; however, one of the major limitations of iontophoresis is the time commitment, especially early in the course of treatment. Some people find it to be too much of a hassle. But others enjoy the independence of managing their therapy and getting great results. It's like physical therapy." Successful iontophoresis requires a learned technique to benefit you the most so it's ideal that you find a healthcare professional who can coach you through the correct usage of iontophoresis in his or her office, if possible. If you and your doctor decide that iontophoresis is a good treatment choice for your situation, your doctor can write you a prescription for a home-use iontophoresis device.
Having trouble finding a doctor who understands hyperhidrosis? You can find physicians familiar with iontophoresis specifically by using our Physician Finder and searching with the additional option "Attended IHHS education and training sessions". At our training sessions, we teach the attending healthcare professionals all about iontophoresis best practices, so they have iontophoresis familiarity and knowledge to share.
Here are some important tips and cautions:
Women who are pregnant, people with pacemakers, or metal implants in the current path (such as joint replacements), cardiac conditions, electrical sensitivity, or epilepsy should NOT use iontophoresis.
All jewelry should be removed before iontophoresis treatments.
Before treatment, if you have any cuts, scratches or abrasions, carefully apply a small amount of Vaseline (or similar) with a Q-tip to protect these areas. Cuticles can be especially susceptible to tingling during treatment.
If excessive dryness of the skin occurs, moisturizers are recommended to be applied after the treatment sessions.
If the skin along the "water line" becomes irritated due to iontophoresis, Vaseline can be applied to that area before each treatment. Remember that Vaseline is a barrier to iontophoresis, so apply sparingly and carefully.
To relieve skin irritation that has already occurred, a simple 1% hydrocortisone cream is recommended.
Patients are often concerned about getting an electric shock during iontophoresis, but the current used is not strong enough to cause harm. It can startle you, however, so don't remove your hands or feet from the water bath during treatment. Your doctor will teach you how to avoid such shocks, and the device manufacturers will also offer advice.
Iontophoresis is not usually recommended for excessive underarm sweating (axillary hyperhidrosis) because the skin in the armpits is likely to be irritated by the process and because it is very difficult to perform iontophoresis on the underarms.
To help with the process of obtaining insurance coverage for the purchase of a home-use iontophoresis device from the R.A. Fischer Company, we have information for you and your doctor here.
Have you talked to your doctor about excessive sweating? If not, now is the time! Learn more about how you and your doctor can work together to find the right treatment, or combination of treatments, to manage your hyperhidrosis.
Have you tried antiperspirants and iontophoresis, and still feel like your quality of life is suffering due to excessive sweating? Learn about how Botox injections for hyperhidrosis may be able to help.
And remember, because hyperhidrosis is a serious medical condition, you deserve insurance coverage and reimbursement for your hyperhidrosis treatments! We've got tips to help you navigate the health insurance realm and receive coverage.