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 have found 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. One study found that iontophoresis helped 91% of patients with excessive palmoplantar (hands and feet) sweating. Another study showed that iontophoresis reduced sweating by 81%.
During iontophoresis, a medical device is used to pass a mild electrical current through water (usually utilizing shallow pans big enough for your hands or feet) and through the skin's surface. There are no significant or serious side effects and the benefits are long-term, provided you keep up with the maintenance schedule your doctor recommends (usually once per week).
Treating underarm hyperhidrosis with iontophoresis is not typically recommended (although people can have success with it) because the skin in the armpits is likely to be irritated by the process and because the physical structure of the underarms makes iontophoresis difficult to accomplish.
Instructions for using iontophoresis devices will vary (always follow your healthcare provider’s recommendations) 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 small electrical current through the water. The process is normally repeated three times per week until the desired results are seen. Once satisfactory dryness has been achieved, patients are switched to a maintenance schedule, usually once per week. To maintain sweat-relief, iontophoresis treatments need to be conducted regularly and before sweating begins to return. 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 such as 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 advice: "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."
There have been reports of onabotulinumtoxinA (Botox) being added to iontophoresis water trays. While there have been no conclusive studies of this method, it strikes us as an impractical approach to iontophoresis especially given the high cost of Botox (and the potentially significant amount of Botox needed to have an effect via this delivery method) versus the low cost and significant effectiveness of tap water iontophoresis treatments. If you are interested in Botox treatments for hyperhidrosis you'll find lots of information here.
Specific Iontophoresis Devices & Costs
At first glance, an iontophoresis device may seem pricey, but the upfront expense is relatively reasonable when you realize that the devices last for many years (if not decades), you can self-manage your treatments, and the devices can be shared among family members who suffer from excessive sweating (hyperhidrosis frequently runs in families). Also, healthinsuranceoften covers the cost of an iontophoresis device and sometimes “rent-to-own” is an option (more information on this below).
There are a variety of prescription, plug-in iontophoresis devices available including those made by R.A. Fischer in the U.S. and Avanor Healthcare (makers of the Hidrex, Idromed, and Galvan devices) in the U.K. The R.A. Fischer devices are registered with the U.S. Food and Drug Administration (FDA) and the Avanor devices are currently undergoing FDA review. Representatives from Avanor indicate that one of their devices may be approved for use in the U.S. in early 2015.
R.A. Fischer has two iontophoresis devices 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. Both are available in either 110 volt for the North America market, or 220-240-volt versions for international customers.R.A. Fischer also lets you rent an iontophoresis device so that you can try it before deciding if you'd like to make a purchase. This is especially useful for parents who are trying the device for their children. The cost to rent the MD-1a or MD-2 models is $100/$150 per month, respectively, plus initial shipping costs. Half of the first month's rental fee will be applied toward the purchase price, and all subsequent monthly rental fees are applied in full toward the purchase price. This plan allows you to buy the device in 7 months. This makes a lot of sense and is easy on the wallet, too! Please note that a prescription from a physician is required. Contact Bill Schuler at R.A. Fischer Company at (800) 525-3467 to discuss this option or you can order a rental online>
We hear positive things about the Hidrex device and have been impressed with the research behind it and reports of its ease of use. You can find out more at the manufacturer's website: www.Hidrex.de.
For mild to moderate hyperhidrosis, a battery-operated, non-prescription iontophoresis device may suffice. In the U.S., the Drionic device is available without a doctor's prescription. At least one study has found that the Drionic device can improve sweating symptoms by approximately 50%. Patients outside the U.S. may consider the Idrostardevice which, according to its manufacturer, is as powerful as prescription plug-in models.
Some people have also tried alternative, less expensive, homemade iontophoresis devices but we've heard that these types of devices yield unsatisfactory results.
Tips for Successful Iontophoresis
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: "The ideal candidate for this treatment is a motivated patient. 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."
Effective iontophoresis requires a learned technique so, ideally, you'll have access to a healthcare professional who can coach you through the first few sessions of your therapy. Then, if you and your doctor decide that iontophoresis is a good treatment choice for you, your doctor can write you a prescription for a home-use iontophoresis device. This type of back and forth with your doctor is not, however, always possible. If that's the case, don't be discouraged, many patients can learn how to use iontophoresis effectively by reading the manual carefully, talking to experts at their device's manufacturer, and by reading resources on this website.
Having trouble finding a doctor who truly understands hyperhidrosis? You can find physicians familiar with excessive sweating by using our Physician Finder and using the additional search criteria: "Attended IHHS education and training sessions". At our training sessions, we teach healthcare professionals about all the current hyperhidrosis treatment options, including iontophoresis.
Ready to give iontophoresis a shot? Here are some important tips:
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 or miraDry 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.
Research and References
Interested in reading what the medical literature has to say about iontophoresis for hyperhidrosis? Here are links to relevant abstracts and articles published in medical journals: