Iontophoresis has been used to treat uncontrollable, excessive sweating on the hands and feet since the 1940s. It's 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 can dramatically decrease sweating. 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 as common (although some 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 achieved. Once satisfactory dryness has been reached, 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 your device's manufacturer recommendations.
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/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 given the high cost of Botox, the potentially significant amount of Botox needed to have an effect via this delivery method, and 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, health insurance often covers the cost of an iontophoresis device and sometimes “rent-to-own” is an option (more information on this below). Hint: Always check our Deals and Discounts section for discount codes before you buy.
There are a variety of popular prescription, plug-in iontophoresis devices available including: the R.A. Fischer devices, the Hidrex devices and the Idromed device. The R.A. Fischer devices and the Hidrex USA devices are registered with and cleared by the U.S. Food and Drug Administration (FDA).
R.A. Fischer, which does its manufacturing in the U.S., has two iontophoresis devices available. The original analog model (MD-1a) with water bath trays is $675. The newer digital model (MD-2) includes more features and costs $975. Both are available in either 110 volt for the North American market, or 220-240-volt versions for international customers. U.S. customers have the option of renting an iontophoresis device; allowing you to try the device before deciding 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 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 devices and have been impressed with the research behind them and the reports we hear about their ease-of-use. In Europe, visit www.Hidrex.de. In the U.S. and North, Central, and South America, visit www.HidrexUSA.com. Hidrex USA provides sales and service of Hidrex GmbH products (made in Germany). The DVP1000 model and the DP450 model cost $895 and $650, respectively. Hidrex USA also has a money-back guarantee if their iontophoresis device doesn't suit you after you've tried it for 45 days.
The Idromed is a snazzy-looking device with a beautiful user interface. Manufactured by Dr. Hoenle Medizintechnik GmbH in Germany, and available to order here, the Idromed is available in the Idromed 5 PS model and the Idromed 5 GS model.
The battery-operated Idrostar device is manufactured by i2M in France and is predominately available to hyperhidrosis patients in France and the UK, but can be shipped worldwide. According to the manufacturer, this device may be as powerful as prescription plug-in devices. i2M prides itself on customer service and representatives say they will work with any patient who does not respond to iontophoresis by offering a refund.
If you've tried one of these iontophoresis devices, let us know your experiences let at info@SweatHelp.org.
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%. Note that this result is much lower (meaning less effective) than the reported data for the plug-in devices. Patients outside the U.S. may consider the Idrostar device detailed above.
Some people have also tried alternative, less expensive, homemade iontophoresis devices but we've heard that these types of devices yield unsatisfactory results and may even cause harm.
Medical Devices: Cleared vs. Approved
If you've read this far, you already know that iontophoresis is a hyperhidrosis treatment using primarily a medical device, not a medicine. But medical devices and medications have something in common in the U.S. - they both fall under the regulations of the FDA, with some subtle differences.
When FDA review is needed prior to marketing a medical device, the FDA will either:
- "Clear" the device after reviewing a premarket notification, or
- "Approve" the device after reviewing a premarket approval application
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, uncontrollable sweating by using our Physician Finder and using the additional search criteria: "IHHS Educated". 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:
- If possible, learn how to use iontophoresis effectively in your doctor’s office from a trained health professional before trying it at home.
- Expect to feel a mild tingling sensation during iontophoresis.
- Know that the electric current used during iontophoresis is not strong enough to cause a harmful shock but it could startle you, so don’t remove your hands or feet from the water during treatment.
- Don’t use iontophoresis if you are pregnant, have a pacemaker, have a substantial metal implant in the current path (such as a joint replacement), or have a cardiac condition or epilepsy. Not sure? Talk to your doctor.
- Remove jewelry before iontophoresis treatments.
- Cover scratches, tender cuticles, and nicks in your skin with a petroleum jelly (like Vaseline) before treatment. If redness occurs at the water line, cover that area with petroleum jelly, too. Keep in mind that petroleum jelly is, however, a barrier to iontophoresis, so apply it only as necessary. Use a Q-tip to help.
- Treat any post-treatment, mild skin irritation or redness with 1% hydrocortisone cream.
- Talk to your doctor if the treatment doesn’t seem to be working. Adding baking soda or a prescription medicine (anticholinergic) to the water can help.
- If excessive dryness occurs, use a moisturizer after treatment sessions.
- When it comes to obtaining insurance coverage for the purchase of a home-use iontophoresis device from the R.A. Fischer Company, help is available.
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: