Iontophoresis

Iontophoresis has been used to treat excessive sweating on the hands and feet since the 1940s. Recently there have been device improvements to make the treatment more effective for other body areas, too.

Iontophoresis is often recommended for people who've tried prescription or clinical strength antiperspirants, but need a stronger treatment. For people with hyperhidrosis of the hands and/or feet, iontophoresis treatments has been shown to 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 palmoplantar sweating by 81%. 

During iontophoresis, a medical device is used to pass a mild electrical current through water (usually using shallow pans for hands or feet or specific pads for other body areas) 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).

Treatment Regimen

Instructions for using iontophoresis devices will vary (always follow your healthcare provider’s or device maker'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 (15 to 40 minutes depending on the device) while the device sends a small electrical current through the water. (For other body areas, recommendations will vary and pads that hook up to the iontophoresis machine are used.) 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 -- 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 can help. 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 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.

Iontophoresis Devices & Costs

At first glance, an iontophoresis device may seem pricey, but the expense is relatively reasonable when you realize that the devices last for many years (even decades), you can self-manage your treatments, and devices can be shared among family members (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 below). Hint: Always check our Fan Fave Products for discount codes before you buy.

There are a variety of prescription plug-in iontophoresis devices available. If you are in the U.S., before buying, check to see if the device you are considering is registered with and cleared by the U.S. Food and Drug Administration (FDA). In Canada, check for a medical device license by Health Canada. Elsewhere in the world, check with the appropriate regulatory bodies.

Note that a prescription from a physician is often required. 

For mild to moderate hyperhidrosis, a battery-operated, non-prescription iontophoresis device may suffice but note that their reported sweat reduction rates are often less than that those of plug-in devices. 

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.

For information about specific iontophoresis devices and for discount codes specifically for International Hyperhidrosis Society readers, visit our Fan Faves page.

Medical Devices: Cleared vs. Approved

If you've read this far, you already know that iontophoresis is a hyperhidrosis treatment using 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:

  1. "Clear" the device after reviewing a premarket notification, or
  2. "Approve" the device after reviewing a premarket approval application
A device is "cleared" when it is substantially equivalent to another device that is already legally marketed for the same use.
 
A device is "approved" when it's a new type of device and sufficient evidence has been provided to the FDA to show that it's safe and effective. This approval process generally involves rigorous review for safety. 
 

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 their device's manufacturer, and by reading resources on this website.

Having trouble finding a healthcare provider (HCP) who truly understands hyperhidrosis? You can find physicians (and other HCPs) familiar with excessive 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 a clinical 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, help is available.

 Next Steps

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:

Iontophoresis for palmar and plantar hyperhidrosis

Iontophoresis with glycopyrrolate for the treatment of palmoplantar hyperhidrosis

BOTOX delivery by iontophoresis

Safe control of palmoplantar hyperhidrosis with direct electrical current

Treatment of hyperhidrosis manuum by tap water iontophoresis

Treatment of excessive sweating of the palms by iontophoresis

Mechanism of action of iontophoresis in the treatment of palmar hyperhidrosis

Treatment of hyperhidrosis by tap water iontophoresis

The treatment of hyperhidrosis of hands and feet with constant current

 

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