It is up to the patient to find what treatment regime works best to maintain results. Iontophoresis is generally a safe procedure. It is important to avoid direct contact with the electrodes during treatment, as it may cause a mild electric shock. A feeling of pins and needles or burning sensation is experienced by most people. Adverse effects may include:.
Topical corticosteroids can be applied. If used, anticholinergic drugs such as glycopyrronium may be absorbed into the body and produce systemic side effects such as dizziness, dry eyes and dry mouth. Patients should delay treatment if they have a recent wound, skin graft, or scar in the area requiring treatment, as iontophoresis may be painful and the treatment less effective.
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Iontophoresis — codes and concepts open. Treatment or procedure. Manual of Dermatologic Therapeutics, 7th edition. Usually, simple tap water iontophoresis is enough to achieve desired results but in some cases clinicians may need to add baking soda to "soft water" or use iontophoresis to deliver anticholinergics or other medications to hyperhidrotic areas affected.
In the 18th century, not long after electricity was discovered, people started trying to use it to treat various human conditions. Pivati is reported to have used iontophoresis to treat arthritis in Interestingly, the sweat glands are the main portal of entry for any pharmaceutical agents delivered through the skin, since electrical resistance is lowest by that route.
The treatment became increasingly popular after , when F. Levit published a paper on a practical device for iontophoresis. In addition, many health insurance organizations in the U. The manner in which iontophoresis halts or diminishes sweating is not yet fully understood but there are several theories.
One of the physical principles of electricity is that molecules with the same charge repel one another and those with opposite charge attract one another. In iontophoresis, a charged molecule is delivered across the skin by placing it near the electrode of like charge, while the electrode of opposite charge is placed elsewhere on the body.
This concept was based on the development of iatrogenic miliaria when iontophoresis was done on the back, chest, or arms of patients. Microscopic analysis showed keratin plugs obstructing sweat ducts. However, light and electron microscopy of sweat glands in a patient with palmar hyperhidrosis did not show ductal obstruction. Use of saline in iontophoresis has not been found to be as effective as use of tap water; researchers Sato and colleagues also found that the pH of anodal water did not drop during saline iontophoresis.
Recommended regimen The regimen recommended for iontophoresis will vary with the device used, the areas to be treated, and whether the treatment is to be carried out in the clinic or at home. Some general advice:. Treatment usually begins in the medical office under the direct care and instruction of a healthcare professional. Once the desired dryness has been accomplished, or once it appears that the patient is ready, willing, and fully trained enough, it may be determined that treatments can continue in the home environment under the patient's self-management utilizing a device purchased or rented for home use.
Women who are pregnant or patients with pacemakers or substantial metal implants in the path of the electrical current, such as joint replacements , cardiac conditions, or epilepsy should not use iontophoresis. A note regarding iontophoresis devices and their regulation: w hen FDA review is needed prior to marketing a medical device such as an iontophoresis device , the FDA will either:.
In another study, 30 patients with palmoplantar hyperhidrosis were successfully treated with iontophoresis using different pan and electrode configurations, current levels, and duration of sessions. Patients were found to require 2 to 3 weeks of 6-days-per-week treatment to reach that endpoint and remained in remission for an average 6. Observing that some patients could not tolerate the usual current level when the electrodes were placed in separate pans, one group of patients was treated with both electrodes in the same pans.
This configuration required longer times to reach anhidrosis despite higher current levels. In another study, a group of 18 patients with palmar hyperhidrosis had iontophoresis treatment for one hand with the other hand serving as the control. The results showed that 15 of 18 participants had markedly reduced sweat production in their treated hands.
In , a double-blind controlled study of 11 patients with palmar hyperhidrosis used a sham treatment of one involved hand as placebo. Similarly, a controlled trial of patients diagnosed with palmar hyperhidrosis showed that, after 8 treatments, sweating was reduced This reduction was seen 20 days after the eighth treatment, with the mean return of symptoms occurring at 35 days.
While most iontophoresis devices require a plug, portable devices are available. A study of one such device was carried out on 27 treatment sites in 22 patients: sites included 10 palms, 9 feet, and 8 axillae.
Patients used the device on the involved area, using the opposite side as control, for 30 minutes twice a day for 5 days followed by 30 minutes daily. It conforms to most recent safety regulations as approved by Underwriter's Laboratory. Hyperhidrosis was completely controlled after treatments as revealed by quantitative gravimetric measurements of sweat rates and semiquantitative estimation of starch iodine paper imprints.
There was no apparent difference in efficacy between the two apparatuses. Not only hyperhidrosis was abolished, but associated symptoms, such as lividity of palms or soles, acral hypothermia and edema of fingers or toes, also subsided. Skin temperature on palms rose from
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