The procedure is administered for excessive, abnormal sweating of hands (hyperhidrosis palmaris), feet (hyperhidrosis plantaris), underarm sweating (hyperhidrosis axillaris) and occasionally also other areas of the body (for example sweating in the face, in the neck area, and the groin). The procedure is administered for excessive, abnormal sweating of hands (hyperhidrosis palmaris), feet (hyperhidrosis plantaris), underarm sweating (hyperhidrosis axillaris) and occasionally also other areas of the body (for example sweating in the face, in the neck area, and the groin).
Hyperhidrosis is diagnosed by a skin doctor (dermatologist). He/she can write a prescription for iontophoresis treatment in form of a number of therapy sessions in the medical practice. Later on, important a prescription for special equipment to be used may follow or a suitable iontophoresis unit may be recommended.
Detailed information on hyperhidrosis diagnostics: there are several qualitative and quantitative test methods available which primarily establish extent and location of the hyperhidrosis for diagnostic purposes. While qualitative test methods detect the areas where increased sweat production manifests itself, quantitative measuring procedures determine the amount of sweat per time interval. These objective test procedures assist the treating physician – in combination with a comprehensive medical history (in addition to the subjective feeling also the family anamnesis) – in determining the degree of hyperhidrosis as well as selecting suitable therapies.2
Starch-iodine test (also called Minor-Test): The Minor-Test helps to color-mark the afflicted body parts by means of a special iodine-solution. Potentially afflicted skin areas are covered with it and then starch is applied. Those areas where excessive sweat is produced will turn brown.2
Gravimetric analysis: a special paper is attached to the skin area of the afflicted person for a certain period of time. By measuring the weight difference of the test paper before and after, the amount of sweat per time unit can be determined.2
Who can benefit from iontophoresis?
Theoretically, Iontophoresis can be used without any age limitation for a diagnosed hyperhidrosis. In spite of the fact that electricity and water are applied, this therapy is entirely harmless and – if correctly applied – absolutely painless. Thus it is basically also suitable for sensitive patients, children and older individuals.
Having said this, it is often difficult to administer a proper iontophoresis-application to children under the age of 6 years since they are hardly able to comprehend the practical instructions. Indeed, it is also difficult for them to keep still during the session. These are only a few reasons why iontophoresis should only be conducted with medical assistance to children under the age of 6. Do not under any circumstances try to do it at home! Indispensable at any age is the initial instruction by a specialist (in most cases the dermatologist) and the ensuing proper operation.
The modern plate electrodes which are placed in tray baths to feed the current are oftentimes made of nickel-free material or even silicone. Hence, iontophoresis is also suitable for users with metal allergies. For users with a chrome allergy, there are electrodes made of aluminum and, for some time now, silicone-/graphite electrodes.1
The following, however, may not be treated:
patients with (cardiac) pace maker
patients with metal implants on/in those arms/legs to be treated (bone nails, endoprostheses)
patients with metal pessaries (diaphragms)
patients with osteoporosis or osteomalacia, since the so-called periosteal pain can occur
large wounds or injuries to the skin that cannot be covered
patients with chronic skin diseases, fissures, skin rash etc.
children under the age of 6 (only with medically competent supervision)
Where and how is iontophoresis administered?
The iontophoresis procedure can be used to treat hands, feet, face, armpits and in less frequent cases also additional body regions.
In most cases, the treating dermatologist prescribes 10 to 15 therapy sessions in his/her own medical practice. Every day or several times per week, patients submerge their afflicted body areas on-site in two plastic trays filled with tap water into which a slowly increased weak current (galvano-bath) is fed. The armpits are treated by tucking moist sponges with attached electrodes under the arms. Even the simultaneous treatment of hands and feet in one single session is possible with tap water iontophoresis!
The session usually lasts about 15 minutes. It is harmless and painless; you might merely experience a temporary tingling sensation as well as slight muscle tension. Important is a consistently proper application – initially under supervision, later on according to instruction – to ensure that in spite of the harmless low voltage of max. 60 Volt (current flow of about 7 to 30 mA) an unpleasant electric shock (“electric fence effect”) does not occur.
Nowadays, however, the latest generation of iontophoresis units is already designed to prevent the so-called “electric fence effect” by sophisticated technology and optimized control software.
For very sensible patients who perceive even this weak current as unpleasant, there are therapy devices1, which administer pulsed current instead of direct current which is even more tolerable.
One iontophoresis device which offers pulsed as well as direct current is theSaalio® tap water iontophoresis device1 which was newly developed in 2015. This device generation offers you the advantage of a more effective strength (direct current) and also the more gentle treatment flow of pulsed current, which renders the application more effective and more pleasant. New iontophoresis devices even facilitate an independent operation without additional assistance, as these are equipped with an automatic start-stop function as well as a pause function (see Saalio®)
If the “test phase” renders successful outcomes, the physician can write a prescription for an iontophoresis device to be regularly used in home therapy. If this meets approval by the health insurance, this arrangement can unburden the afflicted. They can administer their regular treatments independent of physician appointments and without long waiting times or having to travel long distances. “Home therapy devices” are in most cases small and consist of 2 trays, 2 electrodes for power input and an infinitely variable power supply. “Home use units”, like the Saalio® (see above oben), ideally have a modern design and can be comfortably operated by technical laymen.
How often is iontophoresis administered?
Treatment must be conducted very regularly, at least 3x per week – ideally even 5x per week. As soon as the desired healing success is imminent, therapy sessions can be reduced to 1x per week.
Important for a lasting success is the regular, long-term application without any longer interruptions. Compared to alternative therapies for the treatment of excessive sweating, iontophoresis is very affordable. The one-time acquisition cost is compensated by low operating expenses (extremely low water and current use) for a very long time.
What has to be considered when applying iontophoresis?
The iontophoresis-procedure is simple and harmless. It is, therefore, safe to let the patient conduct it – after previous instruction by a medical professional – on their own at home.
Care has to be taken, however, to…
remove all metallic items (rings, bracelets, watches etc.) prior to the session
cover open sores, wounds, injuries with petroleum jelly (or additionally with bandages, if applicable)
place hands or feet in the water bath first and only then the slowly increase the current strength (an automated process)1
turn off electricity(not applicable)1 prior to immersion into water bath
immediately interrupt the session or turn off the input current, respectively; if there is any pain
Do not touch any metal during a treatment session
Do not use any antiperspirants / deodorants on the treated areas during the entire period of application
In very rare cases (e.g. a tap water deionizing equipment) the water conductance may be insufficient. Try using non-carbonated mineral or table water in this case.
What are the alternatives for iontophoresis?
Iontophoresis has been successfully used for a long time to treat excessive sweating (hyperhidrosis). Nevertheless it can occur that in isolated cases individuals do not experience the desired effect or for the reasons mentioned above, iontophoresis cannot be applied. In this case, the treating dermatologist will consider alternative treatment possibilities.
The only non-surgical, non-medical alternative for iontophoresis is the use of antiperspirants. These antiperspirants (products to treat perspiration) contain aluminum salts which narrow the ducts of the sweat glands so that significantly less sweat surfaces the skin. In most cases, this physical effect can reduce the main symptom of hyperhidrosis – excessive sweating – to a normal level. Antiperspirants are over-the-counter cosmetics and accordingly not drugs that could heal the condition itself.
Individuals with sensitive skin who already had problems with iontophoresis treatments should exclusively use modern antiperspirants1 which contain plant extracts (e.g. sage, clove, beard moss) that are well tolerated by the skin. These products irritate the skin significantly less, which is very important in the long run. On the internet you can find gentle over-the-counter products to treat sweating1. The price for a bottle sufficient for a 6-month-treatment regimen is about 18.80 Euros (incl. shipping).
Additional medicinal treatment options are
chemical denervation with botulinum neurotoxin A (injections)
systemic therapy with anhidrotic or psychotropic drugs (e.g. pills taken by mouth)
last resort for palmar hyperhidrosis:operative thoracic sympathectomy (nerve separation)
for axillary hyperhidrosis:surgical sweat gland removal (suction removal, e.g. by suction curette)
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