Modification and optimisation of tap water iontophoresis
The aim of this study was to develop an optimal regimen for the treatment of hyperhidrosis of the hands or feet using tap water iontophoresis.
For this purpose, the polarity of the direct current, the duration of a treatment session, the effect of electrolyte additions, and the frequency of treatment in the maintenance phase were investigated. DC devices made by HIDREX GmbH were used in the study.
Polarity
The anode proved to be more effective than the cathode in the study, but without any significant impact on the overall therapeutic effect.
There were no grounds for recommending a change in the polarity during a treatment session. Patients complained more often of pain, erythema, and burning after the polarity change and could then tolerate only lower voltages in the second half of the session. The lower voltages reduced the inhibiting effect and more treatments were needed to achieve therapeutic success.
The result was a recommendation to keep the anode consistently on one hand or foot until the sweat levels were normalised on that side. After subsequent switching of the polarity, the treatment is continued until both sides experience normal levels of hidrosis. The study also found that it is better to place the anode on the dominant hand first.
Duration
The study showed no difference in the efficacy of the treatment whether the session was 10 or 30 minutes. Sessions shorter than 10 minutes, however, were unsuccessful. Therefore, 10 minutes is the recommended duration of an iontophoresis session.
Addition of electrolytes
Additions of salts such as sodium chloride or ammonium chloride proved to be unhelpful, even harmful, as they increase the occurrence of side effects and reduce the success of the treatment. Anticholinergic additives were also rejected because of local and systemic side effects. Adding aluminium chloride hinders the effectiveness of tap water iontophoresis. Care should also be taken not to use deionized water. Highly deionized water (created, for example, using a water softener) may result in the inability to provide sufficient current flow for treatment.
Frequency of treatment in the maintenance phase
To maintain the therapeutic effect, long-term treatment is required in the maintenance phase. The study has shown that, on average, a treatment is required every 6.5 days to maintain normal sweating levels. The polarity should be changed from one treatment session to the next.
No long-term side effects from tap water iontophoresis are known.
Summary of treatment recommendation
- In the initial phase: treatment 3-5 times a week for 10 minutes each. The anode should be used on the dominant hand or on the same foot until consistent, complaint-free sweat levels are achieved. Only then should the anode be shifted to the other hand or foot until full normal hidrosis occurs on both sides.
- In the subsequent maintenance phase: treatment every 3 to 9 days for 10 minutes each. The anode should be switched from one side to the other with each session.
- Only normal, non-deionized tap water should be used
