Nothing but the truth! Palmar and plantar HH By Dr Davin Lim...
Iontophoresis is the next step for patients who suffer from excessive sweating of the hands and feet who do not respond to antiperspirants. This treatment has been in use for many decades, and can be effective in up to 60-80% of palmar and plantar hyperhidrosis- sweating of the hands and feet. Iontophoresis uses water to conduct a mild electrical current to the sweat gland unit. Over time the sweat glands reduces production of sweat.
Many theories have been postulated over the decades about how this treatment works. We initially thought that iontophoresis blocked the sweat gland with keratin, causing a plug at the surface of the eccrine (sweat) unit. This has been dispelled. We now think that iontophoresis works by passing charged particles into the sweat gland, causing to loose function.
(For scientist and chemistry majors out there- iontophoresis may transfer ions to cause a chemical change within the eccrine units to increase the threshold for sympathetic nerve impulse, essentially changing the cellular secretory physiology of the sweat gland)
This treatment is best suited for sweating of the hands and feet- palmar and plantar hyperhidrosis. Typically, 60-80% of patients who suffer excessive sweating in these areas respond to this treatment. Once sweating stops, iontophoresis treatments can be reduced. In some cases, patients only need to perform the procedure once every 12-14 days.
Underarm sweating can also respond to iontophoresis, however the use of underarm pads are needed. Iontophoresis in this area has a lower success rate compared to sweat stopping treatments.
Excessive underarm sweating may respond to iontophoresis with the use of special underarm pads. The success rate for iontophoresis in this area is not as good as the hands and feet. Other treatments such as sweat stopping treatments injections have a much higher success rate. Sweat stopping treatments for the treatment of underarm sweating is now on the PBS, and claimable through Medicare.
Iontophoresis is a very safe treatment, however certain exclusions do apply.
- Pregnant women
- People with pace makers
- Patients with metal implants in the path of the current, eg. Joint replacements
- Patients who suffer for epilepsy
There are several ways to perform iontophoresis for excessive sweating, and this will depend on several factors including- location of sweating, the type of machine used, severity of sweating and previous response and failures. In general iontophoresis is carried out in the following way:
Patient use either the two hands technique, two feet method or one hand one foot. This depends on the areas treated.
The sweaty areas are immersed in either water or a solution containing ions and chemicals. In Brisbane, we generally use tap water due to the high mineral content.
A very mild electrical current is sent thru the water for 15-30 minutes
This process is repeated every two to three days for 8-10 sessions
Once sweating decreases, patients go on to a maintenance schedule of one to three sessions per week
Tap water ionto has a success rate of around 50%
Glycopyrrolate ionto has a success rate of around 80+%
Iontophoresis is conducted in the premises of the Sweat Free Clinic
Sometimes side effects can be seen during iontophoresis treatments, however are not severe enough to lead to discontinuation. Most can be prevented or treated effectively.
Open cuts on the hands and feet should be covered with Vaseline to reduce discomfort during iontophoresis.
Starting with a low voltage will reduce any ‘shocking experiences’.
Side effects such as redness along the water line can be seen in 10% of patients, and often fades within a day or two. In a minority of cases ‘bubbles’ of the skin (thought to be blocked sweat glands) can be seen, and usually resolve by themselves. Other rare and transient side effects include dryness of the skin, and skin irritation. Using a mild steroid cream as well as a moisturiser can reduce the severity of this side effect.
Absolutely! The Specialists at Sweat Free can find a solution for you. In fact, overall we have a 96% of sweat reduction, no matter how difficult the condition. Some of our ‘tricks’ and ‘secrets’ include-
Combining tablets for sweating as well as iontophoresis
Adding sodium bicarbonate to the iontophoresis mix
Using antiperspirants with iontophoresis
Combining chemicals with tap water (glycopyrrolate solution)
Using special creams with iontophoresis
Swapping the iontophoresis protocols
Other treatments to help patients with excessive sweating of the hands and feet include sweat stopping treatments injections. Generally we do not advise sweat stopping treatments for these areas, however if all else fails, this maybe a treatment option.
For patients who suffer from palmar hyperhidrosis who do not respond to all forms of iontophoresis, ETS or endoscopic thoracic surgery can be of benefit.
NOTE: sweat stopping treatments injections are claimable via Medicare ONLY if it is used to treat severe excessive sweating of the armpits/ underarm sweating. It is not PBS listed for treating excessive sweating of the hands and feet.
Yes. However, the Ionto Dry Course adds glycopyrrotate to your regime, and optimises all settings according to your sweat profile. Using ordinary tap water 20-30% of patients can achieve modest sweat reduction. With the Ionto Dry Course, results are seen in up to 90% of patients.
For more information on purchasing iontophoresis machines email: firstname.lastname@example.org
Sweat Free Clinics
Iontophoresis is the next step if antiperspirants don’t work. Ionto is best suited for excessive sweating of the hands and feet, however it can also be used for excessive sweating of the underarms. In our clinic, our success rate for iontophoresis is in the order of 80%. Most commonly we start up with tap water with a pinch of sodium bicarbonate, however we can compound chemicals to further block sweating. The addition of glycopyrrolate to the solution is more effective than tap water alone, and will result in remission rates of up to 2 weeks following iontophoresis.
Sweat stopping treatments injections can be used on the hands, however this treatment is best suited for excessive underarm sweating. Sweat stopping treatments to the hand and feet, can be effective in up to 90% of patients, however it only lasts 3-4 months, and it is not covered under the PBS- unlike it’s use for underarm sweating.
If patients fail iontophoresis, or find it too inconvenient to use, ETS or endoscopic thoracic sympathectomy is the next step, and an opinion from a Vascular Surgeon is valued.