Advertisement

Iontophoresis

  • Erhard Hölzle
Living reference work entry

Abstract

The prevalence of idiopathic hyperhidrosis is between 1% and 2%.

Focal hyperhidrosis has a severe impact on quality of life. Impairment for the patients includes limitations in work, social interaction, physical activities, and leisure as well as emotional and psychological distress.

The first description of iontophoresis was given in the eighteenth century. Its clinical use was manifold, also in dermatology. In 1952 tap water iontophoresis was first described for the treatment of palmoplantar hyperhidrosis.

The most comfortable means of iontophoretic treatment employs pulsed direct current of high frequency (5–10 kHz).

Side effects are minimal and transient. Only slight skin irritation or sensations of discomfort may occur during treatment. Electric burns and electric shock have to be avoided.

The main cause of anhidrosis after tap water iontophoresis is most likely a transient functional disturbance of the secretory mechanism of eccrine glands.

It was shown that tap water iontophoresis with pulsed current can extend symptom-free intervals in dyshidrotic palmar eczema.

Contraindications of tap water iontophoresis are pregnancy and metallic implants, such as cardiac pacemakers or orthopedic joint or bone implants. Defects in the skin barrier, which cannot be protected by petrolatum or insulating tape, also represent a transient contraindication.

Keywords

Palmoplantar hyperhidrosis Axillary hyperhidrosis Dyshidrotic eczema Tap water iontophoresis Pulsed direct current 

References

  1. Abell E, Morgan K (1974) The treatment of idiopathic hyperhidrosis by glycopyrronium bromide and tap water iontophoresis. Br J Dermatol 91:87–91CrossRefGoogle Scholar
  2. Adar R, Kurchin A, Zweig A, Mozes M (1977) Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg 186:34–41CrossRefGoogle Scholar
  3. Bouman HD, Grunewald Lentzer M (1952) The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med 31:158–169PubMedGoogle Scholar
  4. Brand CU, Brun del Re CE, Kernland K, Hunziker T (2000) Leitungswasser-iontophorese als langzeitbehandlung der hyperhidrosis palmoplantaris. Aktuelle Dermatol 26:366–370Google Scholar
  5. Chia HJ, Tan AS, Chong WS, Tey HL (2012) Efficacy of iontophoresis with glycopyrronium btomide for treatment of primary palmar hyperhidrosis. J Eur Acad Dermatol Venereol 26:1167–1170CrossRefGoogle Scholar
  6. Dolianitis C, Scarff CE, Kelly J, Sinclair R (2004) Iontophoresis with glycopyrrolate for the treatment of palmoplantar hyperhidrosis. Australas J Dermatol 45:208–212CrossRefGoogle Scholar
  7. Freis ED (1946) Treatment of dermatophytosis and hyperhidrosis with formaldehyde and cupric sulfate iontophoresis. Arch Dermatol Syph 53:34–38CrossRefGoogle Scholar
  8. Gibinski K, Giec L, Zmudzinski J et al (1973) Transcutaneous inhibition of sweat gland function by atropine. J Appl Physiol 34:850–852CrossRefGoogle Scholar
  9. Gordon BI, Maibach HI (1969) Eccrine anhidrosis due to glutaraldehyde, formaldehyde and iontophoresis. J Invest Dermatol 53:436–439CrossRefGoogle Scholar
  10. Grice K, Sattar H, Baker H (1972) Treatment of idiopathic hyperhidrosis with iontophoresis of tap water and poldine methosulfate. Br J Dermatol 86:72–78CrossRefGoogle Scholar
  11. Grimnes S (1984) Pathways of ionic flow through human skin in vivo. Acta Derm Venereol 64:93–98PubMedGoogle Scholar
  12. Hill BHR (1976) Poldine iontophoresis in the treatment of palmar and plantar hyperhidrosis. Aust J Dermatol 17:92–93CrossRefGoogle Scholar
  13. Hill AC, Baker GF, Jansen GT (1981) Mechanism of action of iontophoresis in the treatment of palmar hyperhidrosis. Cutis 28:69–72PubMedGoogle Scholar
  14. Hölzle E (1984) Die essentielle Hyperhidrose. Habilitationsschrift, DüsseldorfGoogle Scholar
  15. Hölzle E (2002) Pathophysiology of sweating. In: Kreyden OP et al (eds) Hyperhidrosis and botulinum toxin in dermatology. Karger, BaselGoogle Scholar
  16. Hölzle E, Alberti N (1987) Long-term efficacy and side effects of tap water iontophoresis of palmoplantar hyperhidrosis – the usefulness of home therapy. Dermatologica 175:126–136CrossRefGoogle Scholar
  17. Hölzle E, Pauli M, Braun-Falco O (1984) Leitungswasser-iontophorese zur behandlung von hyperhidrosis manuum et pedum. Hautarzt 35:142–147PubMedGoogle Scholar
  18. Hölzle E, Hund M, Lommel K, Melnik B (2009) Qualitätssicherung der leitungswasser-iontophorese. In: Korting HC et al (eds) Dermatologische qualitätssicherung. ABW Wissenschaftsverlag, BerlinGoogle Scholar
  19. Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe N, Naver H, Ahn S, Stolman LP (2004) Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 51:274–286CrossRefGoogle Scholar
  20. Ichihashi T (1936) Effect of drugs on the sweat glands by cataphoresis, and an effective method for suppression of local sweating. Observation on the effect of diaphoretics and anaphoretics. J Orient Med 25:101–102Google Scholar
  21. Junker J, Kreyden OP (2008) Essential focal hyperhidrosis – severe illness or lifestyle disease? Kosmet Med 2:94–98Google Scholar
  22. Karakoc Y, Aydemir EH, Kalkan MT (2004) Placebo-controlled evaluation of direct electrical current administration for palmoplantar hyperhidrosis. Int J Dermatol 43:503–505CrossRefGoogle Scholar
  23. Kavanagh GM, Shams K (2005) Botulinum toxin type A by iontophoresis for primary palmar hyperhidrosis. J Am Acad Dermatol 55:115–117CrossRefGoogle Scholar
  24. Levit F (1968) Simple device for treatment of hyperhidrosis by iontophoresis. Arch Dermatol 98:505–507CrossRefGoogle Scholar
  25. Levit F (1980) Treatment of hyperhidrosis by tap water iontophoresis. Cutis 26:192–196PubMedGoogle Scholar
  26. Montaser-Kouhsari L, Zartab H, Fanian F, Noorian N, Sadr B, Nassiri-Kashani M, Firooz A (2014) Comparison of intradermal injection with iontophoresis of botulinum toxin A for the treatment of primary axillary hyperhidrosis: a randomozed controlled trial. J Dermatolog Treat 25:337–341Google Scholar
  27. Morgan K (1980) The technique of treating hyperhidrosis by iontophoresis. Physiotherapy 66:45–48PubMedGoogle Scholar
  28. Naumann MK, Hamm H, Lowe NJ (2002) Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial. Br J Dermatol 147:1218–1226CrossRefGoogle Scholar
  29. Odia S, Vocks E, Rakoski J, Ring J (1996) Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol 76:472–474PubMedGoogle Scholar
  30. Oesterle IS, Owen T, Rustin MH (1995) Neuropeptides in the skin of patients with atopic dermatitis. Clin Exp Dermatol 20:462–467CrossRefGoogle Scholar
  31. Ohshima Y, Shimizu H, Yanagishita T, Watanabe D, Tamada Y, Sugenoya J, Tsuda T, Matsumoto Y (2008) Changes in Na+, K+ concentrations in perspiration and perspiration volume with alternating current iontophoresis in palmoplantar hyperhidrosis patients. Arch Dermatol Res 300:595–600CrossRefGoogle Scholar
  32. Raulin C, Rösing S, Petzoldt D (1988) Heimbehandlung der hyperhidrosis manuum et pedum durch leitungswasser-iontophorese. Hautarzt 39:504–508PubMedGoogle Scholar
  33. Reinauer S, Schauf G, Hubert M, Hölzle E (1992) Mechanism of action of tap water iontophoresis: functional disturbance of the secretory epithelium. Z Hautkr 67:622–626Google Scholar
  34. Reinauer S, Neußer A, Schauf G, Hölzle E (1993a) Iontophoresis with alternating current and direct current offset (AC-DC iontophoresis): a new approach for the treatment of hyperhidrosis. Br J Dermatol 129:166–169CrossRefGoogle Scholar
  35. Reinauer S, Schauf G, Hölzle E (1993b) Ross syndrome: treatment of segmental compensatory hyperhidrosis by a modified iontophoretic device. J Am Acad Dermatol 28:308–312CrossRefGoogle Scholar
  36. Reinauer S, Neußer A, Schauf G, Hölzle E (1995) Die gepulste gleichstrom-iontophorese als neue behandlungsmöglichkeit der hyperhidrosis. Hautarzt 46:543–547CrossRefGoogle Scholar
  37. Sato K, Timm DE, Sato F, Templeton EA, Meletiou DS, Toyomoto T, Soos G, Sato SK (1993) Generation and transit pathway of H+ is critical for inhibition of palmar sweating by iontophoresis in water. J Appl Physiol 75:2258–2264CrossRefGoogle Scholar
  38. Schauf G, Hubert M, Reinauer S, Hölzle E (1994) Modifikation und optimierung der leitungswasser-iontophorese. Hautarzt 45:756–761CrossRefGoogle Scholar
  39. Schempp CM, Czech W, Schöpf E, Simon JC (1996) Leitungswasser-iontophorese bei der behandlung dyshidrotischer mit hyperhidrosis assoziierter palmoplantarekzeme. Akt Dermatol 22:198–201Google Scholar
  40. Shelley W, Horvath P, Weidman F et al (1948) Experimental miliaria in man. I. Production of sweat retention anhidrosis and vesicles by means of iontophoresis. J Invest Dermatol 11:275CrossRefGoogle Scholar
  41. Shimizu H, Tamada Y, Ohshima Y, Matsumoto Y, Sugenoya J (2003) Effectiveness of iontophoresis with alternating current (AC) in the treatment of patients with palmoplantar hyperhidrosis. J Dermatol 30:444–449CrossRefGoogle Scholar
  42. Shrivastava SN, Singh G (1977) Tap water iontophoresis in palmoplantar hyperhidrosis. Br J Dermatol 96:189–195CrossRefGoogle Scholar
  43. Sloan JB, Soltani K (1986) Iontophoresis in dermatology. J Am Acad Dermatol 15:671–684CrossRefGoogle Scholar
  44. Strutton DR, Kowalski JW, Glaser DA, Stang PE (2004) US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 51:241–248CrossRefGoogle Scholar
  45. Turnell WJ (1921) Therapeutic action of constant current. Proc R Soc Med 14:41–52Google Scholar
  46. van der Schaar WW (1974) Die behandlung der hyperhidrosis mit iontophorese. Hautarzt 25:504–506PubMedGoogle Scholar
  47. Wang L, Hilliges M, Gajecki MJA, Johansson O (1994) No change in skin innervation in patients with palmar hyperhidrosis treated with tap-water iontophoresis. Br J Dermatol 13:742CrossRefGoogle Scholar
  48. Wollina U, Karamfilov T (2002) Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left-right comparison. J Eur Acad Dermatol Venereol 1:40–42CrossRefGoogle Scholar
  49. Wollina U, Uhlemann C, Elstermann D, Köber L, Barta U (1998) Therapie der hyperhidrosis mittels leitungswasseriontophorese. Hautarzt 49:109–113CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Dermatology and AllergologyUniversity Hospital, Klinikum OldenburgOldenburgGermany

Personalised recommendations