Lincolnshire Knowledge
and Resource Service
This search summary contains the results of a literature search undertaken by
the Lincolnshire Knowledge and Resource Service librarians in;
April 2013
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Alison Price
Janet Badcock
alison.price@lincolnshire.gov.uk
janet.badcock@lincolnshire.gov.uk
Lincolnshire Knowledge and Resource Service
Lexicon House, Stephenson Road
North Hykeham, Lincoln LN6 3QU
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“Google can bring you back 100,000 answers, a librarian can bring you back the right one.”
Neil Gaiman
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Neil Gaiman
Lincolnshire Knowledge
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Literature Search Results
Search request date:
Search completion date:
Search completed by:
22nd April 2013
25th April 2013
Alison Price
Enquiry Details
Clinical effectiveness and cost effectiveness of iontophoresis for axillary hyperhidrosis.
Comment
The theme of collected guideline / recommendation documents is that whilst iontophoresis is
an effective treatment for palmar or plantar hyperhidrosis, special axillary electrodes are
required to treat axillary hyperhidrosis and the documents do not include iontophoresis as an
evidence-based option for axillary hyperhidrosis.
I have not been able to locate any randomised controlled trials focusing upon its use for this
specific area of hyperhidrosis.
Disclaimer
Every effort has been made to ensure that this information is accurate, up-to-date, and complete. However it is
possible that it is not representative of the whole body of evidence available. No responsibility can be accepted
for any action taken on the basis of this information. It is the responsibility of the requester to determine the
accuracy, validity and interpretation of the search results.
All links from this resource are provided for information only. A link does not imply endorsement of that site and
the Lincolnshire Knowledge and Resource Service does not accept responsibility for the information displayed
there, or for the wording, content and accuracy of the information supplied which has been extracted in good faith
from reputable sources.
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Guidelines and Evidence-Based Best Practice Recommendations
BMJ Best Practice
Palmar hyperhidrosis
Topical aluminium chloride is often the first-choice treatment for palmar hyperhidrosis but
tends to be less effective than it is for treating axillary hyperhidrosis. [4] [9] [13] [28]
For patients who do not respond or cannot tolerate topical aluminium chloride on their
hands, iontophoresis with tap water may be used. Using an iontophoresis device, ions are
introduced into cutaneous tissues via an electrical current. The mechanism most probably
involves the ionic current temporarily blocking the sweat duct at the level of the stratum
corneum. The addition of anticholinergics or botulinum toxin A to the iontophoresis tap water
may improve its efficacy. [9] [29] Skin irritation from galvanic currents may occur.
Iontophoresis is contraindicated in patients with pacemakers or metal implants, or who are
pregnant. [9]
NB – iontophoresis is not mentioned as a treatment option for axillary hyperhidrosis;
Axillary hyperhidrosis
Topical aluminium chloride is the first-line treatment for axillary hyperhidrosis and is usually effective.
4] [9] [13
[
] Commonly-used preparations include 20% aluminium chloride in ethanol and 6.25%
aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid
when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may
9
help if this occurs. [ ]
If symptoms do not resolve with aluminium chloride, botulinum toxin type A (BTX-A) injections may be
considered. BTX-A is approved in many countries for axillary use and can be effective for months at a
9] [14
time. [
] [B Evidence] The agent inhibits the release of acetylcholine at the sympathetic cholinergic
nerve terminals that innervate eccrine sweat glands. The injection process may be painful. However,
9
local topical anaesthetic may help. [ ]
If the patient does not respond to BTX-A or does not want repeated painful injections with temporary
results, local sweat gland excision by curettage or liposuction should be considered next. Local
axillary gland surgeries (including subcutaneous gland resection with or without resection of the
overlying skin, curettage-liposuction, or electrosurgical or laser glandular destruction) have been
15] [16] [17] [18] [19
shown to be effective. [
] Local procedures seem to be more effective with better patient
satisfaction than thoracoscopic sympathetic surgeries, and have less compensatory and gustatory
20
sweating. [ ] Axillary surgery may result in poor wound healing or scarring. Unlike surgical
sympathectomy, local surgical procedures generally have no systemic manifestations (e.g.,
compensatory hyperhidrosis).
If symptoms persist, endoscopic thoracoscopic sympathectomy (ETS) may be considered. This is a
minimally invasive video-assisted procedure. [6] The specific hyperhidrosis disorder determines the
level of the sympathetic procedure. For example, surgery at the third (T3) or fourth (T4) thoracic
ganglia is recommended for axillary hyperhidrosis. View image Some controversy exists whether
compensatory sweating is more problematic at higher sympathectomy levels, but patient selection is
21
likely to be far more important. [ ] Sympathetic surgery at T3 or T4 can be expected to benefit 80% to
90% of patients with axillary hyperhidrosis. However, several studies have shown that sympathetic
surgery in patients with axillary hyperhidrosis is less successful and that the level of patient
10] [22] [23] [24] [25] [26] [27
satisfaction is lower than it is for patients with palmar hyperhidrosis. [
]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term
oral anticholinergic (e.g., glycopyrronium bromide, propantheline) taken as required can be
considered together with any of the other therapies, although the side effects may limit its usefulness.
http://bestpractice.bmj.com/best-practice/monograph/856/treatment/step-by-step.html
The Society of Thoracic Surgeons expert consensus for the surgical treatment of
hyperhidrosis
Annals of Thoracic Surgery, May 2011, vol./is. 91/5(1642-1648)
Cerfolio R.J., De Campos J.R.M., Bryant A.S., Connery C.P., Miller D.L., Decamp M.M.,
Abstract: Significant controversies surround the optimal treatment of primary
hyperhidrosis of the hands, axillae, feet, and face. The world's literature on hyperhidrosis
from 1991 to 2009 was obtained through PubMed. There were 1,097 published articles, of
which 102 were clinical trials. Twelve were randomized clinical trials and 90 were
nonrandomized comparative studies. After review and discussion by task force members of
The Society of Thoracic Surgeons' General Thoracic Workforce, expert consensus was
reached from which specific treatment strategies are suggested. These studies suggest that
primary hyperhidrosis of the extremities, axillae or face is best treated by endoscopic
thoracic sympathectomy (ETS). Interruption of the sympathetic chain can be achieved either
by electrocautery or clipping. An international nomenclature should be adopted that refers to
the rib levels (R) instead of the vertebral level at which the nerve is interrupted, and how the
chain is interrupted, along with systematic pre and postoperative assessments of sweating
pattern, intensity and quality-of-life. The recent body of literature suggests that the highest
success rates occur when interruption is performed at the top of R3 or the top of R4 for
palmar-only hyperhidrosis. R4 may offer a lower incidence of compensatory hyperhidrosis
but moister hands. For palmar and axillary, palmar, axillary and pedal and for axillary-only
hyperhidrosis interruptions at R4 and R5 are recommended. The top of R3 is best for
craniofacial hyperhidrosis. 2011 The Society of Thoracic Surgeons.
Iontophoresis is the introduction of ionized substances through intact skin by the application of direct
current. Iontophoresis is most often used for palmar or plantar hyperhidrosis, but a special
axillary electrode can be used to treat axillary hyperhidrosis as well.
Although there are only limited data from randomized trials, iontophoresis appears to alleviate
symptoms in approximately 85% of patients with palmar or plantar hyperhidrosis and is safe and
11, 12
simple to perform [
]. The drawback is that it is often irritating to the skin, leaves a “pins and
13
needles” feeling, and may cause scaling and fissuring [ ], and it is very labor intensive.
www.sts.org/sites/default/files/documents/pdf/expertconsensus/Surgical_Treatment_of_Hyp
erhidrosis.pdf
Recommendations for tap water iontophoresis
Erhard Hölzle, Martina Hund, Kerstin Lommel, Bodo Melnik
JDDG | 5˙2010 (Band 8)
Tap water iontophoresis is a process in which continuous or high frequency pulsed direct
current is applied to defined skin areas with the help of water baths or moist electrodes. It is
most often employed for the palms and soles, less frequently for the axillae or other areas.
4.1 Indications
The specific indications are idiopathic palmar, plantar and axillary hyperhidrosis. A
medium or higher degree of severity of hyperhidrosis should exist (see Appendix II).
The treatment of palms and soles is the domain of tap water iontophoresis. In the
treatment of axillary hyperhidrosis, other therapy options (topical application
of 15–20 % aluminum chloride solutions or intracutaneous injection of
botulinum toxin type A) are possibly superior.
The therapy alternatives should be weighed for each individual case.
The treatment of the soles is analogous to that of the palms. To treat the axillae
some manufacturers provide spherical sponge electrodes. They are also
moistened and in principle the treatment is analogous to the described treatment of
the palms. The same holds true for use at other body sites.
REQUEST FROM LKRS
Treatment of Hyperhidrosis
Association of American Family Physicians, 2011 Feb 15;83(4):464-466.
Clinical Question
What treatments are effective for excessive sweating (i.e., hyperhidrosis)?
Evidence-Based Answer
Iontophoresis may be effective for treating hyperhidrosis. In a controlled study of 22 patients
with focal hyperhidrosis (including the axillae, palms, and soles), one-half of participants'
affected areas were treated with tap water iontophoresis.9 Patients served as their own
controls, and were treated until symptoms resolved. The longest duration of treatment was
41 days. Patients were reevaluated at the final treatment and at one month after the final
treatment. Sweat output was measured using Persprint paper and computer analysis.
Overall, 93 percent of the affected areas had responded to treatment by day 20.
9. Akins DL, Meisenheimer JL, Dobson RL. Efficacy of the Drionic unit in the treatment of hyperhidrosis. J Am Acad
Dermatol. 1987;16(4):828–832.
A single-blind, right-left comparison study of 20 patients with palmoplantar hyperhidrosis
compared tap water iontophoresis with glycopyrrolate iontophoresis. In patients treated with
glycopyrrolate iontophoresis, the median number of days of self-reported hand dryness was
11, compared with three days for those treated with tap water iontophoresis (P < .0001).10
http://www.aafp.org/afp/2011/0215/p464.html
A comprehensive approach to the recognition, diagnosis, and severity-based
treatment of focal hyperhidrosis: Recommendations of the Canadian Hyperhidrosis
Advisory Committee
Dermatologic Surgery, 2007, vol./is. 33/8(908-923)
Solish N., Bertucci V., Dansereau A., Hong H.C.-H., Lynde C., Lupin M., Smith K.C.,
Abstract: BACKGROUND: Hyperhidrosis can have profound effects on a patient's quality of
life. Current treatment guidelines ignore disease severity. OBJECTIVE: The objective was to
establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal
hyperhidrosis. METHODS AND MATERIALS: A working group of eight nationally recognized
experts was convened to develop the consensus statement using an evidence-based
approach. RECOMMENDATIONS: An algorithm was designed to consider both disease
severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a
qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar
hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum
chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A;
axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line
therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or
4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line
therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be
treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery
(axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be
considered after failure of all other treatment options. CONCLUSIONS: These guidelines
offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis
according to severity.
Patient Information
NHS Choices - Iontophoresis
Iontophoresis is an effective treatment if you have excessive sweating that affects your
hands or feet. It can also be used to treat armpits, although this is usually less
effective.
If your hands and feet need treating, you place them in a bowl of water and a weak electric
current is passed through the water.
If your armpits need treating, then a wet contact pad is placed against each armpit and then
a current is then passed through the pad.
The current is thought to help block the sweat glands.
The treatment is not painful but the electric current can cause some mild, short-lived
discomfort and skin irritation.
Each session of iontophoresis lasts between 20 and 30 minutes and you will usually need to
have two to four sessions a week. Your symptoms should begin to improve after a week or
two, after which further treatment will be required at one-to-four week intervals, depending
on how severe your symptoms are.
Iontophoresis has proved to be effective in 80% to 90% of cases. However, you will need to
make regular visits to your local hospital’s dermatology clinic to receive treatment.
Alternatively, iontophoresis kits that you can use at home are also available, with prices
ranging from £325 to £500.
http://www.nhs.uk/Conditions/Hyperhidrosis/Pages/Treatment.aspx
International Hyperhidrosis Society
Iontophoresis is not usually recommended for axillary hyperhidrosis because the skin
in the armpits is likely to be irritated by the process and because it is very difficult to perform
iontophoresis on the underarms.
http://www.sweathelp.org/en/hyperhidrosis-treatments/iontophoresis
Research
Search History: MEDLINE and EMBASE
Thesaurus terms: HYPERHIDROSIS/ IONTOPHORESIS/ AXILLA/
Free text terms: (axillary AND hyperhidrosis) (armpit OR underarm) (axillae OR axillary)
Systematic Reviews
Primary focal hyperhidrosis: current treatment options and a step-by-step approach.
Journal of the European Academy of Dermatology & Venereology, 2012, vol./is. 26/1(1-8),
Hoorens I, Ongenae K
Abstract: Primary focal hyperhidrosis is a common disorder for which treatment is often a
therapeutic challenge. A systematic review of current literature on the various treatment
modalities for primary focal hyperhidrosis was performed and a step-by-step approach for
the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial)
was established. Non-surgical treatments (aluminium salts, local and systemic
anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately
supported by the current literature. More invasive surgical procedures (suction curettage and
sympathetic denervation) have also been extensively investigated, and can offer a more
definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical
treatments. There is no consensus on specific techniques for sympathetic denervation, and
this issue should be further examined by meta-analysis. There are numerous treatment
options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice,
however, the challenge for the dermatologist remains to evaluate the severity of
hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively
using the Hyperhidrosis Disease Severity Scale (HDSS).
Iontophoresis Tap water iontophoresis (TWI): While the mechanism of action of TWI is not yet
entirely clear, it is an effective treatment in the inhibition of sweat secretion (Fig. 1). TWI treatment
consists of 20–30 min treatments, three to four times per week. Each palm or sole is placed in a
26
small tray filled with tap water with a current of 15–20 mA. Upon euhidrosis, maintenance treatment
consisting of one session per week or even one session per month can be effective. Favourable
results are attained in 81.2% of patients with palmoplantar hyperhidrosis after eight initial treatments.
The main side effects are erythema, burning sensation and temporary vesicle formation on the palms
35
and soles.
TWI is a safe, cost-effective and efficient treatment for the motivated patient with palmar or plantar
hyperhidrosis and should be considered when topical treatment fails (Table 4).
If TWI fails, administration of low dose anticholinergic agents through iontophoresis may be
considered. However, this treatment option is not recommended by the Canadian Hyperhidrosis
Advisory Committee (Table 4).
Dry-type iontophoretic device: The dry-type iontophoretic device uses patient sweat for conduction.
The patient holds a cylinder during treatment. Effects similar to TWI have been described with the
advantage of this method being that it can be administered while performing daily activities such as
reading, watching TV or even jogging.43 One study confirms the effectiveness of dry-type
iontophoresis for palmar hyperhidrosis using conductive pads applied to the patients’ palmar side of
the lower forearm.44 This system induces an immediate reduction in sweat production confirmed by
the Minor iodine test. Further studies should be performed directly comparing dry-type iontophoresis
and TWI.
Table 4 Current surgical and non-surgical treatment options in a step-by-step approach
Axillary hyperhidrosis
Step 1
Topical aluminium chloride hexahydrate
Step 2
BTX-A injections
Step 3
Systemic anticholinergics
Step 4
Suction curettage or excision of the sweat glands
Step 5
Repeat suction curettage or sympathetic denervation
REQUEST FROM LKRS
Literature Reviews
Treatment options for hyperhidrosis.
American Journal of Clinical Dermatology, October 2011, vol./is. 12/5(285-95)
Walling HW, Swick BL
Abstract: Hyperhidrosis is a disorder of excessive sweating beyond what is expected for
thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an
estimated prevalence of nearly 3% and is associated with significant medical and
psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine
density, particularly the axillae, palms, and soles, and less often the craniofacial area.
Multiple therapies are available for the treatment of hyperhidrosis. Options include topical
medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections,
systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly
endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to
comprehensively review the literature on the subject, with a focus on new and emerging
treatment options. Updated therapeutic algorithms are proposed for each commonly affected
anatomic site, with practical procedural guidelines. For axillary and palmoplantar
hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary
hyperhidrosis, botulinum toxin injections are recommended as second-line treatment,
oral medications as third-line treatment, local surgery as fourth-line treatment, and
ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral
medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice
daily) as second-line therapy due to the low cost, convenience, and emerging literature
supporting their excellent safety and reasonable efficacy. Iontophoresis is considered
third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the
initial levels of cost and inconvenience. Botulinum toxin injections are considered fourthline treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains
expensive, must be repeated every 3-6 months, and is associated with pain and/or
anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not
recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis,
oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical
medications or botulinum toxin injections may be useful in some cases and ETS is an option
for severe craniofacial hyperhidrosis.
Hyperhidrosis: evolving concepts and a comprehensive review.
Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland, 2010, 8/5(287-92)
Vorkamp T, Foo FJ, Khan S, Schmitto JD, Wilson P
Abstract: Hyperhidrosis (primary or secondary) describes a disorder of excessive sweating.
It has a significant negative impact on quality of life and affects nearly 1% of the population
living in the United Kingdom (UK). Axillary involvement is the most common affecting 80% of
cases. A common link to these disorders is an extreme non-thermoregulatory sympathetic
stimulus of exocrine sweat glands, mostly due to emotional stimuli. Non-surgical treatment
involves topical medication, iontophoresis and systemic anti-cholinergics. More recently the
use of intradermal botulinum toxin has gained popularity. Surgical treatment reserved for
severe cases, not responding to conservative management involves local excision, curettage
and thoracoscopic sympathectomy. Evolving concepts for treatment, risks and benefits are
discussed in the paper herein.
Iontophoresis
Tap water iontophoresis, developed in 1952 is a traditional technique,22 which
remains the non-surgical treatment of choice for palmareplantar hyperhidrosis.23
Moisturised pedals are applied to skin, while the pedals are in contact with an
electrolyte solution. Direct electrical current is passed through the solution. The
intention is to disrupt ion channels reversibly, which leads to a blockage of sweat
glands.24 Success rates of up to 81% have been reported. It is contraindicated in
pregnant women and patients with pacemakers.
Adverse effects include temporary skin irritation, pain and blistering.25 Negative longterm effects have not been reported.
Additionally, anti-cholinergics added to tap water have shown better results in terms
of longer lasting and quicker effects. The idea is to block sweat production at the
level of neuroglandular junction. Systemic use of anti-cholinergics is not generally
recommended because of the broad spectrum of side effects such as mydriasis,
glaucoma, drowsiness, urinary retention and constipation.26
Iontophoresis is non-invasive and particularly useful for palmareplantar
hyperhydrosis patients not responding to topical treatment. However the therapy is
relatively unpleasant and time-consuming. Patients will need maintenance treatment
and availability of machines can be a limiting factor.
This paper includes a Therapeutic Pathway for Axillary and for Palmar
Hyperhidrosis. Iontophoresis is listed for palmar, but not axillary.
REQUEST FROM LKRS
Evidence-based review of the nonsurgical management of hyperhidrosis.
Thoracic Surgery Clinics, May 2008, vol./is. 18/2(157-66), 1547-4127 (2008 May)
Reisfeld R, Berliner KI
Topical treatments should always be first-line therapy. For those who fail such treatment,
iontophoresis is typically recommended for those with palmar or plantar
hyperhidrosis, whereas BTX is often considered as first- or second-line therapy in
severe axillary hyperhidrosis. Oral anticholinergics are considered after failure of all other
nonsurgical treatments.
Primary Focal Hyperhidrosis
Kathani A. Amin, MD
DermatologyReview.com Journal, February 2007
Iontophoresis
Because hands and feet are easiest to submerge in water, iontophoresis is usually
used for palmar and plantar hyperhidrosis, but can be used for axillary hyperhidrosis
with specialized electrode pads.
The duration of treatment should be 20-30 minutes daily, and halfway through the session
the polarity should be switched to achieve the same result on each palm or sole, since the
anodal current has the strongest inhibitory effect. Initially treatments should be daily, but the
frequency can be reduced when anhidrosis is achieved, usually after 10-15 sessions.
Maintenance therapy should be tailored to an individual schedule, but usually requires
treatments once to three times weekly. Although it is a timeconsuming procedure, adverse
effects are few, consisting of dry, cracked skin, punctuate electrical burns in unnoticed skin
defects, and erythema or vesiculation along the water line. These are minimized with caution
and proper technique.
Iontophoresis has been reported to be 80-100% effective in clinical trials.
Overall, iontophoresis is highly effective for palmoplantar hyperhidrosis but less effective for
axillary hyperhidrosis.
REQUEST FROM LKRS
Treatments for excessive armpit sweating.
Drug & Therapeutics Bulletin, October 2005, vol./is. 43/10(77-80)
Abstract: Many people who complain of excessive sweating have primary hyperhidrosis.
This idiopathic disorder is characterised by excessive, bilateral and roughly symmetrical
sweating, most commonly affecting the axillae, palms, feet and face. For some patients,
excessive sweating is intolerable as it stains and damages clothes, reduces confidence and
limits social contact. Treatment options have been limited but now include botulinum toxin for
severe axillary hyperhidrosis. Here we review treatments for primary focal hyperhidrosis,
focusing on axillary sweating.
Additional Studies
A new device for the treatment of hyperhidrosis by iontophoresis.
British Journal of Dermatology, 1986, vol./is. 114/4(485-8) Midtgaard K
Abstract: A new device for the treatment of hyperhidrosis by iontophoresis is described.
Twenty-five patients have so far been treated, six with hyperhidrosis of the palms, 13 with
hyperhidrosis of the soles and six with axillary hyperhidrosis. In 21 cases there was an
excellent result. The effect of the treatment usually lasted for several weeks. Maintenance
treatment every 4-6 weeks was found to be required.
Treatment of hyperhidrosis by a battery-operated iontophoretic device.
Dermatologica, 1986, vol./is. 172/1(41-7) Holzle E, Ruzicka T
Abstract: A new iontophoretic device was utilized in the treatment of hyperhidrosis axillaris
(5 patients), hyperhidrosis manuum (12 patients) and hyperhidrosis pedum (10 patients).
Unilateral treatment was carried out daily for 3 weeks. Degree of sweat inhibition was
assessed quantitatively in relation to the untreated control side by means of hygrometry and
also estimated by a colorimetric method. In 3 patients with palmar hyperhidrosis and in 2
patients with plantar hyperhidrosis sweating returned to normal levels, thus hyperhidrosis
was completely curbed. A moderate reduction of sweat rates was induced in 4 patients on
palms and in 3 patients on soles. In the remaining group sweat inhibition was only slight. In
treatment of palmo-plantar hyperhidrosis side effects were minimal. Axillary hyperhidrosis
was only moderately reduced in some patients. Skin irritation due to iontophoresis posed a
problem.