Downloads and information about iontophoresis
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+ Flyer
Hidrex iontophoresis flyer: “STOP SWEATING! – Hidrex iontophoresis devices: the latest generation with many convenient features” (2021)
Hidrex iontophoresis brochure: “STOP SWEATING! – TWI Treatment for Hyperhidrosis” (2021)
+ Forms
Form: Declaration of consent in the collection and processing of data by the HIDREX GmbH according to the Data Protection Act
Form: “Repair/Service Order for a HIDREX Iontophoresis Treatment Home Device”
Form: (only for dealers!): “Repair/Service Order for a HIDREX Iontophoresis Treatment Home Device”
+ Studies
Ross syndrome
Ross syndrome: treatment of segmental compensatory hyperhidrosis with a modified iontophoresis device
Study for download (PDF) EN 1993: Ross Syndrome
Summary of the study:
Ross syndrome is a neurological disease of the skin characterised by the simultaneous occurrence of decreased or absent sweat secretion (hypohidrosis), tonic pupil contraction, and attenuated muscle reflexes. The hypohidrosis on one side of the body is compensated with increased sweat secretion on the other side (hyperhidrosis), which is the most disturbing symptom for the patient.
The aim of the study was to investigate the effectiveness of tap water iontophoresis (TWI) in treating this syndrome. To treat excessive sweating, an iontophoresis device from HIDREX GmbH was used with specially designed applicators for the treatment of the legs and back.
After 20 treatments, the test subjects experienced a satisfactory relief of their hyperhidrosis. In the maintenance phase, iontophoresis therapy was continued once weekly. There were no side effects.
(cf. Reinauer, S., Schauf, G., Hölzle, E.: Ross syndrome: Treatment of segmental compensatory hyperhidrosis by a modified iontophoretic device. in: Journal of the American Academy of Dermatology, Volume 28, Number 2, Part 2)
AC and pulse current iontophoresis
A new approach to the treatment of hyperhidrosis
Study for download (PDF) EN 1993: AC and pulse current iontophoresis: a new approach to treating hyperhidrosis
Summary of the study:
For the treatment of hyperhidrosis of the hands or feet, iontophoresis treatment with direct current (DC) is the most effective treatment. The positive effect has been proven in several studies. However, treatment with DC does come with some side effects. These include: burns and tingling in the treatment area and skin irritation with redness and blistering. In addition, treatment with DC may be uncomfortable for the patient.
The aim of this study was to minimize the side effects of tap water iontophoresis while improving technology and safety standards. For this purpose, conventional treatment with direct current was compared to treatment using alternating and pulse currents.
AC therapy failed to show any results in relieving hyperhidrosis. The subjects’ excessive sweating remained unchanged. Treatment with pulse current, as with DC treatment, normalised the amount of sweat production after an average of 11 treatments. For both types of current, the side effects of hyperhidrosis such as a blue discoloration of the skin and swelling were reduced.
There were no side effects with the pulse current treatment compared to treatment with DC. This is probably due to the fact that treatment with pulse current requires lower voltage levels than DC in order to alleviate excessive sweating. Therefore, treatment with pulse current should be the treatment of choice for hyperhidrosis of the hands or feet.
(cf. Reinauer, S., Neusser, A. et al.: Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. in: British Journal of Dermatology (1993) 129, 166-169.)
Therapy Iontophoresis
Modification and optimisation of tap water iontophoresis
Modification and optimisation of tap water iontophoresis
Study for download (PDF / DE 1994): Modification and optimisation of tap water iontophoresis
Summary of the study:
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
(cf. Schauf, G.,Hubert, M. et al.: Modifikation und Optimierung der Leitungswasser-Iontophorese in: Hautarzt (1994) 45, p. 759-761)
The Usefulness of Home Therapy
Long-Term Efficacy and Side Effects of Tap Water Iontophoresis of Palmoplantar Hyperhidrosis
Study for download (PDF) EN 1987: Long-Term Efficacy and Side Effects of Tap Water Iontophoresis of Palmoplantar Hyperhidrosis (Original in English)
Summary of the study:
This study had 3 goals:
- To demonstrate the effectiveness of tap water iontophoresis by quantitative measurements,
- to show possible long-term side effects,
- and to test the practical benefits of a HIDREX home treatment device.
To answer the research questions, 71 patients with hyperhidrosis of the hands or feet were examined, with most patients (84.5%) suffering from excessive sweating on both hands and feet. Three methods were chosen to measure the effectiveness: a gravimetric measurement of sweat volume, a semiquantitative estimation of the degree of perspiration by impressions of perspiring skin areas on special paper (colorimetric measurement), and a measurement of skin temperature.
Results:
- The reduction of sweating during treatment was measurable with all three methods. A gradual relief of the hidrosis began to occur after 3-5 treatments. After an average of 12 treatments on the hands and 10 treatments on the feet, the amount of sweat could be normalised. Skin temperature measurements before and after the therapy showed an average increase in temperature of 3.5 degrees.
The treatment thus stopped more than the excessive sweating. It also affected symptoms associated with hyperhidrosis such as a blue discoloration of the hands or soles, hypothermia of the fingers and toes, and swelling of the fingers and toes.
- The effect of tap water iontophoresis therapy is reversible. A complete inhibition of hyperhidrosis lasted only 1-2 weeks. On average, patients had to perform 1.3 treatments a week to keep their sweating at normal levels. No long-term side effects were noted.
- There were no significant differences in efficacy or side effects between the HIDREX home treatment device and the control device. Nevertheless, some patients felt very little discomfort when using the HIDREX device.
(cf. Hölzle, E., Alberti, N.: Long-Term Efficacy and Side Effects of Tap Water Iontophoresis of Palmoplantar Hyperhidrosis – the Usefulness of Home Therapy, In: Dermatologica 175: 126-135 (1987)).
Pulsed DC iontophoresis
Pulsed DC iontophoresis as a new treatment option for hyperhidrosis (PDF / DE 1995)
Study for download (PDF) DE 1995: Die gepulste Gleichstromiontophorese als neue Behandlungsmöglichkeit der Hyperhidrosis
Summary of the study:
Tap water iontophoresis with direct current has become the treatment of choice for excessive sweating of the hands or feet due to its high success rate (98%).
Because of such side effects as discomfort and issues such as shocks that sometimes occur with direct current iontophoresis, the aim of the present study was to minimize the side effects of tap water iontophoresis, increase safety standards, and reduce the technical effort without losing therapeutic efficacy.
In the investigation, the effectiveness and side effects of a DC device made by HIDREX GmbH, a device with pulsed direct current with triangular voltage curve (experimental device, manufacturer unnamed), and a pulse current device made by HIDREX GmbH with rectangular voltage curve were compared.
Overview of the study’s results:
| Current type | Normhidrosis after (n) treatments | Response rate in % | Side effects |
|---|---|---|---|
| Direct current HIDREX | 10,0 | 100 | tingling, burning, electric shocks |
| Triangular pulse current | 12,3 | 80 | Minor skin sensations like tingling, no electric shocks |
| Pulse current HIDREX | 12,4 | 100 | Minimal skin sensations, no electric shocks |
Normal sweating was achieved with DC treatment after an average of 10 treatments, with both pulse current forms achieving the same results after about 12 treatments. Adverse events such as pain, skin irritation, or mild electric shock due to improper use occasionally occurred during treatment with DC. The subjects reported few side effects when treated with pulse currents. Skin irritations occurred only rarely when subjects were treated with triangular pulse current and the occurrence was further minimized when treated with the rectangular pulse current of the HIDREX GmbH device. Neither pulse current devices caused electric shocks. Both DC and pulse current treatment with HIDREX devices was 100% effective in normalising the sweat levels of all subjects. The device using triangular pulse current was successful with only 80% of the subjects.
Conclusion: Due to the reduced occurrence of side effects, tap water iontophoresis with pulse current, despite its somewhat lower efficiency, is a viable alternative to DC iontophoresis. It should be considered the method of choice for treating children. In extreme cases of hyperhidrosis, the use of pulse current may not be sufficient. In these cases, treatment with DC is also recommended.
(cf. Reinauer, S., Neußer, A. et al.: Die gepulste Gleichstrom-Iontophorese als neue Behandlungsmöglichkeit der Hyperhidrosis. in: Hautarzt (1995) 46, p. 543 – 547)
Positive effects on healing time and freedom from recurrence in hand-foot eczemas
Treating hyperhidrosis using tap water iontophoresis: positive effects on healing time and freedom from recurrence in hand-foot eczema
Study for download (PDF) DE 1998: Positive Effekte auf Abheilungszeit und Rezidivfreiheit bei Hand-Fuß-Ekzemen
Summary of the study:
Excessive sweating caused by hyperhidrosis of the hands and feet can severely restrict the lives of affected patients. This lends this phenomenon its own disease character. Morbid sweating is also discussed as a factor that worsens eczema of the hands and feet.
The aim of the study was to investigate the influence of eczema on treatment of hyperhidrosis with tap water iontophoresis. The study used a HIDREX pulse current device.
The study showed that tap water iontophoresis is not only effective in relieving excessive perspiration on the hands and feet, but also cuts the healing time and reduces recurrence of eczema. On average, there was a shorter healing time (20 days with iontophoresis vs. 22.3 days without iontophoresis), which might not be significant itself, but the length of the relapse-free period (24.8 weeks with iontophoresis vs. 8.35 weeks without iontophoresis) is highly significant.
This is not only due to the reduction in sweat but also to an influence on the inflammatory reactions in the eczematous skin. The capsaicin-like effects of the electrical current are suspected. The inflammation is interrupted, which has a positive effect on prolonged freedom from recurrence in hyperhidrotic hand-foot eczema.
(cf. Wollina, U., Uhlemann, C. et al.: Therapie der Hyperhidrosis mittels Leitungswasseriontophorese: Positive Effekte auf Abheilungszeit und Rezidivfreiheit bei Hand-Fuß-Ekzemen. in: Hautarzt (1998) 49, p. 109-113).
The mechanism of tap water iontophoresis
The mechanism of tap water iontophoresis: a functional disturbance of the secretory epithelium
Study for download (PDF) DE 1992: Wirkungsmechanismus der Iontophorese
Summary of the study:
Despite decades of positive results with tap water iontophoresis for the treatment of hyperhidrosis, the exact mechanism is still unclear.
The aim of the study was to review the hitherto common hypothesis of a mechanical closure of the excretory ducts in the sweat glands and propose an alternative theory as to how tap water iontophoresis works.
Histomorphological, functional, and electro-physical examinations were performed to assess the condition of the sweat glands under tap water iontophoresis treatment. The current used came from a device made by HIDREX GmbH.
Results:
The histomorphological examination showed that the sweat glands do not close mechanically nor are there structural changes in the excretory ducts of the sweat glands after iontophoresis. All that was observed was their inactivity.
As part of the functional examination of the sweat glands after tap water iontophoresis had eliminated or reduced sweat levels, they were shown to be refractory to pharmacological stimuli, indicating that the effect takes place through a change in the postsynaptic region.
Skin resistance measurements were performed during the electro-physical examination. The low increase in resistance after tap water iontophoresis in contrast to the comparative study (use of aluminium chloride) also speaks against the closing of the excretory ducts of the sweat glands as a mechanism of action.
From the results of the study it can be concluded that the effect of tap water iontophoresis is not based on a mechanical blocking of the ducts, as had previously been assumed. Rather, it is believed that the TWI disrupts the way stimuli and secretion are coupled in the sweat glands.
(cf. Reinauer, S., Schauf, G. et al.: Wirkungsmechanismus der Leitungswasser-Iontophorese: Funktionelle Störung des sekretorischen Epithels. in: Z. Hautkr. 67 (7), 1992, p. 622-626)
+ Video
Hidrex video explaining how hyperhidrosis can be treated with tap water iontophoresis
