Category: Iontophoresis

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Hospital-Based Tap Water Iontophoresis for Primary Focal Hyperhidrosis: A Real-World Analysis of Treatment Adherence, Efficacy, and Relapse

J Clin Med. 2026 Jan 13;15(2):640. doi: 10.3390/jcm15020640.

ABSTRACT

Background: Tap water iontophoresis (TWI) is a well-established second-line treatment for primary focal hyperhidrosis. While its efficacy is proven, data regarding the correlation between session frequency and clinical response, as well as long-term adherence in hospital-based settings, remain limited. Objective: We aimed to evaluate the efficacy and safety of hospital-based TWI and to analyze the relationship between the number of treatment sessions and clinical outcomes. Methods: This retrospective study included 92 patients with primary focal hyperhidrosis treated with TWI. Disease severity was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Clinical response was categorized as “Excellent” (≥2-point HDSS reduction), “Good” (1-point reduction), or “No Response.” Relapse rates and reasons for treatment discontinuation were analyzed over a 6-month follow-up period. Results: The overall objective response rate was 65.2% (46.7% Excellent, 18.5% Good). A significant positive correlation was found between the total number of treatment sessions and the degree of clinical response (r = 0.401, p < 0.001). Patients achieving an “Excellent” response completed a significantly higher median number of sessions compared to non-responders (p = 0.001). However, among responders, the relapse rate was 85% within six months. Logistical difficulties were the most common reason for treatment discontinuation (17.5%). No compensatory hyperhidrosis or severe adverse events were observed. Conclusions: Hospital-based TWI is a safe and highly effective induction therapy, with success rates closely linked to the number of completed sessions. However, the high relapse rate and logistical barriers to adherence suggest that hospital-based protocols should serve primarily as a bridge to home-based maintenance therapy to ensure sustained long-term remission.

PMID:41598578 | DOI:10.3390/jcm15020640

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A significant gap between inadequate pharmacotherapy and substantial unmet needs in palmar hyperhidrosis management in China: insights from a questionnaire-based survey among outpatients

Front Pharmacol. 2026 Jan 8;16:1715189. doi: 10.3389/fphar.2025.1715189. eCollection 2025.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis, characterized by excessive sweating primarily affecting the hands, significantly impairs quality of life and psychological well-being. Although topical agents, iontophoresis, microwave therapy, and sympathectomy are established interventions, real-world treatment patterns and pharmacotherapeutic adequacy among Chinese patients remain poorly delineated.

METHODS: An anonymous, questionnaire-based survey was conducted among consecutive patients at a tertiary thoracic surgery clinic in China between March 2023 and October 2024. A total of 363 valid responses were collected and analyzed using SPSS 27.0. Descriptive statistics and multivariable logistic regression were used to evaluate treatment patterns, patient preference, and predictors of treatment selection.

RESULTS: The study cohort was composed predominantly of individuals with severe disease (87.3% HDSS grade 3-4), and nearly all participants (97.8%) presented with palmar hyperhidrosis. Regarding treatment history, only 38.1% had previously received pharmacotherapy, while 32.6% had utilized Traditional Chinese Medicine (TCM) therapeutic approaches, including TCM, acupuncture, massage and manipulation therapies. Antiperspirants (28.6%) and TCM (25.0%) were the most frequently used prior pharmacotherapies, yet both were associated with limited therapeutic efficacy. According to our survey, owing to high symptom severity, 52.9% had a general knowledge of surgical intervention before the outpatient visit. Primary concerns regarding previous pharmacotherapy included insufficient efficacy and localized adverse effects, particularly skin irritation. Notably, 50.0% of participants remained receptive to future pharmacotherapy, showing a preference for topical formulations (29.3%) and reduced dosing frequency (31.6%). Gender and disease severity were identified as significant determinants of treatment choice. Importantly, prior negative experiences – such as inefficacy and side effects – did not significantly diminish willingness to consider future pharmacologic treatment.

CONCLUSION: Inadequate management and suboptimal treatment outcomes represent considerable challenges in the care of palmar hyperhidrosis in China. Existing pharmacotherapeutic options are constrained by limited availability, inadequate efficacy, and a narrow range of approved agents – a reality that highlights a critical disconnect with substantial patient demand. These findings underscore an urgent need to accelerate drug development and clinical translation in this field.

PMID:41585901 | PMC:PMC12823788 | DOI:10.3389/fphar.2025.1715189

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Hyperhidrosis: Prevalence, Diagnosis, and Stepwise Treatment

Dtsch Arztebl Int. 2026 May 1;(Forthcoming):arztebl.m2025.0229. doi: 10.3238/arztebl.m2025.0229. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperhidrosis, or sweating beyond the physiological amount, can be either focal or generalized and sometimes runs in families. The prevalence of primary idiopathic hyperhidrosis is 2-5%. Secondary hyperhidrosis is associated with specific illnesses and medications. In this article, we discuss the diagnostic evaluation of hyperhidrosis and treatments for it, along with their efficacy and side effects.

METHODS: This narrative review is based on publications retrieved from the Medline and Cochrane databases with the search term “hyperhidrosis” and other specific terms relating to treatment. Expert recommendations and guidelines were considered as well.

RESULTS: The diagnostic evaluation consists of a clinical history, a Minor (starch-iodine) test, gravimetry, and dynamic sudometry. There have been no more than a few high-quality published studies on specific interventions. Depending on the severity and symptom burden, aluminum chloride and anticholinergic drugs are used first, followed by botulinum toxin injections and subcutaneous curettage for axillary hyperhidrosis. These treatments reportedly bring about marked improvement in 60-70 % of patients; their side effects, depending on the particular treatment used, include local reactions such as itch, pain, and cutaneous irritation and anticholinergic effects such as dry mouth, mydriasis, urinary retention, and headache. Further therapeutic options are tap water iontophoresis; radiofrequency, focused ultrasound, and microwave treatment; systemically administered anticholinergic drugs; and thoracic or lumbar sympathectomy for palmar or plantar hyperhidrosis, respectively.

CONCLUSION: A variety of methods can be used to relieve hyperhidrosis and improve these patients’ quality of life. There have been no more than a few high-quality studies on their efficacy and long-term results.

PMID:41572865 | DOI:10.3238/arztebl.m2025.0229

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Efficacy and Safety of Treatments for Primary Palmar Hyperhidrosis: A Systematic Review Assessing Patient-Centric Outcomes

Dermatol Res Pract. 2025 Aug 20;2025:8867838. doi: 10.1155/drp/8867838. eCollection 2025.

ABSTRACT

Background: Primary palmar hyperhidrosis (PH) is a chronic condition characterized by excessive sweating in the palms, significantly affecting the quality of life (QOL) of affected individuals. Despite the availability of various treatment modalities, the long-term efficacy and safety of these interventions remain unclear, warranting a comprehensive evaluation. This systematic review aims to assess the efficacy, safety and patient-reported outcomes of treatments for PH. Methods: A systematic search was conducted in PubMed, Embase and the Cochrane Library from their inception until March 2024, adhering to PRISMA guidelines. Inclusion criteria focused on prospective and retrospective studies examining PH treatments published in English. Data from eligible studies were extracted, analysed qualitatively and reported based on outcomes, including efficacy, QOL improvements and adverse effects. Results: Fourteen studies, including 1733 patients aged 4-77 years, were included in the final review. The treatments assessed included oral and topical oxybutynin, iontophoresis, botulinum toxin A injections, photodynamic therapy (PDT) and endoscopic thoracic sympathectomy (ETS). Oral oxybutynin demonstrated symptomatic relief in 60%-97% of the patients although anticholinergic side effects were frequently reported. ETS, while providing the highest rates of complete sweat cessation, was associated with compensatory hyperhidrosis. Noninvasive treatments like iontophoresis showed moderate efficacy with minimal side effects but required ongoing sessions for maintenance. Conclusion: This review highlights the efficacy of several therapeutic approaches for PH though most treatments are hindered by significant adverse effects or practical limitations. Future research should prioritize long-term studies and standardized outcome measures to guide clinical decision-making more effectively.

PMID:40881604 | PMC:PMC12390518 | DOI:10.1155/drp/8867838

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Primary hyperhidrosis: an updated review

Drugs Context. 2025 Jun 16;14:2025-3-2. doi: 10.7573/dic.2025-3-2. eCollection 2025.

ABSTRACT

BACKGROUND: Hyperhidrosis (HH) is a condition characterized by excessive sweating beyond the physiological needs of thermoregulation. HH can be classified as primary (idiopathic) hyperhidrosis (PHH) or secondary hyperhidrosis (SHH), which is associated with underlying medical conditions, medications or systemic disorders. This narrative review provides an updated overview of PHH, with a focus on epidemiology, aetiopathogenesis, clinical manifestations, diagnostic approaches and current management strategies, particularly highlighting pharmacological and procedural treatment options.

METHODS: A literature search was conducted in February 2025 across Ovid Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) using the key term “hyperhidrosis”. The review included observational studies, clinical trials, narrative reviews, guidelines and meta-analyses published in the past 10 years. Additional references were identified through manual searches of relevant bibliographies.

RESULTS: The global prevalence of PHH is estimated to range between 0.072% and 9%, with PHH accounting for 93% of all HH cases. Whilst the precise pathophysiology remains unclear, PHH is believed to result from sympathetic overactivity, whereas SHH is associated with endocrine, neurological, infectious, malignant and medication-induced causes. PHH is diagnosed clinically and distinguishing between primary and secondary forms is essential. Management options vary based on severity, ranging from topical therapies (antiperspirants, anticholinergics), systemic medications (oral anticholinergics, adrenergic modulators), device-based interventions (iontophoresis, microwave thermolysis), injectable therapies (botulinum toxin) and surgical approaches (sympathectomy, excision, liposuction/curettage). Whilst these interventions can significantly improve symptoms and quality of life, long-term efficacy, recurrence and adverse effects remain concerns.

CONCLUSION: PHH significantly impacts the quality life of patients contributing to both physical discomfort and psychosocial distress. An individualized, multi-modal approach is crucial to optimizing management. Further research is warranted to refine existing therapies and evaluate emerging treatment modalities for improved long-term outcomes.

PMID:40575073 | PMC:PMC12201942 | DOI:10.7573/dic.2025-3-2

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Primary Hyperhidrosis in Children: Current Perspectives and Therapeutic Options

Pediatr Ann. 2025 Jun;54(6):e196-e202. doi: 10.3928/19382359-20250321-03. Epub 2025 Jun 1.

ABSTRACT

Primary hyperhidrosis is a common condition that often begins before age 18 years and frequently presents to the pediatric primary care provider. It can have significant negative impacts on a child’s quality of life (QOL) and emotional well-being. There are a variety of treatment options available that have been shown to decrease symptoms, as well as improve QOL. These treatments include over-the-counter antiperspirants, prescription antiperspirants, topical anticholinergics, iontophoresis, systemic anticholinergics, injectable botulinum toxin, and surgical sympathectomy. Treatment of this condition is lifelong and often nuanced. It is imperative for the pediatric practitioner to be well versed in the risks and benefits, as well as proper usage, of these various therapeutic modalities. With this knowledge, effective treatment plans can be crafted to improve both the physical and mental health of affected children. [Pediatr Ann. 2025;54(6):e196-e202.].

PMID:40489364 | DOI:10.3928/19382359-20250321-03

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Global research trends and hotspots of hyperhidrosis: a bibliometric analysis (2008-2023)

Front Surg. 2025 Apr 22;12:1559951. doi: 10.3389/fsurg.2025.1559951. eCollection 2025.

ABSTRACT

BACKGROUND: Recent studies have demonstrated significant advancements in the treatment of hyperhidrosis. However, a bibliometric analysis of relevant studies in this field is notably lacking. This study aims to provide a detailed analysis of research trends and key areas of interest in hyperhidrosis over the last 16 years using bibliometric methods.

METHODS: We searched the Web of Science Core Collection (WoSCC) database for hyperhidrosis-related publications from 2008 to 2023 and conducted bibliometric analysis using VOS viewer and the R package “bibliometrix.”

RESULTS: The main research institutions involved in this study are the University of São Paulo, Hospital Israelita Albert Einstein, Yonsei University and Fujian Medical University, with a total of 728 articles included from 52 countries. Authors from these institutions have published in top journals, with Dermatologic Surgery being the most popular journal and the Journal of the American Academy of Dermatology being the most cited. A total of 2,830 authors have contributed to this field, with prominent researchers including Nelson Wolosker, Paulo Kauffman, Pedro Puech-Leão, Jose Ribas Milanez de Campos, and Dee Anna Glaser. Nelson Wolosker stands out as the most co-cited author. The primary focus of research in this area is on the treatment of hyperhidrosis and the prevention of post-operative complications. Emerging re-search hotspots include keywords such as “botulinum toxin,” “oxybutynin,” “sympathectomy,” “iontophoresis,” and “compensatory sweating”.

CONCLUSION: The most prevalent academic emphasis within this field remains the treatment of hyperhidrosis and the management of compensatory hyperhidrosis. Despite this academic preponderance, there is a compelling necessity to foster enhanced collaboration and exchange between disparate countries and institutions.

PMID:40330089 | PMC:PMC12052815 | DOI:10.3389/fsurg.2025.1559951

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Comparative study between fractional laser assisted drug delivery of botulinum toxin versus botulinum toxin injection in primary palmar and axillary hyperhidrosis

Arch Dermatol Res. 2025 Jan 13;317(1):241. doi: 10.1007/s00403-024-03715-5.

ABSTRACT

Palmar hyperhidrosis is common condition that is challenging to treat. Nonsurgical treatments include topical antiperspirants, iontophoresis, anticholinergic drugs and botulinum toxin injections. To evaluate the safety and efficacy of ablative fractional laser therapy, combined with topically applied botulinum toxin versus its injection for the treatment of hyperhidrosis. This study included 40 patients with pimary hyperhydrosis divided into two groups. Group A (n = 20) diagnosed with primary axillary hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right axilla and botulinum toxin injection in left axilla. Group B (n = 20) diagnosed with primary palmer hyperhidrosis was further subdivided into 2 equal subgroups; for which was used fractional laser assisted drug delivery of botulinum toxin in right palm and botulinum toxin injection in left palm. There was a statistically significant decrease in the hyperhidrosis disease severity scale (HDSS) in all subgroups after treatment as compared to before treatment. Following 3 months of treatment, the amount of sweat as detected by transepidermal water loss (TEWL) was statistically significantly lower in the injection subgroup in both the axillary group (p = 0.075) and the palmer group (p < 0.001). The use of both botulinum toxin injection and laser assisted botulinum toxin drug delivery were associated with significant improvement in the manifestation, disease severity and quality of life in the cases with both axillary and palmer hyperhidrosis. Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A.

PMID:39804494 | DOI:10.1007/s00403-024-03715-5

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Iontophoresis Improves the Impact on the Quality of Life of Children with Primary Hyperhidrosis-A Prospective Study and a Short Review

Children (Basel). 2024 Oct 17;11(10):1253. doi: 10.3390/children11101253.

ABSTRACT

BACKGROUND: Primary hyperhidrosis (PH) is a somatic and idiopathic pediatric skin disease. The eccrine glands are tiny and very numerous, with approximately 3 million distributed throughout the skin. There is no commonly accepted amount of sweating to define hyperhidrosis, but people with this disease suffer real limitations integrating into society, which can be quantified through quality of life measurement scales. We want to draw attention to this disease and its impact on children’s quality of life because it is significant and there are no studies conducted on groups consisting solely of children.

METHODS: There are various quality of life evaluation questionnaires for hyperhidrosis. We studied 103 children with hyperhidrosis by monitoring their sweat severity and its impact on quality of life, using the Hyperhidrosis Disease Severity Scale. We compared the scale results before and after 10 days of iontophoresis. This study includes only children under 18 years old, treated with iontophoresis.

RESULTS: The average age of the group is 11.84 ± 2.89 years. Treatment success is recorded in 68 (66.02%) children, but a change in the score is recorded in 74 (71.84%) children. The average HDSS score at T0 is 2.95 ± 0.70, compared to the HDSS score at T1 of 1.92 ± 0.86.

CONCLUSIONS: Hyperhidrosis has a negative impact on daily life, especially self-esteem, occupational productivity, emotional well-being, and interpersonal relationships. Iontophoresis is a safe and effective treatment method that reduces the severity of hyperhidrosis and increases the quality of life.

PMID:39457218 | DOI:10.3390/children11101253

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The Influence of the COVID-19 Pandemic on the Addressability to Treatment of Children with Hyperhidrosis-A Retrospective Study and a Short Review

Life (Basel). 2024 Aug 10;14(8):995. doi: 10.3390/life14080995.

ABSTRACT

INTRODUCTION: This study was carried out to demonstrate the negative influence that the COVID-19 pandemic had on the ability of patients to treat hyperhidrosis with iontophoresis. The purpose of this study is to identify the annual distribution of patients with hyperhidrosis as well as elaborate a curve of cases within the time interval studied.

METHODS: It is a retrospective study initiated in the Department of Neuropsychomotor Rehabilitation of the “Sf. Ioan” Emergency Clinical Hospital for Children, Galati, Romania, in which we analyzed the electronic database, the treatment, and the consultation files of all the children who presented between January 2013 and December 2023. We found 111 patients who met the inclusion criteria.

RESULTS: During the 3 years of the pandemic, the number of patients who came to our clinic suddenly dropped to 0.

LIMITATIONS: This study was conducted on a relatively small number of patients in a Neuropsychomotor Recovery clinic. This study includes only patients with palmar and/or plantar hyperhidrosis who presented to the clinic for iontophoresis.

CONCLUSION: Although it is a disease that significantly influences the quality of life, patients and their families do not consider hyperhidrosis to be an urgent problem that can be improved by treatment.

PMID:39202737 | DOI:10.3390/life14080995