Health Problem: Primary hyperhidrosis is defined as sweat production beyond what is physiologically necessary for the maintenance of thermal homeostasis without any discernible cause. The most common sites for involvement are the axillae, palms, and soles of the feet. Hyperhidrosis may have marked impact on ability to perform activities of daily living as well as quality of life, including employability, education, and social life.

Technology Description: In tap water iontophoresis (TWI), the palms of the hands and/or soles of the feet are immersed in a tray of tap water through which a weak electrical current is run. Sponges soaked in water can be used to treat the axillae. The conventional electrical source is direct current using 15 to 20 milliamperes of current. The mechanism of action is unknown but may include obstruction of the sweat glands by ion deposition, inhibition of sympathetic nerve activity, or localized alterations of acidity that inhibit the sweat gland.

Controversy: The efficacy of current clinically available medical treatments for primary hyperhidrosis is unclear. Furthermore, medical treatments are focused on symptom relief and not curative. Common side effects associated with topical antiperspirants and deodorants containing 10% to 20% aluminum chloride include skin irritation often leading to treatment cessation. Botulinum toxin injections have demonstrated temporary efficacy but are costly, associated with discomfort, and require continued treatment. Anticholinergic agents and beta blockers used in the treatment of mild primary hyperhidrosis are associated with substantial side effects, including drowsiness, dry mouth, dilation of the pupils, constipation, confusion, nausea, vomiting, giddiness, tachycardia, palpitations, and arrhythmias. Surgical treatments reserved for severe primary hyperhidrosis, including thoracic sympathectomy, are associated with serious adverse events such as pneumothorax and commonly associated with compensatory hyperhidrosis.

The optimal treatment protocol for TWI, including the duration and frequency necessary for maintenance of primary hyperhidrosis, is unknown.

Key Questions:

  • Is TWI effective in treating primary hyperhidrosis in adult and pediatric patients?
  • How does TWI compare with other treatments for primary hyperhidrosis (e.g., topical antiperspirants, oral anticholinergics, botulism toxin injections, or surgical intervention)?
  • Is TWI safe?
  • Have definitive patient selection criteria been identified for TWI for the treatment of primary hyperhidrosis in adult and pediatric patients?

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