Iontophoresis treatment usually begins in the clinic under the direction and care of a health care professional. Once the desired results have been achieved, or it seems that the patient has a clear understanding of iontophoresis and has gained the necessary know-how, the health care provider may determine that they are ready to perform treatments at home using an Iontophoresis Device purchased or rented for that purpose. As mentioned earlier, apply petroleum jelly with a cotton swab to cover any cuts on hands or feet before immersing them in the water trays/baths. To relieve skin irritation that may have already occurred, apply 1% hydrocortisone cream after treatment.
Initially, iontophoresis treatments are required on a more frequent basis. It is often recommended that treatments begin with a Monday, Wednesday, and Friday schedule until the condition improves. Then, the treatments can be tapered down to once per week. Once per week seems to be ideal in terms of maintaining effectiveness and limiting inconvenience to the patient.
Use regular tap water fill the trays with just enough water to cover the hands or feet. After placing the body part in the device tray, turn the machine on. Slowly increase the amperage until a tingling that is not unpleasant is felt in the affected area, or to a maximum of 20 mA. To start, treat for 20 minutes a session every 2 to 3 days. Halfway through the 20-minute session, reverse current flow to switch anode site to opposite side. Frequency of maintenance treatment varies, but 1 to 3 times a week is usually necessary. If mineral content of tap water is low (water may be termed as being too soft), insufficient current flow may occur. This situation can be corrected by adding 5g (1 teaspoon) of baking soda to each tray. If a patient fails to respond to tap water iontophoresis alone, and after mineral content of the tap water has been addressed, consider adding an anticholinergic to the water trays, such as 2-mg tablets of glycopyrrolate (crushed). Adjust the dose based on efficacy or side effects. In a study of 20 patients with palmar and plantar hyperhidrosis, when glycopyrrolate was added to the iontophoresis water trays (bilateral/both trays, unilateral/1 side only, or tap water alone), dryness was achieved for 11 days (bilateral glycopyrrolate), 5 days (unilateral glycopyrrolate), and 3 days (tap water alone). It has been suggested that the bilateral glycopyrrolate was more effective because of greater systemic absorption of the anticholinergic. Patients who do not respond to iontophoresis may be candidates for a combination therapy, such as an iontophoresis regimen combined with clinical strength over-the-counter antiperspirants or prescription antiperspirants applied at night, This mixed therapy can allow for less frequent iontophoresis treatment of patient convenience and compliance. Iontophoresis has a long history of safe and effective use and, once a home device is obtained and the patient has received adequate education and training, the maintenance cost and effort are minimal for the patient and health care provider, alike. Thus, iontophoresis should not be overlooked as a primary treatment of palmar and plantar hyperhidrosis.