Hyperhidrosis, that is, abnormal sweating

What is hyperhidrosis? What is iontophoresis?

Let's start with the basics, because it's important you understand exactly what we're talking about.

Hyperhidrosis is a medical term of Greek origin that means excessive sweating. 'Hydro' means water and '-osis' indicates an abnormal condition. Hyperhidrosis is therefore a condition in which your body sweats far more than necessary—not because of heat or physical exertion, but because the sweat glands are overactive.

Think of it like a tap whose shut-off mechanism is broken. Your body's 'thermostat' is set wrong: it keeps cooling when it doesn't need to. This isn't a disease in the classic sense but a functional disorder—the regulation of the sweat glands isn't working properly.

Iontophoresis is also a Greek-derived term: 'ion' (charged particle) and 'phoresis' (carrying, transmission). Iontophoresis is thus a procedure that uses electric current to deliver charged particles into or across the skin.

Tap water iontophoresis is a method specifically used to treat hyperhidrosis that uses ordinary tap water as the conductive medium. In the international literature you'll find it as 'tap water iontophoresis'.

Types of hyperhidrosis

Primary (idiopathic) hyperhidrosis: This is the most common form, accounting for about 90% of cases. It starts in childhood or adolescence and is typically genetic. Symptoms are symmetric—both palms, both soles, or both underarms are affected. Studies show that 30–65% of affected people have a family history of similar problems. An important characteristic is that it does not occur at night during sleep—this helps distinguish it from secondary forms.

Secondary hyperhidrosis: This arises as a result of an underlying disease or as a side effect of medication. Causes include hyperthyroidism, diabetes, menopause, infections, malignancies, or certain drugs. It can start at any age, is often asymmetric, and may occur at night. If your hyperhidrosis began suddenly in adulthood, consult a doctor to rule out underlying causes!

How does tap water iontophoresis work?

The application of iontophoresis for treating hyperhidrosis has been known since the 1940s, but the real breakthrough came in the past decade with modern home-use devices. During treatment, a mild electric current is passed through the skin via tap water. But how does this reduce sweating?

Mechanism of action

The exact mechanism isn't fully clarified—several hypotheses exist, and likely each contributes to the effect.

The first and most accepted theory is the temporary blockage of sweat gland ducts. The electric current causes tiny particles—probably proteins and ions—to deposit in the excretory ducts of the sweat glands. This doesn't damage the glands; it simply 'plugs' them temporarily, like a stopper in a pipe. The effect is reversible: if you stop treatment, the ducts gradually reopen.

The second mechanism involves electrochemical changes. The current alters the pH balance in the sweat glands. Sweat production requires a specific chemical environment—if this is disturbed, gland activity slows down.

The third theory is a reduction in nerve excitability. The current raises the threshold at which nerves activate the sweat glands. Put simply: the glands become less 'sensitive' to signals that trigger sweating.

Important to understand: the effect is not permanent—typically it lasts a few weeks after a course. Therefore, regular maintenance treatments are needed to sustain results. But this isn't a drawback: it gives you control over the effect, and there is no irreversible intervention. If you stop treatment, no permanent change occurs.

Pulsed current vs. direct current – which to choose?

Devices can use two types of current, and this is key for both effectiveness and user comfort.

Direct current (DC): Older-generation iontophoresis devices used continuous direct current. In theory this is the most effective method because the current is continuous. In practice, however, it has significant limitations. Effective DC treatment can be uncomfortable and cause skin irritation, and underarm treatment can be particularly painful. Many patients cannot tolerate the current strength required for effectiveness. It's like having a very effective medicine that is so bitter you can't swallow it. The IontoBravo device can provide DC current as well.

Pulsed current (PC): Modern devices, such as DermaDry, operate with pulsed current. 10 kHz square-wave pulses do not stimulate the skin's pain receptors as intensely, making treatment much more comfortable.

What does this mean in practice? According to the DermaDry manual, pulsed current is as effective as direct current while reducing the risk of irritation and pain.¹ In Reinauer and colleagues' 1993 clinical study, patients treated with pulsed current reached a completely dry state after an average of 11 treatments—this was the same result as the direct current control group, but with minimal side effects.²

DermaDry technology: The device operates with a fixed 90% duty cycle (90% active, 10% pause) at 10 kHz. This means that during a 20-minute session you receive 18 minutes of actual therapeutic dose—close to the effectiveness of direct current. The pulse ratio is not adjustable, but this is intentional: the manufacturer optimized this setting for the best efficacy-comfort balance.

In summary: the biggest advantage of pulsed current is greater comfort—meaning you can tolerate higher current levels, which yields a more effective treatment. It's like coating a bitter pill with a tasty layer: same effect, much easier to take.

Scientific background – what do studies say?

It's important to know what the scientific studies claim. Tap water iontophoresis is not a miracle cure, but decades of clinical experience and numerous studies support its effectiveness.

According to the International Hyperhidrosis Society, 91% of people with palmar-plantar hyperhidrosis experience significant improvement with iontophoresis.³ This is an outstanding rate compared with other treatments.

Kim et al.'s 2017 randomized, placebo-controlled trial is one of the strongest pieces of evidence for the method's efficacy.⁴ In that trial the active treatment group showed 92.9% improvement while the placebo group only 38.5%—a statistically significant difference.

Hölzle et al.'s 1987 long-term study showed that home tap water iontophoresis resulted in an 81% reduction in sweating with continued use.⁵ This is important because it demonstrates durability over years of use.

A 2024 pediatric study confirmed that quality of life in children significantly improved after just 10 iontophoresis sessions.⁶ This is particularly important because hyperhidrosis often begins in adolescence, a time when young people are especially vulnerable to social embarrassment.

Comparing iontophoresis with other treatments

If you have hyperhidrosis, you have several treatment options. Each has pros and cons—the ideal choice depends on your individual situation. Below I compare the main methods so you can make an informed decision.

Antiperspirants

What you should know: Aluminum chloride antiperspirants temporarily block the openings of sweat glands. These are first-line treatments—so it's worth trying them before moving on to other methods.

Effectiveness: For mild to moderate hyperhidrosis, expect about 30–50% improvement. In more severe cases they are usually insufficient.

Advantages: Cheap and easy to obtain. No prescription required (though stronger prescription options exist). Very simple to use—apply like a deodorant.

Disadvantages: Limited effect, and usually not enough for severe hyperhidrosis. Many users experience skin irritation, especially with higher aluminum concentrations. Effects wear off quickly—daily or every-other-day application is needed.

Who is it ideal for? Someone with mild sweating issues seeking a quick, simple solution. It's the first step—if it doesn't work, consider other options.

Botulinum toxin (Botox) injections

What you should know: Botox temporarily blocks the nerve signals that activate sweat production. A physician injects it at multiple points in the affected area (underarm, palm, sole).

Effectiveness: 85–95%, lasting 4–12 months depending on the person.

Advantages: Excellent efficacy and rapid results (within days). Not a daily routine—one treatment lasts months.

Disadvantages: Painful, especially for palms and soles (these areas have many nerve endings). Expensive—a single treatment typically costs around 80,000–150,000 HUF and must be repeated every 4–6 months. Over the long term this can amount to millions of forints. Side effects can include temporary muscle weakness in the treated area.

Who is it ideal for? Those for whom iontophoresis was ineffective, or who cannot/will not perform regular home treatments. Popular for underarm sweating where it is less painful.

Medications (anticholinergics)

What you should know: Anticholinergic drugs (e.g., oxybutynin, glycopyrrolate) block the neurotransmitter acetylcholine, which also mediates sweat production. They are taken in tablet form.

Effectiveness: 60–80%, but varies widely between individuals. Some respond very well, others little.

Advantages: Treat the whole body—useful if you sweat on multiple areas (palms, soles, underarms, face). Simple to use—take a tablet daily.

Disadvantages: Systemic side effects because they affect the whole body. The most common: dry mouth (very common, up to 80%), blurred vision, constipation, palpitations, urinary retention. Not suitable for older adults or people with certain conditions (e.g., glaucoma, enlarged prostate). Long-term use can lead to tolerance (reduced effect).

Who is it ideal for? Those with severe sweating on multiple body areas and for whom iontophoresis is unsuitable (e.g., cannot perform regular sessions). Should be used after medical consultation and careful weighing of side effects.

Surgical intervention (endoscopic thoracic sympathectomy – ETS)

What you should know: During surgery the surgeon cuts or clips the nerves (sympathetic chain) that control sweat production. This is a permanent procedure.

Effectiveness: Over 95% effective for palmar sweating, though results vary for other areas.

Advantages: Often a durable, sometimes permanent solution. One operation and it's 'done'.

Disadvantages: Irreversible—if problems arise you can't simply 'undo' it. The most significant and fairly common risk is compensatory sweating: increased sweating in other areas (back, abdomen, thighs) that can be worse than the original problem. This occurs in 50–80% of operated patients to some degree. Surgical risks include infection, bleeding, nerve damage. Rarely Horner syndrome (eye symptoms) can occur.

Who is it ideal for? Only as a last resort, when every other method has failed and hyperhidrosis severely impairs quality of life. Young people should be especially cautious due to the irreversible nature.

Tap water iontophoresis (DermaDry or IontoBravo)

What you should know: A mild electric current is passed through the skin via tap water, temporarily 'plugging' the sweat gland ducts.

Effectiveness: 80–93%, based on studies and user experience.

Advantages: Safe—decades of clinical experience with minimal side effects. Cost-effective long term—after the initial investment there are no significant ongoing costs. Home-based—no need to visit a doctor for routine sessions. Non-invasive—no injections or incisions. Reversible—if you stop, no permanent change. Can be used in children (with parental supervision).

Disadvantages: Time-consuming—the initial phase requires daily 15–20 minute sessions, then 1–2 maintenance sessions per week. Requires consistency—if you stop, sweating returns. Not suitable for all areas (not indicated for face, neck, or hairy scalp).

Who is it ideal for? Someone willing to commit to regular sessions and seeking a long-term, cost-effective, safe solution. Recommended as a second step after antiperspirants and before Botox or systemic medications.

Children and iontophoresis

If your child suffers from abnormal sweating, you're not alone—hyperhidrosis often begins in adolescence and this period can be particularly challenging psychologically. The good news: tap water iontophoresis can be safely used in children.

A study of children aged 6–17 confirmed the method's safety and efficacy in this age group.⁷ A 2024 study showed that quality of life significantly improved after just 10 iontophoresis sessions.⁶ This matters because young people's self-esteem and social interactions are heavily affected by sweating.

My advice: Always start children at lower current levels and increase gradually. The DermaDry device is recommended by the manufacturer from age 13. For children under 13 perform treatment only under strict parental supervision!

What to expect during treatment

Treatment protocol

Intensive phase (2–4 weeks): Daily or every-other-day sessions until the desired dryness is achieved. Treatment time is 15–20 minutes per area. DermaDry automatically alternates polarity, which reduces the likelihood of side effects.

Maintenance phase: One to two sessions per week are sufficient to maintain results. In mild cases once a week may be enough. Adjust the maintenance frequency to your individual needs—if sweating returns, perform an extra session or two.

Most people reach maximum effect after 10–14 sessions. Be patient—you may not see dramatic changes in the first few days!

Possible side effects

Iontophoresis is a safe treatment, but temporary reactions can occur:

Common, transient reactions: Mild tingling or stinging during treatment—this is normal and indicates the current is passing. Redness at the treated area (usually fades within minutes). Temporary skin dryness—hydration is recommended because treatment reduces moisture.

Less common reactions: Small blisters (if the current is too high—reduce it!). Skin irritation at the waterline (the boundary between water and air).

Tip: Apply petroleum jelly to the waterline and any small cuts before treatment—this prevents irritation!

Before you start treatment

For safe use it's important to know the contraindications.

When NOT to use it

Do NOT use the device if you have an implanted pacemaker or defibrillator; if you are pregnant; if you have metallic implants in the treatment area (e.g., bone plates, screws); if you're being treated for heart rhythm disorders; if you have a history of epileptic seizures; or if there is an open wound, infection, or skin lesion in the treatment area.

Use with caution

Seek medical advice if you have diabetes (reduced sensation in the limbs); peripheral neuropathy; or a skin disease (eczema, psoriasis) in the treatment area.

Practical tips for home treatment

Water quality

Tap water quality varies by location. Very soft water may not contain enough minerals to conduct the current effectively, reducing efficacy. What can you do if your water is soft? Add a teaspoon of baking soda to the water, or use mineral water. Under medical advice an anticholinergic additive (e.g., glycopyrrolate) may be added to the water to boost effect.

Treatment areas

Palm and sole: Place your hands or feet in a water-filled tray. Treatment time: 20 minutes (with automatic polarity switching).

Underarm: Treated with special moist electrode pads. The DermaDry device includes an underarm accessory. Treatment time: 15 minutes.

Home iontophoresis devices

If you decide on iontophoresis, the next step is choosing the right device. Medimarket offers two iontophoresis devices that serve different needs. Below I introduce both in detail to help you decide which is right for you.

DermaDry Total – specialized tap water iontophoresis

The DermaDry Total is a purpose-built, CE-certified and FDA-cleared medical device designed specifically for tap water iontophoresis. The device uses only pulsed current (PC), which makes application more comfortable.

Package contents: DermaDry control unit with power adapter; 2 treatment trays for palm/sole use; underarm electrodes and sponge covers; silicone nets to protect electrodes; cables and user manual.

Technical data: Fixed 90% duty cycle, 10 kHz frequency; treatment time 15–20 minutes; maximum current: hand 15 mA, foot 25 mA, underarm 8 mA; automatic polarity switching; safety current limit.

Advantages: Specifically optimized for tap water iontophoresis; automatic polarity switching; 5-year manufacturer warranty; FDA and Health Canada approvals.

Who is it recommended for? Someone who wants to perform only tap water iontophoresis (palm, sole, underarm) and values simple, automated operation.

IontoBravo – dual-function iontophoresis device

The IontoBravo is a CE-certified, dual-use iontophoresis device. Unlike the DermaDry, this unit is suitable not only for tap water iontophoresis but also for traditional (medicated) iontophoresis.

Dual use:

1. Tap water iontophoresis: For palm, sole and underarm treatment, same as DermaDry.
2. Traditional iontophoresis: With electrodes you can deliver anti-inflammatory agents (e.g., Voltaren, Fastum gel) to joints and muscles, avoiding the digestive system. Useful for joint and tendon inflammations and sports injuries.

Technical data: Both direct current (DC) and pulsed current (PC) modes; broader setting options; treatment time 15–20 minutes.

Package contents: IontoBravo control unit; treatment trays; electrodes and sponge covers; cables and user manual.

Advantages: Dual function (tap water + traditional iontophoresis); both DC and PC available; can be used for musculoskeletal complaints.

Who is it recommended for? Someone who wants to use the device for both hyperhidrosis and joint complaints, or who wants to try both current types (DC and PC).

DermaDry vs. IontoBravo – detailed comparison

Which to choose?

Choose DermaDry if:

• You want to do only tap water iontophoresis (palm, sole, underarm)
• FDA clearance and longer warranty are important to you
• You prefer automated, simple operation
• You appreciate the comfort of pulsed current

Choose IontoBravo if:

• You want to use the device for joint complaints as well as tap water iontophoresis
• You want to try direct current (DC) treatments too
• Versatility and broader settings are important to you
• You are active in sports and want to support post-injury recovery

Both devices are suitable for tap water iontophoresis and are CE-certified medical devices. The choice mainly depends on whether you need the dual function.

Step by step: your first iontophoresis session

If you just bought your device and don't know how to start, here is a simple guide.

Step 1: Preparation. Fill the treatment trays with warm tap water up to the marked level. Water temperature should be comfortable—ideally between 20–40°C.

Step 2: Skin care. Check the treatment area. If there are small cuts, peeling or cracks, apply petroleum jelly! This insulates the damaged area and prevents irritation.

Step 3: Settings. Start at a low current (5–10 mA) and gradually increase until you feel a mild tingling. That's the optimal level. Don't go too high—the tingling shouldn't be painful.

Step 4: Treatment. Place your hands or feet in the trays and switch the device on. Sit comfortably and keep your hands/feet still during the session. DermaDry switches polarity automatically.

Step 5: Finish. After treatment dry your hands/feet and apply a moisturizing cream to prevent dryness.

Step 6: Consistency. In the first 2–4 weeks treat every day or every other day. Once you reach the desired dryness switch to weekly 1–2 maintenance sessions.

Watch short videos demonstrating the procedures

When to see a doctor?

Although iontophoresis is a safe home treatment, there are cases when you should consult a physician:

If hyperhidrosis began suddenly in adulthood (may indicate secondary causes); if you sweat at night (can signal other diseases); if sweating is accompanied by fever, weight loss, or other unusual symptoms; if iontophoresis shows no improvement after 4 weeks; or if you have a skin reaction that does not resolve within a few days.

Summary – Quick overview

What is this article? A comprehensive guide to treating hyperhidrosis (abnormal sweating) with tap water iontophoresis. It covers the scientific background, compares other treatment options, and gives practical advice for home use.

Who is it for? Anyone with palmar, plantar, or underarm sweating; parents of children with hyperhidrosis; healthcare professionals informing their patients; and anyone seeking an effective, drug-free solution.

Main message: Tap water iontophoresis is a scientifically supported, safe method that can be used at home. 80–93% of treated people report significant improvement. It doesn't replace medical care but can effectively reduce symptoms and improve quality of life when used alongside medical advice.

Key terms and definitions:

Mechanism summary:

Iontophoresis works through three main mechanisms. First, blockage of sweat gland ducts: current causes tiny particles to deposit in the ducts, temporarily sealing them. Second, electrochemical changes: the pH balance in the glands changes, slowing sweat production. Third, reduced nerve excitability: the activation threshold for nerve signals rises, so glands respond less to sweat-inducing signals.

Detailed comparison of treatments:

Application areas and evidence level:

Contraindications (when NOT to use):

Iontophoresis is not recommended if you have an implanted pacemaker or defibrillator, are pregnant, have metallic implants in the treatment area, are being treated for heart rhythm disorders, have a history of epilepsy, or have an open wound or infection in the treatment area.

Frequently asked questions

How often should I perform treatments? During the intensive phase daily or every other day for 2–4 weeks. For maintenance, 1–2 sessions per week are sufficient.

When can I expect results? Many feel improvement within 1–2 weeks. Full effect usually requires 10–14 treatments.

Is the treatment painful? Not painful. Mild tingling may be felt, indicating the current is flowing. If uncomfortable, lower the current.

Can children use it? Yes, studies support safety from age 6. The manufacturer recommends from age 13; under 13 use only after medical consultation and under parental supervision. Start at lower current for children.

What happens if I stop treatment? Sweating gradually returns, usually within 1–4 weeks. That's why maintenance is important.

Can I combine it with other treatments? Yes, iontophoresis can be safely combined with antiperspirants and other treatments. Consult your doctor when taking medications.

How long does one session take? For palms and soles 20 minutes (with automatic polarity switching). Underarms 15 minutes. A full routine takes 20–40 minutes.

Can I travel with the device? Yes, DermaDry is compact and portable. You can carry it in your hand luggage on flights.

What's the difference between direct and pulsed current? Direct current (DC) is continuous; pulsed current (PC) works in pulses. Pulsed is more comfortable and equally effective.

Why is a pulsed-current device better? Because you can tolerate higher currents without discomfort, making treatment more effective. DermaDry's 90% duty cycle gives results close to direct current.

DermaDry or IontoBravo – which should I choose? If you only want tap water iontophoresis, DermaDry is the simpler, more automated choice with a 5-year warranty. If you also have joint complaints or want to deliver medication to muscles/joints, IontoBravo is the more versatile option with DC+PC modes.

References

1. DermaDry Laboratories Inc. (2022). User manual – Iontophoresis device. Section 13: Integrated safety features.
2. Reinauer S, et al. (1993). Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis. British Journal of Dermatology, 129(2):166-169. PubMed: 7654577
3. International Hyperhidrosis Society. Iontophoresis for palmoplantar hyperhidrosis. sweathelp.org
4. Kim WO, et al. (2017). Treatment of Palmar Hyperhidrosis with Tap Water Iontophoresis: A Randomized, Sham-Controlled, Single-Blind, and Parallel-Designed Clinical Trial. Annals of Dermatology, 29(6):728-734. PubMed: 29200761
5. Hölzle E, et al. (1987). Long-term efficacy of home tap water iontophoresis for palmar hyperhidrosis. British Journal of Dermatology, 117(6):761-766. PubMed: 3653460
6. Children (2024). Quality of life improvement in pediatric hyperhidrosis following iontophoresis treatment. DOI: 10.3390/children11101253. MDPI
7. Dagash H, et al. (2017). Pediatric tap water iontophoresis safety and efficacy. Journal of Pediatric Surgery, 52(2):309-311. PubMed: 27912978
8. Pariser DM, Ballard A. (2014). Iontophoresis for palmar and plantar hyperhidrosis. Dermatologic Clinics, 32(4):491-494. PubMed: 25152342
9. Stolman LP. (1987). Treatment of excess sweating of the palms by iontophoresis. Archives of Dermatology, 123(7):893-896. PubMed: 3606167
10. Siah TW, Hampton PJ. (2013). The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime. Dermatology Online Journal, 19(3):2. PubMed: 23552011

Final thoughts

Excessive sweating is not only uncomfortable—it can impair quality of life and limit social interactions. You may avoid handshakes, dread someone noticing a soaked shirt, and feel constant embarrassment. But you don't have to live with this anymore.

Tap water iontophoresis offers a safe, effective and cost-efficient long-term solution. Numerous studies show that the vast majority of treated people experience significant improvement. It's not a miracle, but it works.

If you've been postponing action, now is the time. Modern devices are simple to use at home. After 2–4 weeks of regular treatment you can finally be free of clammy palms, soaked shirts, and shame. The choice is yours—if you decide, we're here to help. The Medimarket team brings 30 years of experience behind you.

The information in this article is for informational purposes only. Iontophoresis is intended as an adjunct to medical treatment and does not replace it. Consult your treating physician in case of symptoms. For correct use of home therapeutic devices refer to the product description and user manual.