Iontophoresis is a non-invasive electrotherapeutic technique used for transdermal drug delivery and the management of hyperhidrosis. With its roots tracing back to the 18th century, this technology continues to evolve, offering clinicians a unique tool to treat localized sweating, deliver medications through the skin, and reduce inflammation. This expanded article examines the history, mechanism, scientific evidence, real-life case studies, and modern applications of iontophoresis in physiotherapy and dermatology.
Historical Background
The concept of using electric current to deliver substances through the skin dates back to the mid-1700s. In 1740, Italian physician Giovanni Pivati is said to have applied electrical currents to treat arthritis, a rudimentary form of what we now call iontophoresis.
By the 19th century, the method gained scientific credibility thanks to contributions from:
- Benjamin Ward Richardson – experimented with electric drug delivery in the 1850s
- Hermann Munk and William James Morton – contributed to electrotherapy in neurology and dermatology
- Stephane Leduc – developed early electrical delivery systems for drugs
- Fritz Frankenhauser – first to use the term “iontophoresis” before 1908
Throughout the 20th century, iontophoresis evolved to become a clinically recognized treatment for hyperhidrosis and local drug delivery. In 1936, Ichikasa demonstrated that applying electric current could reduce sweating. By 1968, F. Levit popularized practical iontophoresis devices, which are still used today.
Mechanism of Action
Iontophoresis involves the application of a low-voltage direct current (DC) to facilitate the movement of charged molecules through the skin. The skin’s sweat ducts and hair follicles act as natural channels for drug absorption.
Basic Iontophoresis Setup
Description: A labeled diagram showing two trays filled with water, each with electrodes connected to a small power unit. A patient's hands are immersed in each tray. Anode and cathode are labeled, along with current flow direction.
There are several proposed theories for how iontophoresis works in hyperhidrosis treatment:
- Sweat duct plugging by keratinized cells due to current stimulation
- Functional impairment of sweat glands by altering sympathetic nerve signaling
- pH alteration inside ducts, especially under the anode, impairing gland function
- Inhibition of neurotransmitter release (though not conclusively proven)
Indications and Use Cases
Iontophoresis is currently used for the following medical purposes:
- Primary focal hyperhidrosis: hands, feet, axillae
- Transdermal drug delivery: anti-inflammatories, anesthetics, antibiotics
- Musculoskeletal pain management: through iontophoretic delivery of corticosteroids or NSAIDs
- Wound healing and scar management
Skin Target Route
Description: A cross-sectional diagram of the skin showing the ion pathway during iontophoresis with labeled drug molecules.
Recommended Clinical Protocol
The protocol varies by device and area treated. However, general clinical guidelines are:
- Session duration: 20 minutes
- Initial frequency: 3–5 sessions/week for 2–3 weeks
- Maintenance: 1–2 sessions/week depending on relapse
- Current intensity: 10–20 mA or until tolerable tingling is felt
- Medium: Non-deionized tap water; add baking soda if soft
- Electrode polarity: Switch halfway to balance exposure
Real-Life Case Studies
Case 1: Adolescent with Palmar Hyperhidrosis
Patient: 15-year-old male, unable to hold pens during exams due to excessive hand sweating.
Treatment: Tap water iontophoresis, 20 mA, 5 sessions/week for 3 weeks.
Outcome: Achieved euhidrosis by week 3. Maintenance required every 10 days. No side effects reported.
Case 2: Working Woman with Plantar Hyperhidrosis
Patient: 32-year-old woman, discomfort wearing office shoes due to wet soles.
Treatment: Combined iontophoresis with 2 mg glycopyrrolate tablets dissolved in water trays.
Outcome: Achieved dryness after 8 sessions. Minor dry mouth observed. Maintenance every 2 weeks.
Case 3: Double-blind Clinical Study
A 1989 study (n=11) used one hand for treatment and the other for placebo. After 10 sessions:
- Reduction: 81% decrease in sweating from baseline
- Duration: Benefits lasted 35 days post-treatment
- Significance: P<0.05
Side Effects
While safe, some patients experience mild adverse effects:
- Redness or erythema (treated with 1% hydrocortisone cream)
- Vesiculation (blisters)
- Burning or pins and needles sensation
- Dry or cracked skin
Prevention tips: Cover cuts with petroleum jelly, keep hands/feet still during treatment, avoid touching electrodes.
Contraindications
- Pregnancy
- Pacemakers or internal metal implants
- Epilepsy or seizure disorders
- Open wounds at treatment site
- Children bellow 10 years can't tolerate iontophoresis therapy
Emerging Applications and Future Research
Modern research is exploring the use of iontophoresis for advanced drug delivery:
- Peptides and proteins: Especially for insulin and vaccines
- Pain relief medications: Diclofenac and lidocaine delivery
- Combination therapy: Glycopyrrolate + aluminum chloride for hyperhidrosis
- Portable devices: Rechargeable systems for home use
One promising study using AC/DC hybrid current showed similar efficacy to standard DC, with fewer skin irritations.
Final Thoughts
Iontophoresis is a versatile, evidence-based treatment for localized hyperhidrosis and transdermal drug delivery. Though simple in design, it has shown consistent results across decades of use. Physiotherapists and dermatologists now recommend it as a first-line, low-risk option, especially when patients wish to self-manage treatment from home. With research expanding into protein therapy, hybrid currents, and portable technology, iontophoresis is poised to remain a key player in non-invasive medicine for years to come.
Disclaimer: This article is for educational purposes only. Consult with a physiotherapist or healthcare provider before starting any treatment.
More:
1) Iontophoresis in Physiotherapy