In contrast to axillary hyperhidrosis, there are more studies on the efficacy of iontophoresis in palmar and plantar hyperhidrosis. There are two RCTs, one double-blind, comprising a total of 31 patients. Dahl et al.25 demonstrated in 11 patients that iontophoresis with direct current reduced sweat production by 38% (median quartiles: 7%, 53%) compared with placebo. Phadke et al.18 reported a good or excellent response in 11 of 20 patients after 4 weeks of iontophoresis with direct current. Iontophoresis was compared with glutaraldehyde and topical methenamine in this study (see above).

Akins et al.,13 using the Drionic unit, reported a 50% decrease in sweating compared with the control site in eight of ten hands. In a non-randomised study, Holzle et al4 reported that sweating was reduced to normal or to a moderate extent using the Drionic unit in 7 of 12 patients. The average reduction of spontaneous palmar sweating was 19 ± 17% compared with the untreated site after 3 weeks' treatment. In another study by Reinauer et al.,2 different types of current (4-3 kHz and 10 kHz pulsed direct current versus direct current) were investigated in a total of 30 patients. All patients were reported to return to normal sweat rate after an average of 10-12 sessions. Treatment failed in two patients in the 4-3 kHz pulse group. However, the generalisability of this study is limited as only patients with moderate palmar hyperhidrosis were included.

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