Original Title: Iontoforesis en hiperhidrosis primaria palmoplantar

Authors' recommendations: Low-quality evidence suggests that tap water iontophoresis, when compared with topical aluminum chloride or no active treatment, might produce a significant net benefit in the treatment of primary palmar and plantar hyperhidrosis since it would reduce sweating, as shown by the iodine-starch test, gravimetry and/or hyperhidrosis disease severity measure. No evidence has been found that allows comparing tap water iontophoresis with botulinum toxin treatment or sympathectomy in palmar and plantar hyperhidrosis. The three clinical practice guidelines found for this condition recommend tap water iontophoresis to treat primary focal hyperhidrosis as second or third-line therapy after no therapeutic response or intolerance to topical treatment with aluminum salts and/or botulinum toxin, in some cases. There is consensus on recommending the use of topical agents as first-line therapy. None of these guidelines mentions the use of iontophoresis as first-line therapy. As regards portable iontophoresis for home-use, no evidence comparing its effects with those of standard iontophoresis carried out by a healthcare provider has been found. However, the clinical practice guidelines surveyed recommend initiating treatment under the instructions of a healthcare provider and, once the patient has been trained on its use, home treatment may continue with the device purchased for this purpose. Among the coverage policies analyzed for this clinical condition, only two private health funders from the United States of America mention this technology. One of them covers iontophoresis for primary focal hyperhidrosis in those cases where no satisfactory response has been achieved or there is intolerance to oral pharmacological therapy or topical treatment indicated for excessive sweating, or in situations where excessive sweating has resulted in a significant impact on the patient’s professional or social life. In contrast, the other American private funder considers that the iontophoresis therapy is at an experimental stage. In Argentina, the National Administration of Drugs, Food and Medical Technologies (ANMAT) authorized the use of different professional tap water iontophoresis devices for palmar, plantar and axillar hyperhidrosis. For home use, ANMAT has authorized “Dermadry®”, a tap water iontophoresis device for single-patient treatment. From the economic point of view (cost-effectiveness or budget impact), no evidence from Argentina, Latin America and other regions surveyed has been found; therefore its economic dimension is considered as uncertain.

Project Status: Completed

Year Published: 2024

URL for published report: https://ets.iecs.org.ar/publication/2188

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: <p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>