Swedish Agency for Health Technology Assessment and Assessment of Social Services
Iontophoresis for hyperhidrosis
Hyperhidrosis involves excessive sweating caused by overactive sweat glands mainly on the palms, soles of the feet or in the armpits. Hyperhidrosis can have a negative impact on an individual's health-related quality of life. Iontophoresis is a non-invasive method for decreasing sweating. Iontophoresis consists of water baths with a very weak electric current. There is also a version of iontophoresis that instead of a water bath uses the patient's own sweat, so-called dry iontophoresis.
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Question
What systematic reviews have been published regarding iontophoresis for hyperhidrosis?
Method
A systematic literature search was performed using the following databases: Medline and SCOPUS.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.
Identified literature
One relevant systematic review with moderate risk of bias was identified [1]. The results and conclusions are presented in Table 1. In one relevant systematic review, the risk of bias was considered to be high, therefore the results and conclusions are not reported [2].
| Included studies | Population, Intervention, Control | Outcome and Results |
|---|---|---|
| Wade et al, 2018 [1] Interventional management of hyperhidrosis in secondary care: a systematic review |
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| Ten studies (four RCTs, five non-RCTs, one case series) of iontophoresis included with a narrative synthesis. Setting: Australia: 1 study USA: 1 study South Korea: 2 studies Turkey: 2 studies Japan: 1 study India: 1 study Poland: 1 study Denmark: 1 study |
Population: Patients with palmar or palmo-plantar hyperhidrosis Intervention: Iontophoresis with variations in the medium used (tap water, with aluminium chloride or an anticholinergic added, or a ‘dry type’ device), the electric current used, and the frequency of iontophoresis sessions. Control (intervention)/Comparison: Placebo, no treatment, treatment with botulinum toxin |
Tap water iontophoresis vs. sham treatment, gravimetry/ iodine starch assessment (2 studies): Statistically significant difference in sweat reduction between treated and untreated hand. Dry type iontophoresis vs. no treatment, gravimetry assessment (2 studies): Statistically significant difference in sweat reduction between treated and untreated hand (1 study). No significant difference between treated and untreated hand performed at home (1 study). Tap water iontophoresis vs. Botulinum toxin injections, patient reported sweating assessment (2 studies): Statistically significant difference in sweat reduction in hands in favour of botulinum toxin injections. |
| Authors' conclusion: “Overall, there is very low-quality but consistent evidencesuggesting a short-term beneficial effect of tap-water iontophoresisin the treatment of palmar hyperhidrosis. […] There is very low-quality evidence suggesting that BTX is more effective than iontophoresis for palmar hyperhidrosis in the short term. No serious adverse events related to iontophoresis were reported.” |
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References
- Wade R, Llewellyn A, Jones-Diette J, Wright K, Rice S, Layton AM, et al. Interventional management of hyperhidrosis in secondary care: a systematic review. The British journal of dermatology. 2018;179(3):599-608. Available from: https://doi.org/https://dx.doi.org/10.1111/bjd.16558.
- Kristensen JK, Nielsen C. Progress and lack of progress in hyperhidrosis research 2015-2020. A concise systematic review. International journal of dermatology. 2022;61(2):148-57. Available from: https://doi.org/https://dx.doi.org/10.1111/ijd.15654.
Search strategies
Medline via OvidSP 29 May 2023
| Search terms | Items found | |
|---|---|---|
| Population: | ||
| 1. | Hyperhidrosis/ | 3403 |
| 2. | ((Excess* OR uncontrollable OR unpredictable OR extreme) adj2 (sweat* OR perspiration*)).ab,bt,kf,ti | 928 |
| 3. | Hyperhidros*.ab,bt,kf,ti | 3803 |
| 4. | Sweat gland diseases/ | 703 |
| 5. | OR 1-4 | 5850 |
| Intervention: | ||
| 6. | Iontophoresis/ | 7537 |
| 7. | Iontophores*.ab,bt,kf,ti. | 5069 |
| 8. | Electrophoresis/ | 43 285 |
| 9. | Electrophores*.ab,bt,kf,ti. | 19 5252 |
| 10. | ((electrochemical or non-invasive) adj3 (treatment* or therap* or technique*))ab,bt,kf,ti. | 19 001 |
| 11. | OR 5-10 | 25 1122 |
| Study types: systematic reviews and meta-analysis | ||
| 12. | ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) | 43 1383 |
| Combined sets: | ||
| 13. | 5 AND 11 AND 12 | 6 |
| Final result | ||
| 14. | 5 AND 11 AND 12 | 6 |
| / = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
Medline via OvidSP 19 June 2023
| Search terms | Items found | |
|---|---|---|
| Population: | ||
| 1. | Hyperhidrosis/ | 3406 |
| 2. | ((excess*) adj2 (sweat*)).ab,bt,kf,ti | 819 |
| 3. | hyperhidros*.ab,bt,kf,ti | 3803 |
| 4. | or/1-3 | 5147 |
| Intervention: | ||
| 5. | Iontophoresis/ | 7539 |
| 6. | Iontophores*.ab,bt,kf,ti. | 4900 |
| 7. | or/5-6 | 9283 |
| Limits | ||
| 8. | Year 2015 - | |
| Combined sets: | ||
| 9. | 4 and 7 and 8 | 48 |
| Final result | ||
| 10. | 48 | |
| / = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
Scopus via scopus.com 29 MAY 2023
| TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other.; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
|---|---|---|
| Population: | ||
| 1. | TITLE-ABS-KEY (hyperhidros*) | 10 574 |
| 2. | TITLE-ABS-KEY (polyhidros*) | 60 |
| 3. | TITLE-ABS-KEY ((excess* OR uncontrollable OR unpredictable OR extreme) W/3 (sweat* OR perspiration)) | 1395 |
| 4. | TITLE-ABS-KEY (“sweat gland disease”*) | 3141 |
| 5. | OR 1-4 | 14 132 |
| Intervention: | ||
| 6. | TITLE-ABS-KEY (iontophores*) | 13 447 |
| 7. | TITLE-ABS-KEY ((electrochemical OR non-invasive) W/3 (treatment* OR therap* OR technique*)) | 80 539 |
| 8. | TITLE-ABS-KEY electrophores* | 54 1323 |
| 9. | OR 4-6 | 633 496 |
| Study types: systematic reviews and meta-analysis | ||
| 10. | TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) | 630 118 |
| Combined sets: | ||
| 11. | 5 AND 9 AND 10 | 8 |
| Final result | ||
| 12. | 5 AND 9 AND 10 | 8 |
Scopus via scopus.com 16 Jun 2023
| TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other.; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
|---|---|---|
| Population: | ||
| 1. | TITLE-ABS-KEY (hyperhidros*) | 10 585 |
| 2. | TITLE-ABS-KEY (excess* W/1 sweat*) | 1133 |
| 3. | OR 1-3 | 11 112 |
| Intervention: | ||
| 4. | TITLE-ABS-KEY (iontophores*) | 13 455 |
| Limits: | ||
| 5. | Year: 2015 - | |
| 6. | Document type: Article | |
| Combined sets: | ||
| 7. | 3 AND 4 | 463 |
| 8. | 5 AND 6 AND 7 | 53 |
| Final result | ||
| 9. | 53 | |
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