Colleen28
Joined: 16 Jun 2008
Posts: 2
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 Posted: Mon Jun 30, 2008 7:30 am Post subject: The Idromed 4 works -- but flies under the radar in the USA |
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I've been meaning to post something here, like 'the post I wish I had found several years ago,' to tell others who may be skeptical that, yes, iontophoresis does actually work to treat even extreme hyperhidrosis. This may take on the quality of a saga or a tome --and I hope the links to .pdf files work-- but, if you've sweated alone for a long time, feeling like some kind of freak, sometimes hearing someone else's experiences helps. At least it helped me and led me, in a round-about way, to eventually finding a solution with the Idromed.
I've had palmar and plantar hyperhidrosis (hereafter, Hyperhidrosis) since I was 12, probably as bad as it ever gets as actual dripping is frequent -- or it was frequent, until using the machine. I'm only 15 days into the treatment now but already the sweating is reduced by at least 85%, mere localized dampness now, sometimes, rather than near-constant beading and dripping. I don't have to carry around a cotton rag in the house anymore (or use only handbags made of absorbent cloth), I can go barefoot without "blackfoot" (from the wetness always picking up dirt), and I've begun to wear heeled open sandals without self-consciousness. It's a new day. At first I was shocked that it worked at all (I was deeply skeptical), but now I'm hoping even 100% dryness is near on the horizon.
As more evidence that Hyperhidrosis is indeed hereditary, my mother also has it (palmar only), and she has been using the new Idromed 4 machine too, with even more dramatic results. After treating for nine days at 10 - 15 mA for approximately 20 minutes, my mom's sweating --yes!-- completely stopped for, so far, five full days. As others have reported, the cessation was sudden, total...like magic. This is the first and only treatment that has ever stopped my mom's sweating a full 100%. So there it is: the Idromed 4 PS machine can work in cases where nothing else has, and my mom has tried all kinds of things, going back to the 1960s. (She was there in the bad old days, before Hyperhidrosis was even recognized as a real physical disorder having nothing to do with 'anxiety,' 'hysteria,' or other idiotic things doctors used to say, especially to women. Even the idea of women "sweating" was anathema then and doctors would often suggest foolishness like tranquilizers. Thankfully that old mentality is passing away now.)
Apparently success with iontophoresis isn't always a sudden and complete cessation, though. With me it seems to be a gradual lessening, first the sweating down by about half, then 70% less, and now about 85% or maybe even 90% less than it was. (I've tested it every few days using tracings on tissue paper and a marked reduction is clear.) In an air-conditioned room, I don't sweat at all now (which is new because the dripping from the palms used to continue no matter the temperature or humidity). I've had some itching and minor dryness so far (imagine...dryness), but handcream with aloe (or straight aloe) does away with that. Colloidal oatmeal and shea butter also help, especially for feet. (Feet look better, too, no more rashes from constant moisture and no chafing from shoes anymore either, and this marked difference is apparent already, only a couple weeks into it.) Seeing my mom's hands finally 100% dry, after all these years, convinces me that 100% dryness may be possible for me too, so naturally I'll stick with it. But I had to post this to tell other skeptics that yes, the Idromed 4 actually works.
Now when I first heard of iontophoresis, it was another story. I was truly incredulous and it actually struck me as some kind of quackery on the order of the old galvanism 'reinvigorating' the dead or the kooky late 19th century 'electrical healing' devices, etc. It didn't help to learn that iontophoresis had been known since at least 1952, yet doctors in our area (USA) knew little to nothing about it and it wasn't offered as a treatment for Hyperhidrosis by a single local dermatologist. As a result of this sad lack of information on iontophoresis for Hyperhidrosis --which makes you think it must not work or someone would offer it, right?-- my mom and I had, between us, tried just about everything else under the sun, short of sympathectomy. (That's quite a dangerous surgery, don't let anyone tell you different. That some doctors now claim the use of endoscopy/thoracoscopy means they no longer need to collapse a lung (!), etc., is cold comfort, we think, especially since such a high percentage of people end up with equal or worse compensatory sweating post-surgery. Anyone considering sympathectomy -- do your homework, know the risks. So it was only when the Drysol, the Maxim, various anticholinergics (i.e., Robinul, glycopyrrolate) and even Botox injections had all failed that I began looking --very skeptically and with some desperation-- into iontophoresis.
The one iontophoresis machine you do occasionally hear about in the US is the Drionic so I began to grill any past users of Drionic machines that I could find, including on-line. For a few it did seem to work but, for the vast majority (and especially those with extreme Hyperhidrosis, of the 'it literally drips' variety, like me), it was no solution, having either no effect or very limited effect. Some said the small home-use Drionic machines just aren't strong enough, while others complained of the expensive (proprietary) battery that must be bought from the company and frequently replaced. One DIY website even described how to circumvent the battery by rewiring the device...but I'm no electrician and that seemed dodgy at best. I also found that it's not uncommon to see Drionic units for sale, used, which implies to me that they are less than sufficient in some significant number of cases. (Drionic machines have only been around since the 1980s so it's too early to see the effects of 'die-off' of the original user population. And who would sell theirs if the Drionic really worked, right?)
Next I broadened the search, looking for a 'full strength' iontophoresis machine, preferably one that could be plugged in rather than using batteries. There was Iomax, Idrostar, I2MA, Iontex, all of which used only batteries, plus the MD1A machine from Fischer and the Idromed 4 from Dr. Hönle Medizintechnik, both using regular electrical power. Beyond the battery issue, the first four ruled themselves out either by seeming rinky-dink like the Drionic, being unavailable or, in one case, being available but only in France. The best of them, intended for use in a clinic setting, seemed to be the Fischer MD1A, sold in the US, and the Idromed 4, GS or PS, out of Germany.
It wasn't long before the Fischer machine ruled itself out, too. First, the MD1A is only available with a prescription. Thus you must happen to live in an area where the dermatologists even know of tap water iontophoresis as a treatment for Hyperhidrosis at all -- and in the US, most don't. (The MD1A manual warns ominously: "CAUTION: Federal Law restricts this device to sale by or on the order of a qualified practitioner licensed by the law of the state in which he practices to use or order the use of this device. Use by a patient must be under the supervision of the prescribing physician." This warning is needed because some of us 'hysterical' sweating females might get it into our heads that we can read a simple manual as well as anyone else and that Doctor doesn't always know best.) If you can find a prescribing local doctor, somewhere, the next problem is that they'll expect you to go through the entire Drysol-through-Botox elimination process again, waiting for everything else to fail, first, before considering anything they don't have in the office -- and none of them have an in-office iontophoresis machine, it seems. (I checked with every major hospital system in one of the largest cities in the US, including university and teaching hospitals, and none of them treated Hyperhidrosis with iontophoresis. This is not because it's not an approved treatment -- it is. There are even CPT codes for in-office iontophoresis treatment of Hyperhidrosis, measured in 15-minute sessions, with FDA Classification Code for the device of "89KTB Iontophoresis, specific use." Not that any of this actually helps the patient, though.) The Fischer company also offers very little information to patients, catering instead to doctors, only. They make available an informational CD for doctors, but what doctor is going to pay $50 for that? So that their patients can buy their own machines, once, and never have to return for $3000 Botox injections again? It's laughable. How does that Fischer CD help the Hyperhidrosis patient at all? But the final strike against the Fischer model: even if you can find someone and get the prescription, it's not covered by American health insurance anyway, unless your policy is uncommonly progressive and also very explicitly covers "durable medical goods." Even with the appropriate CPT code (for in-office treatment), this doesn't help at all in getting your own machine.
And so it was down to the Idromed 4. Though little-known here, apparently the Idromed is much more widely used in Europe than any iontophoresis device in the US, including use in clinics. It also has larger tubs than any of the other machines (can fit both hands in one tray, both feet in the other), and it seems to be the only one with a foot-pedal for on/off, meaning you can use it without aid of a second person. And it was obtainable here. The only downside was having to get an adaptor for the wall plug for a few $, but no big deal, considering all of these machines are expensive and I didn't want to have to worry about replacing batteries in the future. Thus, we determined to go with what appears to be the top of the line, the Idromed 4 PS (pulsed current = gentler), as offered through Bindner Medizintechnik, since they had a complete warranty, the best price we could find, and --uniquely-- a full money-back guarantee that it would work. (No one else offers anything comparable to that, I checked. This mattered to me because, the truth is, I really didn't expect it to work.)
Now, seeing that iontophoresis via the Idromed 4 actually does work, I can only conclude that its current unavailability in the US --except if you buy it on-line-- is due to bureaucratic stupidity. The US is simply behind the times with iontophoresis, just as with mexoryl in sunscreen or any number of other examples. (The most effective UVB/UVA blocker known, widely available across the world by the mid-1990s, mexoryl was unknown and unavailable in the US until very recently on account of a lack of specific FDA approval, no other reason. Since finally gaining approval, now it's everywhere.) Anything that claims to effect a "transformation of the body" is subject to regulation by the FDA so presumably any iontophoresis device also needs particular approval. If the Fischer machine has it (for clinical or home use), the Idromed 4 would also qualify. This is to say, the unavailability of the Idromed in the US appears to be an issue of red tape and, possibly, lack of consumer awareness of its existence. The International Hyperhidrosis Society (actually not so international as one might hope, rather more US-focused) is pushing the Fischer machine now, but this seems to result from the same cause, red tape in the USA. How many of us 'sweaters' could benefit from an Idromed immediately, yet don't even know it's available? And do the American doctors help us, or do they just keep injecting the ($$$) Botox and, at best, helping to set up the Fischer company as some kind of doctor-mediated monopoly? So enough of this. It seems time to take matters into our own hands. No reasonably intelligent person actually needs some special coaching or a doctor lurking over the shoulder to learn to use this simple machine. In fact, the instructions for the GS version are on-line in a few places (though they all seem to be charging more for the machine itself than Bindner Medizintechnik), and that even makes it sound a bit scarier and more difficult than it really is.
I don't recommend things lightly but, if others in the US are suffering with Hyperhidrosis and can afford to get hold of an Idromed 4, don't let the red tape, bias or (dare one say it?) even provincialism of the American medical establishment scare you out of it. And if you have any worries about buying a machine direct from Germany, go with Markus Bindner, no kidding. In our case, there was a problem with the shipping carrier. The tracking indicated the parcel was held up after hitting JFK in New York, after which it went missing completely. We began to panic, as these machines are obviously not cheap, and another supplier might have left us high and dry to fight it out with the carrier. But not Markus. He not only sent out a second Idromed at his own expense --which arrived safely 5 days later and which we've been using-- but he has been in constant communication the whole time, even phoning from Germany at one point. Truly, no one could ask for more. We really can recommend Bindner Medizintechnik without reservation. It's been such a good overall experience buying the Idromed, it seems only reasonable to try to tell others -- especially because most US doctors won't.
Finally, for any fellow hyperhidrosis sufferers who are considering an iontophoresis machine, but have not yet been through the full round of dermatologist visits with the usual process of elimination (you can blow many $1000s that way, trust me), maybe you can benefit from my and my mother's experience.
So, you realize you have Hyperhidrosis, a real condition, and you're not just some freak like you thought. You make an appointment with a dermatologist and what happens? In the US, usually Stages 1 through 4.
Stage 1, the dermatologist will prescribe one or more strong topical antiperspirant (usually containing aluminum chloride of zirconium salts or aluminum hexahydrate in alcohol solution), to be applied at night. Basically these liquids form a microscopic film over the skin, thereby obstructing the eccrine sweat glands...at least in theory. If you're old enough, you may remember doctors recommending (OTC) Mitchum Extra to be used this way, which was really just a slightly stronger men's antiperspirant. Mitchum did nothing for my mom's hands, other than make her smell of cologne, and in general this kind of advice can be ignored for palmar Hyperhidrosis. (Those were the bad old days, when Hyperhidrosis was thought to be semi-imaginary.) The modern versions of topical antiperspirants are definitely better than Mitchum but, for serious palmar/plantar Hyperhidrosis, they're rarely sufficient. Only the lucky ones have success with Drysol, Maxim, etc. (and forget Secret "Clinical Strength," marketed to women...yes, it does beat normal underarm antiperspirants by a little, but for hand sweating, I'd call Secret a joke.) Drysol gave both me and my mom a rash, almost like an allergic reaction, and Maxim, though it did zero for her, did work for me -- for about two days. But then the magic was gone, the sweating returned full force (as others have also reported), and no amount of slathering hands and feet in Maxim or lying motionless to allow it to dry while trying to fall asleep, drying it with a hair-dryer, or other machinations made any difference. Apparently many people build up a resistance to the topical treatments, after which they just stop working, as with me. I could even have tolerated the Drysol rash, if it actually stopped the sweating...but it didn't.
If you're fortunate enough to avoid the lunatic doctors who will tell you to keep trying the topicals pointlessly while, for example, trying to sleep with plastic baggies or rubber gloves on your hands and feet (!), Stage 2 is usually anticholinergics like Robinul (glycopyrrolate) or Ditropan (oxybutynin). Treating Hyperhidrosis is an off-market use of these drugs, which are actually meant to dry up the body in general. (In the case of Robinul, its real purpose is stopping patients' salivation while anesthetized for surgery...and yes, the dry-mouth it causes is horrible.) Glycopyrrolate in tablet form, beyond the many unpleasant and even scary side effects (blurred vision, headaches, "confusion"-!), did nothing for my mom, other than headaches, dry mouth, and dry eyes, and seemed to actually make my sweating worse -- but then maybe that was just from the anxiety caused by the homicidal thoughts the Robinul seemed to induce! (If you are a small female, say 110 lbs. or less, don't take the full dose they recommend for "adults," it's too much!) Eventually they lowered my dose, so the vague 'crazy' feelings subsided, but Robinul still had no sustained effect on the hand sweating, and zero effect on the feet. Apparently Robinul can also dry out the skin, making you look kind of tired and dessicated (but still with sweaty hands/feet), so for me it was a total loser. Our Robinul fiasco ended swiftly and without success. Anticholinergics in general can also lead to dangerous dehydration in hot weather, heat stroke, palpitations, etc., so lots of things to consider with any drug, precautions, counter-indications, etc. Some studies have suggested that glycopyrrolate can be used with iontophoresis (e.g., see (3) and (12) below), but we haven't tried this and, it seems, fortunately we won't have to, hard tap water being sufficient on its own.
Stage 3 is typically Botox injections these days, though "Botox Cosmetic" is only FDA-approved for axillar Hyperhidrosis now, palmar or plantar Hyperhidrosis being out of bounds and, as a result, only rarely if ever covered by insurance. Because it's not covered, you can expect to pay $1500 - $4000 out of pocket each time for hands. (The cost varies by region and number of vials needed, but it never gets inexpensive because Allergan, Inc., out of Irvine, CA, controls the patent, meaning no generics.) And getting Botox in the palms really hurts, even with topical anesthetics. (I never had it in the feet...who could afford it?) For truly sweaty hands, you can expect scores of small needles per hand, including fingertips. Some doctors will do tests with tissue paper or iodine first to determine where sweating is worst but, in my case, it seemed patchy sweating would always break through in some areas, no matter how many times I went back to be re-injected. Hands are sore for some time afterwards, too, and can also experience numbness and even loss of grip-strength, which is why some doctors do only one hand per visit. (This is very scary, only really happened to me once, and was exactly why my mom was afraid to try it. The day I found I couldn't turn a faucet was the day I decided I was done with Botox. Some doctors even say you shouldn't drive at first because gripping the wheel may at times be impossible so...the side-effect can be a bit frightening.) But even if you can deal with the side-effects, can somehow get insurance to cover it, or you do have a few thousand $$ to spend on Botox every 4 to 6 months -- because even if it does work to stop the sweating, it really won't last beyond that-- Botox is not nearly as effective for hands (or feet) as it is for armpits, they say, with a substantial proportion of failures for palmar Hyperhidrosis in particular. (For armpits, however, it's worth seriously considering. Many people say it works there, lasts for months, and armpits aren't subject to loss to strength, either. Botox for axillar Hyperhidrosis should also be covered by US health insurance, not least because Allergan is pushing hard for it. It's Botox treatment of Hyperhidrosis in other areas that's a problem.) For me, Botox lessened the hand sweating on and off for a few weeks, perhaps a 50% reduction on a good day, but it never eliminated it. I'd go back, they'd inject more, then I might have one or two almost-dry days about a week after the injections, but then, as with the Maxim, the magic was fleeting and the sweating would return full force, unpredictably at first, then permanently and covering the entire hand. Botox was no solution.
At Stage 4, the 'tough cases' when just about everything else has been tried and failed, some doctors will suggest surgery: endoscopic thoracic sympathectomy. We think this is insane, including insanely dangerous, and the hospitals that perform the extreme versions of it seem to be dwindling in number. Beyond just Horner's Syndrome, well-known unintended consequences of ETC include compensatory sweating and gustatory sweating, meaning many patients are left far worse off than before. (I knew one poor girl who had palmar-plantar Hyperhidrosis, slightly less awful than mine, but after that surgery in '03, the sweating inexplicably shifted from her palms and soles to her back and face...starting at the hairline and running down the neck! And her doctor was suggesting she try Drysol again to control this, "applied carefully with a cotton pad"! I always thought the surgery seemed risky but that was the last straw, I'd take sweaty hands over that Russian roulette.)
And it was only at Stage 4, after rejecting a surgery where they go cutting into your chest, collapsing a lung to do it in some cases, all in order to alter the sympathetic nervous system so as to stop hand-sweating -- only after that did we begin to hear about iontophoresis, as a kind of rumored 'final frontier' or last ditch effort, almost semi-legendary and only to be found somewhere over the horizon. And based on what we have seen with the Idromed, this delay or backwards order of suggested treatment options is very sad. Iontophoresis should be at stage 2 or even stage 1 (if a person gets a rash from the aluminum-based creams), but in the US, by and large, it's definitely not -- not yet. Thus it may be up to us, those afflicted with Hyperhidrosis, to promulgate this treatment so that the doctors are aware of it, and that includes forcing them to become aware of the established European devices long used to treat it. If some tipping point can be reached, even the American insurance companies will be forced to cover iontophoresis treatment, including devices for home-use, not least because any home-use machine would be more cost-effective in the long run than in-office visits.
So to this end, the raising of awareness more generally, I suggest we users and potential users of these machines compile and keep lists of any known studies on tap water iontophoresis for hyperhidrosis. Apparently there are quite a few in German (from decades ago, not on-line and as yet untranslated), but since it's in the US that iontophoresis seems to fly under the radar for Hyperhidrosis sufferers, I've looked for those in English. Something between 2.8% (see source in note 9 and 3% of the population have some degree of hyperhidrosis, some say even higher. Half of the problem with having constantly sweaty hands (etc.) is in the perception of others, who still have no idea that Hyperhidrosis is even a condition and simply mistake it for 'nerves' or something. So the more attention Hyperhidrosis gets, the better it is for all of us. (In fact, a study is in the data-collection phase now dealing specifically with the hereditary nature of Hyperhidrosis. You don't get anything for participation, but if enough of us do things like this, it can only help in generating interest, more research, and hopefully new and better treatments for all of us.) Allergan has a lot of money to throw around and they're of course pushing Botox, but this shouldn't be allowed to eclipse iontophoresis, which is not only cheaper but, at least in many cases including mine, it's effective where Botox was not. Treatment options should be suggested to patients on the basis of what works, not based on what is in fashion or well-funded at any given moment. Iontophoresis may be out of vogue in the US, but it does work and should be suggested among the first treatment options, not the last.
Some English-language studies dealing with iontophoresis we have come across so far (in order of oldest to most recent):
1) Bouman H.D., Lentzer E.M.G., 1952. "The treatment of hyperhidrosis of hands and feet with constant current," American Journal of Physical Medicine 31:158-162.
2) Levit F., 1968. "Simple device for the treatment of hyperhidrosis by iontophoresis," Archives of Dermatology 98:505-507.
3) Abell E., Morgan K., 1974. "The treatment of idiopathic hyperhidrosis by glycopyrronium bromide and tap water iontophoresis," British Journal of Dermatology 91:87-91.
4) Shrivastava S.N., Singh G., 1977. "Tap water iontophoresis in palmar-plantar hyperhidrosis," British Journal of Dermatology 96:189-195.
5) Levit F., 1980. "Treatment of hyperhidrosis by tap water iontophoresis," Cutis 26:192-194.
6) Stolman L.P., 1987. Treatment of excess sweating of the palms by iontophoresis, Archives of Dermatology 123(7):893-896.
7) Reinauer S., Neusser A., Schauf G., Holzle E., 1993. "Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): A new approach for the treatment of hyperhidrosis," British Journal of Dermatology 129:166-169.
8) Stolman L.P., 1998. Treatment of hyperhidrosis, Dermatologic Clinics 16(4):863-867.
9) Anliker M.D., Kreyden O.P, 2002. "Tap water iontophoresis," Current Problems in Dermatology 30:48-56.
10) Stolman L.P., 2003. "Treatment of hyperhidrosis," Journal of Drugs in Dermatology 2(5):521-527.
11) Gillick B.T., Kloth L.C., Starsky A., Cincinelli-Walker L., 2004. Management of postsurgical hyperhidrosis with direct current & tap water," Physical Therapy 84(3):262-267.
12) Dolianitis C., Scarff C.E., Kelly J., Sinclair R., 2004. Iontophoresis with glycopyrrolate for the treatment of palmoplantar hyperhidrosis, Australasian Journal of Dermatology 45(4):208-212.
--and recently it was even suggested that Botox might be better administered via iontophoresis than needles:
13) Kavanaugh G.M., Oh C., Shams K., 2004. Botox delivery by iontophoresis, British Journal of Dermatology 151:1093-1095. |
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