Aust. J. Derm. (1976), 17, 92
POLDINE IONTOPHORESIS IN THE TREATMENT OF PALMAR AND PLANTAR HYPERHIDROSIS* BRIAN H . R . HILL
Napier, New Zealand SUMMARY
The use of iontophoresis for the treatment of plantar palmar and axillary hyperhidrosis with poldine methosulphate 0-5^/Q solution, is simple and reasonably effective long term. Few side effects other than physical discomfort at the time of therapy were noticed in ten patients in the trial. Palmar sweating is controlled better than other sites. As may be expected, plantar or palmar mtdtiple warts are possibly eradicated with loss of hyperhidrosis. The equipment is of low cost, treatment time and freqitency short. The procedure is beneficial and less traumatic than surgery, and more effective than internal or external medication for this disorder. The method of Levit^ modified by Grice et al.^ was used on a small series of patients for the treatment of idiopathic severe palmar and plantar hyperhidrosis. A simple machine made by a local electrical engineer to be energized by 240 V 50 cycle A.C. domestic supply, variable current rheostat and ammeter 0-20 m.a. scale included, delivered a D.C. output at 0-60 V. Electrodes used were made of aluminium foil frozen dinner packages. Poldine methosulphate 0-5% solution was made by dissolving " Nacton Tablets " in distilled water. Palms or soles were immersed in the dishes to a depth of 1 cm or less, to avoid immersion of nail folds (Figure 1). Duration of therapy was fifteen minutes, alternating equally anode and cathode ( 7 | mins each), and the current gradually increased from 5-20 m.a. Discomfort usually limited the current to 15 m.a. maximum. For the treatment of the axilla, an aluminium foil electrode covering a larger thick gauze pad, saturated with poldine, was strapped on to each axilla and the patient kept the hands clasped on to the back of the head. Six to eight treatments at weekly intervals produced, by patients' and clinicians' subjective and objective assessment, at least 50% improvement and at least a 75% decrease in sweating. This was sustained in all patients for three months or longer. Side effects were mainly discomfort from higher currents applied, slight dryness of the mouth in three patients, mild eye * Presented at the Annual Meeting of the Australasian College of Dermatologists, Adelaide, May 1976.
irritation in two patients and no mydriasis. This is a simple, effective treatment, and of great value where topical and systemic
FIGURE 1.
anhidrotic or anti-cholinergic or sedative agents have failed. The cost of the equipment was less than A|25.00. '[
' "'•-
V'
C O M M E N T S
•• ••
•
'•
''
-
'
- '
The apparatus as shown was found to have no problems ; polarity can be changed by the
PoLDiNE IONTOPHORESIS IN THE TREATMENT OE PALMAR AND PLANTAR HYPERHIDROSIS double pole output switch. A large variable rheostat permits very gradual amperage increases, necessary to avoid tingling and unpleasantness to the patient. Grice et al.^ have proven poldine to be superior to tap water for iontophoresis, and we confirm this observation.
230v;
0-20 FIGURE
2.-—-Circuit for apparatus
Hyperhidrosis of the idiopathic type is known to be common in young adults and teenagers, with a predilection to spontaneous remission in the late twenties. The severity of the disorder and the incapacity, both social and occupational.
93
requires simple remedies, rather than surgical sweat gland removal in the axilla, or S5mipathectomy for the limbs. The high degree of patient acceptance with effective reasonable long term results lead us to beKeve it worthy of consideration. We noted in one patient with multiple digital palmar warts, early resolution of the lesions after four treatments. A further patient with mosaic plantar warts on one foot also showed early clearance. T. &G. Building, Marine Parade, Napier, New Zealand. REFERENCES iLevit, F. (1968) : "Simple Device for Treatment of Hyperhidrosis by Iontophoresis ", Arch. Derm., 98, 506. ^ Grice, K., Sattar, H., Baker, H. (1972) : " Treatment of Idiopathic Hyperhidrosis with Tap Water and Poldine Methosulphate ", Brit. J. Derm., 86, 72.
POLDINE IONTOPHORESIS IN THE TREATMENT OF PALMAR AND PLANTAR HYPERHIDROSIS* BRIAN H . R . HILL
Napier, New Zealand SUMMARY
The use of iontophoresis for the treatment of plantar palmar and axillary hyperhidrosis with poldine methosulphate 0-5^/Q solution, is simple and reasonably effective long term. Few side effects other than physical discomfort at the time of therapy were noticed in ten patients in the trial. Palmar sweating is controlled better than other sites. As may be expected, plantar or palmar mtdtiple warts are possibly eradicated with loss of hyperhidrosis. The equipment is of low cost, treatment time and freqitency short. The procedure is beneficial and less traumatic than surgery, and more effective than internal or external medication for this disorder. The method of Levit^ modified by Grice et al.^ was used on a small series of patients for the treatment of idiopathic severe palmar and plantar hyperhidrosis. A simple machine made by a local electrical engineer to be energized by 240 V 50 cycle A.C. domestic supply, variable current rheostat and ammeter 0-20 m.a. scale included, delivered a D.C. output at 0-60 V. Electrodes used were made of aluminium foil frozen dinner packages. Poldine methosulphate 0-5% solution was made by dissolving " Nacton Tablets " in distilled water. Palms or soles were immersed in the dishes to a depth of 1 cm or less, to avoid immersion of nail folds (Figure 1). Duration of therapy was fifteen minutes, alternating equally anode and cathode ( 7 | mins each), and the current gradually increased from 5-20 m.a. Discomfort usually limited the current to 15 m.a. maximum. For the treatment of the axilla, an aluminium foil electrode covering a larger thick gauze pad, saturated with poldine, was strapped on to each axilla and the patient kept the hands clasped on to the back of the head. Six to eight treatments at weekly intervals produced, by patients' and clinicians' subjective and objective assessment, at least 50% improvement and at least a 75% decrease in sweating. This was sustained in all patients for three months or longer. Side effects were mainly discomfort from higher currents applied, slight dryness of the mouth in three patients, mild eye * Presented at the Annual Meeting of the Australasian College of Dermatologists, Adelaide, May 1976.
irritation in two patients and no mydriasis. This is a simple, effective treatment, and of great value where topical and systemic
FIGURE 1.
anhidrotic or anti-cholinergic or sedative agents have failed. The cost of the equipment was less than A|25.00. '[
' "'•-
V'
C O M M E N T S
•• ••
•
'•
''
-
'
- '
The apparatus as shown was found to have no problems ; polarity can be changed by the
PoLDiNE IONTOPHORESIS IN THE TREATMENT OE PALMAR AND PLANTAR HYPERHIDROSIS double pole output switch. A large variable rheostat permits very gradual amperage increases, necessary to avoid tingling and unpleasantness to the patient. Grice et al.^ have proven poldine to be superior to tap water for iontophoresis, and we confirm this observation.
230v;
0-20 FIGURE
2.-—-Circuit for apparatus
Hyperhidrosis of the idiopathic type is known to be common in young adults and teenagers, with a predilection to spontaneous remission in the late twenties. The severity of the disorder and the incapacity, both social and occupational.
93
requires simple remedies, rather than surgical sweat gland removal in the axilla, or S5mipathectomy for the limbs. The high degree of patient acceptance with effective reasonable long term results lead us to beKeve it worthy of consideration. We noted in one patient with multiple digital palmar warts, early resolution of the lesions after four treatments. A further patient with mosaic plantar warts on one foot also showed early clearance. T. &G. Building, Marine Parade, Napier, New Zealand. REFERENCES iLevit, F. (1968) : "Simple Device for Treatment of Hyperhidrosis by Iontophoresis ", Arch. Derm., 98, 506. ^ Grice, K., Sattar, H., Baker, H. (1972) : " Treatment of Idiopathic Hyperhidrosis with Tap Water and Poldine Methosulphate ", Brit. J. Derm., 86, 72.
