국제 다한증 학회 이온영동치료에 관한 글

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제가 흥미롭게 본 내용들만 한글로 조금 옮겨 볼께용. 도움이 되었으면 좋겠습니다.

제가 맞춤법 문법 띄어쓰기 그런 거 잘 몰라서 틀려도 양해 해주셔요. 의역, 오역이 있을 수 있으나 그걸 알아볼 수 있는 분들이라면 이 글이 필요 없으실 거에용.

바쁘신 분들은 팁 부분만 보시면 시간 절약할 수 있습니다.

이온영동치료는 1940년대 이후로 시작되었으며 최근에 들어 기기가 발전하면서 더 많이 사용되고 있습니다. 이온영동 치료는 손과 발에 발한증상을 보이는 사람들에게 사용되어 왔습니다. 이온영동치료는 극적으로 발한증상을 줄여주는 것으로 보고되고 있습니다. 한 연구에 따르면 91%에 달하는 환자들이 손발바닥땀과다증(palmoplantar)에 도움이 된다고 하였으며 또 다른 연구에서는 발한 증상을 81%만큼 감소시키는 것으로 나타났습니다.

이온영동치료는 심각한 부작용이 없으며 유지치료는 주로 주에 한번 사용됩니다. 기기에 따라 15~40분 정도 사용됩니다. 효과를 볼 때까지 주로 일주일에 세 번정도 사용되고 만족된 뽀송한 상태가 된다면 주로 주에 한번 유지 스케줄에 따라 사용하게 됩니다. 

가끔 몇몇 지역에 수돗물은 이온영동치료가 작용하기에 너무 약하기 때문에 효과를 보지 못할 수 있습니다. (이온이 피부 사이로 움직일 수 있게 도와주는 미네랄과 전해액(electrolyte)을 충분히 함유하고 있지 않기 때문입니다.) 

1티스푼에 베이킹 소다를 물에 넣는 방법이 도움이 될 수 있습니다. 더 나아가 베이킹소다가 뽀송하게 만들어주지 못한다면  항콜린제(anticholinergic ex, Robinul/glycopyrrolate) 를 부셔서 물에 첨가할 수 잇습니다. 대다수의 경우 이 방식이 이온영동치료를 효과적으로 만듭니다. 국제다한증학회 회장인 Dee Anna Glaser, MD(의학박사)는 "저는 보통 2mg정도의 항콜린제를 넣어서 이온영동치료를 합니다, 하지만 효과나 부작용에 따라 용량을 조절하고 있습니다"라고 팁을 남겼습니다. 

보톡스를 이온영동치료 물 판에 첨가하는 경우도 있었지만 이 효과에 대해 결과를 증명하는 연구결과는 없었습니다. 수돗물의 비용과 보톡스의 비용을 비교해 본다면 경제적인 방법은 아닌 것 같습니다.

이온영동 기기와 비용

이온영동치료 비싸보이지만 오래 쓸수 있으니까 사실 비싼 게 아니다. 미국은 FDA승인 받은 걸 쓰면 좋고 캐나다의 경우 Health Canada의 의료 라이센스를 취득한 걸 스면 좋습니다. (귀찮아서 패스)

배터리로 사용되는 것들은 plug-in 기기에 비해 효과가 적습니다. 

몇몇 분들은 자가 이온영동기기를 만들어서 사용하시는데 저희는 그 결과가 신통치 못하고 부상을 입을 수 있다는 이야기를 듣고 있습니다.

성공적인 이온영동치료를 위한 팁

치료는 무기한 적으로 지속 될 수 있기에 환자의 동기가 가장 중요한 요소입니다. 특히 초기에는 많은 시간을 할애해야 하기 때문에 치료를 지속하는 것이 쉽지 않습니다. 

효과적으로 이온영동치료를 하기 위해 초기에 어떻게 하는지 주의점 등은 의사한테 안내 받으면 좋습니다.

중요한 팁들:

가능하면 집에서 시도해 보기 전에 이온영동치료를 어떻게 효과적으로 할 수 있는지 의료인에게 안내받으면 좋습니다.

이온영동치료를 하면서 간지러운 느낌을 받는 다는 것을 알고 있으세요.

이온영동치료 중  이온의 흐름이 해로운 쇼크를 일으킬 정도로 강하지는 않지만 깜짝 놀라게 할 수 있다는 것을 숙지하세요. 그렇기에 손이나 발을 치료 도중에 빼시면 안 됩니다.

임신 중이라면 이온영동치료를 사용하지 마세요. pacemaker(심장 관련 기구인 것 같음) 심장병이 있거나 간질이 있다면 의사와 의논하세요.

이온영동치료 전 보석류는 제거해 주세요.

스크래치나 다치기쉬운(따가운) 각질, 자국 등은 바셀린 같은 걸로 치료 전에 보호해 주세요. 붉어지는 증상이 있다면 그 부위도 바셀린으로 보호해 주세요. 바셀린(petroleum jelly)은 이온영동치료에 방어막 같은 역할을 합니다. 그러니 필요하다면 바르세용. 면봉 사용 추천합니다.

치료 후 가려움이나 붉어지는 증상이 있다면 1%의 hydrocortisone(히드로코르티손, 피부염 관절염 치료제에 쓰이는 부신 피질 호르몬의 하나)을 바르세요.

효과가 없다면 의사선생님과 상의하세요. 베이킹소다를 첨가하거나 항콜린제를 물에 넣는 것이 도움이 될 수 있습니다.

과도하게 건조한 증상이 사용된다면 수분크림(로션)을 치료 후 사용하세요.

가정용 이온영동기 구입에 보험 적용에 도움이 필요하다면 도와드릴 수 있습니다.(링크 걸어놈)

본문 출처 : https://sweathelp.org/hyperhidrosis-treatments/iontophoresis.html

Iontophoresis

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Iontophoresis has been used to treat excessive sweating on the hands and feet since the 1940s. Recently there have been device improvements to make the treatment more effective for other body areas, too.

Iontophoresis is often recommended for people who've tried prescription or clinical strength antiperspirants, but need a stronger treatment. For people with hyperhidrosis of the hands and/or feet, iontophoresis treatments has been shown to dramatically decrease sweating. One study found that iontophoresis helped 91% of patients with excessive palmoplantar (hands and feet) sweating. Another study showed that iontophoresis reduced palmoplantar sweating by 81%. 

During iontophoresis, a medical device is used to pass a mild electrical current through water (usually using shallow pans for hands or feet or specific pads for other body areas) and through the skin's surface. There are no significant or serious side effects and the benefits are long-term, provided you keep up with the maintenance schedule your doctor recommends (usually once per week).

Treatment Regimen

Instructions for using iontophoresis devices will vary (always follow your healthcare provider’s or device maker's recommendations) but, in general, patients sit with both hands or both feet, or one hand and one foot, immersed in shallow trays filled with tap water for a short period of time (15 to 40 minutes depending on the device) while the device sends a small electrical current through the water. (For other body areas, recommendations will vary and pads that hook up to the iontophoresis machine are used.) The process is normally repeated three times per week until the desired results are achieved. Once satisfactory dryness has been reached, patients are switched to a maintenance schedule, usually once per week. To maintain sweat-relief, iontophoresis treatments need to be conducted regularly and before sweating begins to return. Discuss the technique of performing iontophoresis with your doctor and follow your device's manufacturer recommendations.

Sometimes, tap water in certain geographic locations may be too "soft" for iontophoresis to work -- it doesn't contain many minerals or electrolytes (tiny particles that help the electric current travel through the water and into the skin). Adding about a teaspoon of baking soda to the trays of water can help. Further, if iontophoresis with plain tap water or tap water with baking soda doesn't produce the desired dryness, a prescription medicine for hyperhidrosis such as an anticholinergic (for example, Robinul/glycopyrrolate) may be crushed and added to the water. In the majority of cases, this makes the iontophoresis therapy effective. Dee Anna Glaser, MD, President and founding board member of the International Hyperhidrosis Society, offers this advice: "I generally start with 2 mg [of anticholinergic] per tray, but will adjust the dose based on efficacy or side effects. In the majority of cases, this is effective and results in dramatically drier hands and/or feet."

There have been reports of onabotulinumtoxinA (Botox) being added to iontophoresis water trays. While there have been no conclusive studies of this method, it strikes us as an impractical approach to iontophoresis given the high cost of Botox, the potentially significant amount of Botox needed to have an effect via this delivery method, and the low cost and significant effectiveness of tap water iontophoresis treatments. If you are interested in Botox treatments for hyperhidrosis, you'll find lots of information here.

Iontophoresis Devices & Costs

At first glance, an iontophoresis device may seem pricey, but the expense is relatively reasonable when you realize that the devices last for many years (even decades), you can self-manage your treatments, and devices can be shared among family members (hyperhidrosis frequently runs in families). Also, health insurance often covers the cost of an iontophoresis device and sometimes “rent-to-own” is an option (more information below). Hint: Always check our Fan Fave Products for discount codes before you buy.

There are a variety of prescription plug-in iontophoresis devices available. If you are in the U.S., before buying, check to see if the device you are considering is registered with and cleared by the U.S. Food and Drug Administration (FDA). In Canada, check for a medical device license by Health Canada. Elsewhere in the world, check with the appropriate regulatory bodies.

Note that a prescription from a physician is often required. 

For mild to moderate hyperhidrosis, a battery-operated, non-prescription iontophoresis device may suffice but note that their reported sweat reduction rates are often less than that those of plug-in devices. 

Some people have also tried alternative, less expensive, homemade iontophoresis devices but we've heard that these types of devices yield unsatisfactory results and may even cause harm.

For information about specific iontophoresis devices and for discount codes specifically for International Hyperhidrosis Society readers, visit our Fan Faves page.

Medical Devices: Cleared vs. Approved

If you've read this far, you already know that iontophoresis is a hyperhidrosis treatment using a medical device, not a medicine. But medical devices and medications have something in common in the U.S. - they both fall under the regulations of the FDA, with some subtle differences.

When FDA review is needed prior to marketing a medical device, the FDA will either:

1. "Clear" the device after reviewing a premarket notification, or
2. "Approve" the device after reviewing a premarket approval application

A device is "cleared" when it is substantially equivalent to another device that is already legally marketed for the same use.

 

A device is "approved" when it's a new type of device and sufficient evidence has been provided to the FDA to show that it's safe and effective. This approval process generally involves rigorous review for safety. 

 

Tips for Successful Iontophoresis

Successful iontophoresis treatment will depend on the patient. Dr. David Pariser, International Hyperhidrosis Society founding board member and 2009 President of the American Academy of Dermatology, says: "The ideal candidate for this treatment is a motivated patient. Treatments can continue indefinitely; however, one of the major limitations of iontophoresis is the time commitment, especially early in the course of treatment. Some people find it to be too much of a hassle. But others enjoy the independence of managing their therapy and getting great results. It's like physical therapy."

Effective iontophoresis requires a learned technique so, ideally, you'll have access to a healthcare professional who can coach you through the first few sessions of your therapy. Then, if you and your doctor decide that iontophoresis is a good treatment choice for you, your doctor can write you a prescription for a home-use iontophoresis device. This type of back and forth with your doctor is not, however, always possible. If that's the case, don't be discouraged, many patients can learn how to use iontophoresis effectively by reading the manual carefully, talking to their device's manufacturer, and by reading resources on this website.

Having trouble finding a healthcare provider (HCP) who truly understands hyperhidrosis? You can find physicians (and other HCPs) familiar with excessive sweating by using our Physician Finder and using the additional search criteria: "IHhS Educated." At our training sessions, we teach healthcare professionals about all the current hyperhidrosis treatment options, including iontophoresis.

Ready to give iontophoresis a shot? Here are some important tips:

• If possible, learn how to use iontophoresis effectively in a clinical office from a trained health professional before trying it at home.
• Expect to feel a mild tingling sensation during iontophoresis.
• Know that the electric current used during iontophoresis is not strong enough to cause a harmful shock but it could startle you, so don’t remove your hands or feet from the water during treatment.
• Don’t use iontophoresis if you are pregnant, have a pacemaker, have a substantial metal implant in the current path (such as a joint replacement), or have a cardiac condition or epilepsy. Not sure? Talk to your doctor.
• Remove jewelry before iontophoresis treatments.
• Cover scratches, tender cuticles, and nicks in your skin with a petroleum jelly (like Vaseline) before treatment. If redness occurs at the water line, cover that area with petroleum jelly, too. Keep in mind that petroleum jelly is, however, a barrier to iontophoresis, so apply it only as necessary. Use a Q-tip to help.
• Treat any post-treatment, mild skin irritation or redness with 1% hydrocortisone cream.
• Talk to your doctor if the treatment doesn’t seem to be working. Adding baking soda or a prescription medicine (anticholinergic) to the water can help.
• If excessive dryness occurs, use a moisturizer after treatment sessions.
• When it comes to obtaining insurance coverage for the purchase of a home-use iontophoresis device, help is available.

 Next Steps

Have you talked to your doctor about excessive sweating? If not, now is the time! Learn more about how you and your doctor can work together to find the right treatment, or combination of treatments, to manage your hyperhidrosis.

Have you tried antiperspirants and iontophoresis and still feel like your quality of life is suffering due to excessive sweating? Learn about how Botox injections for hyperhidrosis or miraDry may be able to help.

And remember, because hyperhidrosis is a serious medical condition, you deserve insurance coverage and reimbursement for your hyperhidrosis treatments! We've got tips to help you navigate the health insurance realm and receive coverage.

Research and References

Interested in reading what the medical literature has to say about iontophoresis for hyperhidrosis? Here are links to relevant abstracts and articles published in medical journals:

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잘읽었어요ㅎㅎ

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감사합니다~~

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감사합니다~~^^

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좋은정보감사합니다