You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
idiopathic ( primary ) hyperhidrosis is defined as excessive sweating with no clear cause . 

excessive palmoplantar , axillae , facial , or cervical region sweating in idiopathic 
 hyperhidrosis usually occurs bilaterally and causes social , psychological , emotional , and 
 professional difficulties for the afflicted .
the incidence of idiopathic hyperhidrosis is 
 reported to be between 0.6 to 2.8% in both genders1,2,3 .
idiopathic hyperhidrosis may begin in childhood and continues for 
 the rest of the subject s life .
it does not occur during sleep , for it is normally 
 stimulated by emotion and stress which are controlled by the cortex4 , 5 .
a variety of treatments have been proposed to control or decrease the sweating of 
 idiopathic hyperhidrosis .
systemic anticholinergic drugs are somewhat effective at 
 controlling the secretion , but long term usage of the drugs and adverse side effects make 
 them unsafe and ineffective .
injection of botulinum toxin a ( botox ) is painful and requires 
 regular injection with the use of anesthetic .
as well as having some side effects , it is an 
 expensive treatment too4 , 6 , 7 .
if patients fail 
 to respond to drug and injection therapies , surgical treatment including sympathectomy may 
 be considered for idiopathic hyperhidrosis of the palms
. however , some considerable 
 post - surgical dysfunction usually limits the practice of sympathectomy for idiopathic 
 hyperhidrosis of the soles2 , 3 .
it is an electrical treatment that includes 
 local absorption of a drug or chemical , in the forms of ions , on the skin .
it is used in 
 local anesthesia , antibacterial modality , neurogenic pain relief , edema , chronic ulcer 
 repair , skin fungal infection , and hyperhidrosis .
it has been proved to be a safe , 
 effective , and inexpensive treatment .
if it is applied appropriately , it normally does not 
 have any adverse side effects6 , 8,9,10 .
iontophoresis of tap water ( drinking water ) and normal saline 
 ( sodium chloride solution 0.9% ) in idiophatic hyperhidrosis are relatively common 
 treatments11 . however , there is 
 controversy in the literature about the use of tap water as an agent , as tap water differs 
 with area depending on its ions and compositions .
we were not aware of any local use of tap 
 water iontophoresis in the treatment of idiopathic hyperhidrosis .
therefore , the purpose of 
 this study was to evaluate the efficacy of our local tap water in conjunction with 
 iontophoresis in the treatment of idiopathic hyperhidrosis in comparison with normal saline 
 ( as a standard liquid ) iontophoresis .
we present the case of a 21  year - old female who voluntarily participated in this study .
her written , informed consent was 
 then obtained , and the protocol was approved by the tabriz university of medical sciences 
 ethics committee .
her condition was diagnosed to be idiopathic hyperhidrosis , following the 
 definition of hornbeerger et al . for idiopathic hyperhidrosis4 : visible and excessive sweating for a minimum 6 months duration and 
 at least two of the following features : 1 ) bilateral and relatively symmetric sweating , with 
 similar sweat measurements indicating that the severity of hyperhidrosis in both hands is 
 similar , 2 ) disruption of daily physical activities , 3 ) having at least one sweating period 
 in a week , 4 ) occurrence of sweating below the age of 25 , 5 ) having a family history of 
 sweating , and 6 ) having no sweating during sleep .
our patient had almost all of the above 
 mentioned features with the sweating first occurring at 8  years old , and no history of 
 medical , social , or psychological conditions that were possibly associated with 
 hyperhidrosis .
she had received no treatment for at least one year before the study . 
 according to the hyperhidrosis disease severity scale
( hdss)12 , the sweating of the palms was severe and greater than that of the 
 soles ; so we treated the palms of the patient in this study .
tap water and normal saline iontophoresis were performed at the physiotherapy clinic of the 
 faculty of rehabilitation . after a brief explanation ,
the patient was asked to wash her 
 palms and dry them by wiping with a tissue .
the sweat measurement was performed using the 
 pad glove method described by kalkan et al13 .
briefly , a pair of cotton gloves and a pair of surgical gloves 
 were weighed on an electronic scale with 0.0001  g sensitivity .
our patient was then asked to 
 wear the cotton gloves and then the surgical gloves on top of them on both hands .
she sat on 
 a comfortable chair for 10  min . while rubbing her hands together , followed by careful 
 removal and immediate re - weighing of the gloves .
the difference in the weight of the gloves 
 before and after the 10  min of wearing the gloves was determined as the intensity of sweat 
 in each treatment session and calculated as g / h .
the subject was then asked to place her 
 right palm in 400  ml tap water within a fiberglass tub with the dimensions of 15  24  cm . 
 similarly , the left palm was placed in normal saline .
the right and left palms were in 
 contact with rubber pads ( 4.5  3.5  cm ) that were connected to the negative and positive 
 electrodes , respectively .
733a , direct 
 current ( dc ) stimulator , which kept the voltage constant , and dc pulses were delivered with 
 increasing intensity ( up to 20 ma ) until the tolerance limit was reached .
the dc stimulator 
 was used for the conventional iontophoresis treatment as dc causes fewer adverse reactions 
 ( such as pain , skin burning , itching , and irritation ) than alternating current ( ac ) . 
 additionally , using dc with careful selection of treatment factors such as treatment time 
 period and intensity of dc decreases the possibility of adverse reactions . the tap water and 
 normal saline iontophoresis
were administered for 30  min in each session , with 8 
 applications on days 1 , 2 , 4 , 7 , 11 , 16 , 21 , and 28 of the study13 . at the end of each session ,
the patient was asked to wash her hands and dry them by wiping 
 with a tissue . in order to determine the intensity of sweat following iontophoresis 
 application , the pad glove method , described above , was performed again at the end of each 
 session .
subjectively , the patient was asked to report the intensity of sweat using the dermatology 
 life quality index ( dlqi ) questionnaire14 , which has a maximum possible score of 30 ( the worst possible 
 outcome ) , at the end of each week of the study .
she was also asked to report any sweat 
 intensity change on the soles . room temperature and humidity
the patient 
 was also asked not to use any medication during the study . in order to determine the effectiveness of the iontophoresis application ,
the 
 post - iontophoresis sweat intensities of 8 treatment sessions were averaged and normalized 
 relative to the corresponding mean value obtained before iontophoresis .
we observed 24.72% and 42.01% decreases in the sweat intensity of the patient over the 8 
 treatment sessions with tap water and normal saline iontophoresis , respectively .
the 
 percentages decrease in sweat after iontophoresis treatment in each session are shown in 
 table 1table 1 .
sweat decrease ( % ) following tap water and normal saline iontophoresis in the 8 
 treatment sessions ( 18)sweat decrease ( % ) treatmentsessiontap wateriontophoresisnormal salineiontophoresis1386424359370734384858084631457115382944sweat decrease ( % ) was calculated as follows : ( pre tap water iontophoresis sweat 
 intensity  post tap water sweat intensity)/(pre tap water sweat intensity )  100% .
the patient answered the dlqi questionnaire during the first session , and at 
 2 and 4 weeks after the start of treatment ; the scores were 14 , 9 , and 7 , respectively .
she 
 also reported a 20% decrease in sweat on the soles at 4 weeks after the start of the 
 iontophoresis treatment .
sweat decrease ( % ) was calculated as follows : ( pre tap water iontophoresis sweat 
 intensity  post tap water sweat intensity)/(pre tap water sweat intensity ) 
tap water and normal saline iontophoresis are said to be the effective , safe , and 
 inexpensive treatments for idiopathic hyperhidrosis with minimal adverse side effects . 
 similar to some findings
, we showed the efficacy of our local tap water2 , 4 , 15 , 16 and normal 
 saline11 in iontophoresis treatment for 
 idiopathic hyperhidrosis .
however , in contrast to some findings11 , the efficacy of normal saline iontophoresis was greater 
 ( 70% more efficient ) than that of tap water iontophoresis . although some mechanisms have 
 been proposed to explain the improvement in hyperhidrosis after iontophoresis17 , 18 , the exact mechanism behind this improvement is not known . for 
 instance , pore obstruction of sweat ducts secondary to hyperkeratinization , impairment of 
 the electrochemical gradient of sweat , and biofeedback mechanism may be involved in 
 hyperhidrosis following iontophoresis using tap water or normal saline .
subjectively 
 decreased sweat on the soles of our case may be associated with a biofeedback mechanism 
 which needs further investigation . as shown in table 1 , we observed decreases in 
 sweat after every treatment session , with averages of 25% and 42% for tap water and normal 
 saline iontophoresis , respectively .
this indicates that iontophoresis is an effective 
 treatment with an immediate result , possibly due to mechanical or electrochemical occlusion 
 of sweat ducts which lasts for at least four weeks .
it may be associated with the type of currents ( dc or ac ) , 
 intensity or duration of the treatment , electrode placement , or local tap water which 
 differs with area .
further investigation is needed to explain the mechanism of iontophoresis 
 in hyperhidrosis and its residual effects .
support for our finding about the effectiveness 
 of iontophoresis was provided by the dlqi questionnaire scores . in our study
, the dlqi 
 questionnaire scores progressively decreased after 2 and 4 weeks of treatment , and the 
 decrease may have been associated with an improved quality of life . in our area , the tap water is said to be hard which may have adversely affected the 
 efficacy of the treatment compared with normal saline . in most research ,
hydrolysis of ions 
 oh and h is reported to be associated with the degree of 
 efficacy19 .
it seems that hard water 
 might have different ions and compositions which might adversely affect the degree of 
 efficacy .
however , normal saline is considered a standard liquid with almost similar 
 efficacy in the literature .
equipment settings and methodology might have affected the 
 efficacy of iontophoresis with normal saline , as reported in the literature11 . in summary , we report successful tap 
 water and normal saline iontophoresis treatment for idiopathic hyperhidrosis .
however , 
 normal saline iontophoresis was 1.7 times more effective than tap water iontophoresis at 
 obstructing secretion .
[ purpose ] the purpose of this study was to evaluate the efficacy of tap water ( drinking 
 water ) and normal saline ( sodium chloride solution 0.9% ) iontophoresis treatment for a 
 patient with idiopathic hyperhidrosis [ subjects and methods ] in this study , tap water and 
 normal saline iontophoresis were used to treat a 21  year - old female who was suffering from 
 severe palmoplantar idiopathic hyperhidrosis . 
 post - iontophoresis sweat intensity of 8 
 treatment sessions were averaged and then normalized relative to the corresponding mean 
 value which was obtained before iontophoresis treatment . [ results ] 
 the subject showed 
 24.72% and 42.01% decreases in sweat intensity following tap water and normal saline 
 iontophoresis , respectively . 
 [ conclusion ] tap water and normal saline iontophoresis are 
 effective in the treatment of idiopathic hyperhidrosis 
 . however , normal saline 
 iontophoresis is 1.7 times more effective than tapwater iontophoresis at obstructing 
 secretion .