1. Iontophoresis Dr/ Amal Mohamed Abd El Baky Mr. Chandrasekar.L
353 RHPT - 1st / ELECTROTHERAPY 2

2. Lecture outline Definition & Physics of Iontophoresis
Physiological effects, therapeutic effects of Iontophoresis
Indication, Contraindication, Precaution ,Advantages of Iontophoresis
Technique of application of Iontophoresis
353 RHPT Iontophoresis

3. Learning Objective
Define & outline about the mechanism & basic physics of Iontophoresis.
Describe, memorize & recall the operation of apparatus, physiological & therapeutic effects, indication , contraindication, precaution & dangers of Iontophoresis.
Demonstrate safely the application of Iontophoresis in certain conditions or disorders
353 RHPT Iontophoresis

4. Definition Iontophoresis is simply defined as ion transfer
Ionto = ion ; Phoresis = transfer
It is introduction of ions or substance into the body for therapeutic purposes using low voltage direct electrical current (constant GC)
353 RHPT Iontophoresis

5. Important points about iontophoresis
The primary route of ions transfer:
a. Skin pores
b. The hair follicles
c. Sweat gland ducts
N.B
Iontophoresis promote transdermal drug transports by increase the permeability of the stratum corneum.
Ionophoresis has a positive effect on wound healing
353 RHPT Iontophoresis

6. Important points about iontophoresis
Factors affecting therapeutic results :
- Ion introduced
- The pathology present
- The desired effects.
353 RHPT Iontophoresis

7. Some key points
An electron It is small particle that carry negative charge and it is small in size
Electrical current
It is a net movement of electron through any material. It’s unit of measurement is ampere
353 RHPT Iontophoresis

8. Some key points An electrode:
It is a part of the electrical conductor by which the current is being applied.
A cathode:
It is the negative pole or negative electrode of any device.
Anode:
it is the positive pole of any electrical device
353 RHPT Iontophoresis

9. Some key points An electrolyte: It a substance which contain ions.
Anion :
An ion that carrying negative charge, it is attracted to the anode
Cation:
It is an ion carrying a positive charge and so attracted to the cathode.
353 RHPT Iontophoresis

10. Electrolysis
It brings about movement of “+” charged ions towards the negative pole & the “-” charged ions towards the positive pole.
353 RHPT Iontophoresis

11. Iontophoresis vs Phonophoresis
Both techniques deliver chemicals to biologic tissues
Phonophoresis uses acoustic energy (ultrasound) to drive molecules into tissues
Iontophoresis uses electrical current to transport ions into tissues
353 RHPT Iontophoresis

12. Mechanisms of iontophoresis
Application of a voltage to the wet pad applied on the skin electrolysis of chemical produces ions.
The substance to be driven into the tissues needs to be IONIC in nature
The positive charged ions will be drift or repel from the positive pole and inter the skin and vice versa.
The drug that introduce into the skin move deeper by the formation of compound in blood stream
353 RHPT Iontophoresis

13. Introduction of ions
353 RHPT Iontophoresis

14. Introduction of ions
353 RHPT Iontophoresis

15. Introduction of ions
353 RHPT Iontophoresis

16. Physics of iontophoresis
Constant GC is used obtained from low voltage generator.
The amount of substance introduce:
Formula for using iontophoresis:
I x Tx ECE
As I = the intensity of current in amper
T= time in hours
ECE= electrochemical equivalence of the substance
353 RHPT Iontophoresis

17. The number of ion penetrating into the body is directly proportional to
-Current density “ which is limited via skin tolerance
-Time of application
353 RHPT Iontophoresis

18. Important points
Intensity of current: Low intensity of the current greater penetration of ions through the skin
The negative electrode should be large in size than the positive . To avoid the irritation effects and burns under the cathode
Ionic polarity: according to the repel mechanism the positive or the negative ions are repelled into the skin by the identical charge on the electrode .
353 RHPT Iontophoresis

19. Advantages of iontophoresis
Advantages of taking medication via iontophoresis relative to oral medications
Concentrated in a specific area
Does not have to be absorbed within the GI tract
Safer than administering a drug via injection
Painless procedure
Sterile technique
Noninvasive technique
353 RHPT Iontophoresis

20. Physiological effects of iontophoresis
Ion penetration
Acid/ alkaline reaction
Hyperemia
Dissociation
353 RHPT Iontophoresis

21. Physiological effects
1. Ion penetration:
Penetration is less than 1mm
Some studies said that depth of penetration3mm- 20 mm
Bulk of ions deposition may occur under the active electrode
Absorption to deeper tissues via capillary circulation
353 RHPT Iontophoresis

22. 2. Acid/ alkaline reaction:
Anode
Cathode
weak acidic reaction under it
strong alkaline reaction under it
It is sclerotic harden tissues under it
It is sclerolytic soften tissues under it, releasing hydrogen under it
Serving as analgesic due to release of oxygen
Use in management of scars , burns and keloid
353 RHPT Iontophoresis

23. 3. Hyperemia
Both anode and cathode produce hyperemia due to vasodilatation as heat production according to Joule’s law
It disappear within 1h
Cathode hyperemia is longer lasting than anode
353 RHPT Iontophoresis

24. 4. Dissociation:
The ions dissociated and combined with tissue fluid , forming compounds in the tissues that produce therapeutic effects
353 RHPT Iontophoresis

25. Most common drugs Drug/Solution Main Indication Rationale Parameters
Acetic acid
Calcific Tendinitis (Supraspinatus tendinitis), Myositis ossificans
Acetate believed to increase solubility of calcium deposits in tendons & other soft tissues
2 – 5% aqueous solution
NEGATIVE polarity
Dexamethasone
Inflammation
Synthetic - Anti inflammatory
4mg/ml. aqueous solution
Hydrocortisone
Steroid based Anti inflammatory
0.5% ointment
POSITIVE polarity
Hydrocortisone, Prednisone
353 RHPT Iontophoresis

26. Most common drugs Drug/Solution Main Indication Rationale Parameters
Iodine
Adhesive capsulitis, Other soft tissue adhesive presentations, Infection – Microbial
It acts as a broad spectrum antibiotic. Its actions in relation to adhesive presentations are not fully understood.
5 – 10% solution
NEGATIVE polarity
Salicylates
Muscle & Joint Pain, Acute & chronic
Analgesia & anti inflammatory. Inhibits synthesis of prostaglandins.
2 – 3% sodium salicylate solution
Lidocaine
Soft tissue pain, Inflammation
Local anesthetic effect(blocks peripheral nerve activity). May stimulate healing
4 – 5% solution (Ointment)
POSITIVE polarity
Magnesium Sulphate
Muscle Spasm, Myositis
Relaxing effect is achieved by ↓ excitability of muscle membrane & reduced activity at NMJ
2% aqueous solution
(Ointment)
353 RHPT Iontophoresis

27. Most common drugs Drug/Solution Main Indication Rationale Parameters
Hyaluronidase
Edema (Local) Sub acute & Chronic stages
↑ Permeability in CT thus allowing dispersion of accumulated fluid.
150μg/ml. solution
POSITIVE polarity
Calcium chloride
Muscle spasm
Calcium thought to stabilize excitable membranes, appears to ↓ excitability threshold in peripheral nerves & skeletal muscles.
2% aqueous solution
Zinc Oxide
Open wounds – Ulcers. Some dermatological conditions
Antiseptic effects related to zinc. May stimulate healing.
20% ointment
Tap water
Hyperhydrosis
Suppresses sweating in palms, soles of the feet, axilla through keratin plug formation in ducts.
Reverse polarity ½ way through treatment. (Typically 30min: 15+15)
353 RHPT Iontophoresis

28. Indications therapeutic effects
Local analgesia
Neurogenic pain
Edema relief
Ischemic ulcer
Scar mobilization
353 RHPT Iontophoresis

29. Indications therapeutic effects
Allergic Rhinitis
Idiopathic hyperhidrosis
Application of antibiotics
Application of anti- inflammatory drugs
Fungal infection
353 RHPT Iontophoresis

30. Indications therapeutic effects
As in cases of pressure ulcer use zinc iontophoresis.
Ischemic ulcer
Iodine and chlorine enhance the extensibility of scar ts.
Scar mobilization
As in cases of posttraumatic chronic edema ,use hyaluronidase .
Edema relief
As in cases of post herpetic neuralgia, pain due to carcinoma. Iontophoresis of
vincaalkaloids is used
Neurogenic pain
As in cases of trigeminal neuralgia and herpes zoster. Use of lignocaine or procaine.
Local analgesia
353 RHPT Iontophoresis

31. Indications therapeutic effects
Fungal infection
As in tinea pedis, copper iontophoresis can be used
Allergic Rhinitis
Copper or zinc iontophoresis is effective.
Idiopathic hyperhidrosis
Glycopyroneum bromide is effective for sweeting in palms, sole of the foot. Tap water iontophoresis can be also used.
Application of anti- inflammatory drugs
As in tendonitis or bursitis. Its advantages for its painless and sterility. Disadvantages ; expensive.
Application of antibiotics
As in avascular area. Silver iontophoresis is effective. As in cases of ear chondritis following burn, chronic infected ulcer
353 RHPT Iontophoresis

32. Contraindication As in galvanic type stimulation
Skin sensitivity reactions
Sensitivity to aspirin (salicylates)
Gastritis or active stomach ulcer (hydrocortisone)
Asthma
Sensitivity to metals (zinc, copper, magnesium)
Sensitivity to seafood (iodine)
353 RHPT Iontophoresis

33. Dangers Electrical Shock Burns Skin irritation Systemic effects
353 RHPT Iontophoresis

34. shock It is caused by the following:
Inadequate earthling of the apparatus
Faulty ammeters
Wet floor with faulty earthling of the apparatus
Accidently knocking off the main power supply when there is a high output of current
Increasing or decrease the current quickly.
353 RHPT Iontophoresis

35. Burn It caused by: Contact of the metal to the skin
Over dosage or current density is high
Skin lesion lead to low skin resistance.
Metal in the part.
353 RHPT Iontophoresis

36. Skin irritation It is caused by Chemical formed under the electrodes
Irritating nature of the drug
353 RHPT Iontophoresis

37. Systemic effects Can occur with treating large area.
Occur with using anticholinergic drugs
Causes headache, abdominal pain, mild dryness of mouth
353 RHPT Iontophoresis

38. Current used for iontophoresis
Low-amperage currents (usually galvanic current)appear to be more effective as a driving force than currents with higher intensities.
Higher-intensity currents tend to reduce effective penetration into the tissues.
353 RHPT Iontophoresis

39. Amplitude of the current used for Iontophoresis
The comfortable current density used for iontophoresis range between 0.1 and 0.2 mA/ cm2.
When initiating the treatment, the current intensity should always be increased very slowly until the patient reports feeling a tingling or prickly sensation.
If pain or a burning sensation is elicited, the intensity is too great and should be decreased.
When terminating the treatment, current intensity should be slowly decreased to zero before the electrodes are disconnected.
353 RHPT Iontophoresis

40. Duration of the treatment
Recommended treatment durations range between 10 and 30 minutes.
During treatment, the patient should be comfortable with no reported or visible signs of pain or burning.
The therapist should check the patient's skin every 3-5 minutes during treatment, looking for signs of skin irritation. Since skin impedance usually decreases during the treatment, it may be necessary to decrease current intensity to avoid pain or burning
353 RHPT Iontophoresis

41. Techniques for application of direct current
1- Contact method 2- Subaquatic method
353 RHPT Iontophoresis

42. Equipment
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43. Electrodes Types Note Special Pre gelled disposal electrode
Standard metal electrode
Commercial available electrode
Note
The negative ( cathode) electrode is made larger relative to positive one to avoid skin irritation
The negative (cathode) electrode should be 2x larger than the “+” (anode) electrode.
353 RHPT Iontophoresis

44. Electrodes
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45. Application
353 RHPT Iontophoresis

46. General Points to note – Lab Activity
1. Preparation of apparatus 1.a. Assembling of the apparatus 1.b. Testing of the machine 2.Preparation of the patient 3. Application of treatment.
353 RHPT Iontophoresis

47. Application
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48. Application
353 RHPT Iontophoresis