1.

What is iontophoresis, describe technique, indications and contraindications for

iontophoresis. APR’13 10M
2. Discuss the mechanism of iontophoresis. List down the physiological and therapeutic
effects. APR’14 10M
3. Principles of Iontophoresis. What are the indications, selection of current and drugs used
in Iontophoresis. APR’19 10M
4. Explain in detail about Mechanism of iontophoresis, Physics, Physiological & therapeutic
effects. DEC’20 10M
5. Write the basis of iontophoresis, precautions and contra indications. OCT’10 10M
6. Iontophoresis OCT’15 5M
7. Iontophoresis and the mechanism behind. OCT’12 5M
8. Physics of Iontophoresis MAR’20 2M
9. Iontophoresis contraindications APR’16 2M

IONTOPHORESIS:

 Iontophoresis is a technique which uses an electric current to deliver a medicine or

other chemical through the skin.
 In popular (lay) terms it is sometimes called "an injection without the needle".
 In the past it has sometimes been called Electromotive Drug Administration, though in
modern therapy, this is a rarely employed term.
 Iontophoresis is a modality that uses electrical current to introduce ionized medicine
into the tissue of the body.
 Iontophoresis is used to treat inflamed joints, tendons and muscles that occur after
physical activity such as tennis elbow, carpal tunnel and wrist injuries.

TECHNIQUE:

 Skin should be cleaned preferably with soap, and hairy skin must be shaved.
 Electrodes must have proper contact with the skin surface.
 Proper straps must be used to keep the contact of electrodes.
 In case the ions are used in the form of ointment, a layer of it is applied at the site to be
treated. In case the ions are in the form of a solution, lint pad of absorbent material is used
and soaked in the ionic solution.
 Appropriate ions are used for specific conditions.
 The intensity of current and the duration of treatment must be regulated appropriately.
Precaution must be taken to prevent any burning. Use talcum powder if erythema is seen
after treatment.

INDICATIONS:

 Local anesthesia.
 Inflammatory conditions.
 Relief of pain.
 Skin conditions.
 Tension headache.
 Inhibition of spasticity.
 Indicated for administration of ionic solutions to a localized area of the body.
 Pain
 Inflammation
  Fungus gout

CONTRAINDICATIONS:

 Patients with excessive susceptibility to application of electrical currents, Patients with

cardiac pacemakers or other electrically sensitive implanted devices, Patients with known
sensitivity to the Ionic Solutions to be administered.
 Use over damaged or denuded skin, or over recent scar tissue. In the application over the
thoracic area, across train tissue, or in the orbital region Decreased sensation Pregnancy
Cancer Allergic to medication (ion) over metals
 Open wounds or burns.
 Patients with cardiac pacemakers.
 Allergy to medication. Loss of sensation.
 Greasy or dirty skin.
 Sole of foot (hard for the ions to pass inside).

MECHANISM:

There are two mechanisms that are usually involved in iontophoretic transport.

 Electro-migration
 Electro-osmosis
Electro-migration: It is also referred to as electro-repulsion. There occurs movement of
ions across a membrane (the skin) under the direct influence of an electric field. There
are two electrodes, cathode and anode. When an electric field is passed, the negatively
charged drugs repel into the skin under the cathode whereas, the transfer of positively
charged drugs happen under the anode.
Electro-osmosis: This is the second mechanism and electro-osmosis is considered as the
volume flow induced by the current flow. It depends on the physiochemical properties
of the molecules and the polarity of the applied current. For example- When negative
charges are placed on the cathode (-), they will migrate trans dermally towards anode
(+).
NOTE:
1. Drug deliver is local but only penetrates a few mm.
2. Drug must ionize and have net charge (+ or -)
3. Negative charges are placed on the cathode (-) and they migrate transdermally to the
anode (+)
4. Positive drugs are placed on the anode (+) and they migrate transdermally to the
cathode.
5. The electrode in which the drug would be administered are considered as active
electrode. By default, the opposite electrode would be dispersive electrode.

PHYSIOLOGICAL EFFECTS:

 Can describe in terms of ions selected for Rx

 Specialize ions are utilized for pain,spasm,inflammation
 lon penetration:
i) Penetration is less than 1 mm but subsequent absorption to deeper tissue via
capillary circulation & trans membrane transport
ii) Depth of penetration is uncertain, 3 to 20 mm
 iii) Bulk of ions are deposited under the active electrode, as a soluble or insoluble
compound ,depleted by blood, or used locally for further re combination
 Acid/alkaline Reaction
Anode:
i) acid reaction [weak hydrochloric acid]
ii) Sclerotic effect,tend to harden the tissue
iii) Analgesic effect due to local release of 02

Cathode:

i) strong alkaline reaction [sodium hydroxide]

ii) Sclerolytic effect,softening agent
iii) Softening agent, hydrogen release
iv) Used in management of scars, burns, keloids
 Hyperemia
i) Anode & cathode both cause hyperemia due to vasodilation that occurs due to heat
production according to joule's law
ii) Disappear with in one hour
iii) Cathodal hyperemia little pronounced & longer compare to anodal
 Dissociation
i) lonizable substance release ions & radicles ,free to move opposite pole when
applied direct current
ii) That ions combine with the ions in tissue fluid ,forming compound got therapeutic
effect
iii) Additional current enhanced flow of electron, improve normal migration, improve
ion transfer

THERAPEUTIC EFFECTS:

 Local anesthesia:
i) By suitable agent like lignocaine or procaine
ii) Condition like herpes zoster & trigeminal neuralgia
iii) Valuable technique for patient sensitive for needle
 Relief of idiopathic hyperhidrosis:
i) Most successful use of iontophoresis
ii) Condition affecting palms,soles sometime axillae
iii) Need to do symapathectomy for hand & feet ,removal of skin for axillary
hyperhidrosis
iv) Use of Glycopyroneum [Ant cholinergic agent]
v) Sweat gland in palms & soles are controlled by sympathetic system, stimulated by
acetylcholine
vi) Implication of ant cholinergic agent cause relief,cause anhidrosis
vii) The effect last for variable length of time,17-62 days palms & soles average 38
days,axilla 7-10 days
viii) Other drugs like poldine methylsulphate
 Application of antibiotics:
i) Use for avascular area
ii) Metallic silver for chronic infected wound
iii) For chronic non healing ulcer use xanthinol nicotinate [capillary dilator ]& histamine
diphosphate
 iv) For ear chondritis following burns,chronic infected ulcer
 Application of anti inflammatory drugs:
i) For tendinitis & bursitis,tennis elbow
ii) Advantage is over conventional Rx,painless & sterility of Rx
iii) Disadvantage is less efficacy,expensive
iv) The drug reaches the deeply placed structure is doubtful
v) Various steroidal & non steroidal drugs are used in musculoskeletal pain
vi) Sodium salicylate & sodium diclofenac
 Neurogenic pain:
i) Vincia alkaloids are used for Neurogenic pain
ii) That drugs are used as they are cytotoxic & microtubular inhibitors
iii) That drugs act on nerve endings,affect axoplasmic transport,decrese neurogenic
pain
iv) Post herpetic neuralgia,trigeminal neuralgia ,carcinoma pain
 Oedema relief:
i) Hyaluronidase used
ii) Stability & usefulness is doubtful
iii) Anode as a active electrode
iv) lodine & chlorine ions increase extensibility of scar tissue along with passive
stretching
v) Cu ions for tinea pedis, fungal skin infection ,athletes fee
 Ischemic ulcer
 Scar mobilization
 Fungal infection
 Allergic rhinitis

PRINCIPLES:

 Current Required:
i) In order to 'drive' the ions into the tissues, a DIRECT (Galvanic) CURRENT needs to
be employed
ii) A monophasic pulsed application can also be used
iii) Constant current is preferable to constant voltage - thus, the magnitude of the
applied current will not exceed the preset level in terms of skin resistance.
 Ionic Polarity:
i) The basis of successful ion transfer lies in physics principle "like poles repel and
unlike poles attract'
ii) lons with a polarity which is the same as that of the stimulating electrode are
repelled into the skin
iii) the electrode under which the ionic solution is placed is called the ACTIVE electrode
iv) The other electrode, which is used to complete the circuit is most commonly called
the DISPERSIVE, INDIFFERENT, INACTIVE or RETURN
 Low-level Amplitude:
i) low-level amplitude is more effective
ii) The treatment is usually applied with currents up to 5mA
iii) with low ionic concentrations - up to 5%,
iv) Treatment times are typically in the 10 - 30 minute range
 Electrode Size:
i) the negative electrode should be made larger than the positive electrode (usually
twice)
 ii) enlarging the negative electrode size lowers the current density on the negative
pad, leading to reduction of irritation.

SELECTION OF CURRENT:

Electric currents used in therapy are conventionally divided into three basic groups: galvanic
current, pulse direct current and alternating current. It is always DC. It is used mostly for
iontophoresis, or its trophic stimulation (hyperemic) effect is utilized.

COMMONLY USED DRUGS:

The specific medication that is used in iontophoresis depends upon the goals of treatment.
Some medications are used to decrease inflammation, while others are used to decrease
calcium deposits in muscle and tendon tissue.

 Dexamethasone: Dexamethasone is a common anti inflammatory medication used

during iontophoresis treatments in many physical therapy clinics. It is helpful in
decreasing localized inflammation that occurs in musculoskeletal conditions such as
tendonitis or bursitis. Inflammation causes pain, decreased tissue mobility, and
swelling. The dexamethasone helps to decrease the inflammatory process to decrease
your pain and improve the mobility
 Acetic Acid: It is used primarily to decrease calcium deposits in musculoskeletal tissue,
such as that which occurs if you have myositis ossificans.ýb Once the calcium deposits
are broken down, you should work on specific exercises for your frozen shoulder to
improve the range of motion and function
 Chlorine: Chlorine is a negatively charged ion used in iontophoresis in the treatment of
scar tissue and keloid scars. The physical therapist may use this to augment other
treatments for your scar tissue, like stretching and scar tissue massage.
 Calcium Chloride: Calcium chloride is a medication often used in iontophoresis to help
to decrease muscle spasm. Stretching as part of a home exercise program can help to
maintain muscle function between sessions of calcium chloride administration.
 Iodine: Iodine has been reported to be helpful as a medication to help treat sclerotic
conditions such as frozen shoulder. ÿp It has also been shown to help improve local
blood flow to tissues when used in iontophoresis.
 Magnesium Sulfate: Magnesium sulfate is at medication that is often used to help to
treat muscle spasm.yp Iontophoresis administration of magnesium sulfate may also
help decrease localized muscle pain. Stretching can help keep muscle spasms at a
minimum.
 Hyaluronidase: Hyaluronidase is a medication used to help to treat soft tissue edema or
swelling. If you have swelling after injury or surgery, it may be effective in the acute or
chronic stages of healing to help manage edema.
 Tap Water: Believe it or not, simple tap water has been shown to help to treat
hyperhidrosis (sweaty palms or feet) through iontophoresis.'yp The tap water is used on
either the positive or negative electrode during a hand (or foot) immersion bath.

PHYSICS:
The current required for iontophoresis is continuous direct galvanic current, which can be obtained
from standard low-voltage generators. The treatment is not the current itself, but rather the ions
introduced through that current. The completely non-invasive concept of iontophoresis became
very attractive to physical therapists because of the minimal ionic concentrations required for
effective administration.

Formula for iontophoresis:

The basic formula for using iontophoresis is:

I x T x ECE = grams of substance introduced, Where:

I : (Intensity) measured in amperes.

T : (Time) measured in hours.

ECE : (Electro-Chemical Equivalent) represents standardized figures for ionic transfer with known
currents and time factors.

As the determination of the ECE for many complex substances is very difficult, fewer milligrams of
these complex substances will penetrate the skin.

BASIS:

 Distilled water is not good conductor of electricity

 But when ionziable substance is dissolved in water,get dissolved,
 Known as "lonization "
 The solution is called "electrolyte "
 Electrolyte is able to conduct the electric current
 When continuous D.C. is applied via 2 electrodes in electrolyte solution
 +ve ions towards -ve pole,,,-ve ions towards + ve pole

PRECAUTIONS:

 Don't use two chemicals under the same electrode, even if they are of the same polarity.
 Don't administer ions with opposite polarities during the same treatment session.
 Uses the most appropriate ions to accomplish the treatment goal
 Uses appropriate treatment parameters and equipment set-up