Iontophoresis

Iontophoresis

• Iontophoresis involves the movement of ions across

biological membranes by means of a direct current
for therapeutic purposes. It is also called ion transfer.
 Mechanism of Iontophoresis
• If a voltage is applied to electrolyte current will flow.
This consists of positively charged ions moving
towards the negative pole and negatively charged
ions moving to the positive pole.
• If a drug is in an ionic form, i.e., it has a charge, it
can be made to travel in either direction depending
on the polarity applied.
• Atoms and molecules in an electrolyte are constantly
gaining or losing electrons to become ions and then
reverting to their non-ionized form. There is also
considerable random movement of particles.
 Cont…
• When an electric charge is applied it results in a steady drift of
appropriately charged ions in each direction.
• The actual passage of current, hence of ions, occurs mainly via
the sweat gland ducts and to lesser extent via the hair follicles
and sebaceous glands.
• The effects of any drug introduced by iontophoresis are likely
to be either local in the skin under the active electrode or
systemic because when the drug enters the tissue fluid it is
disseminated throughout the body tissues.
• The number of ions entering the tissues from any given area of
active electrolyte is proportional to current density (current per
unit area) and time of application and concentration of ions.
Cont…
• For practical purposes the current density is
limited by the skin tolerance, which usually
allows between 0.1 and 0.3 mA/cm2.
• The concentration of ions in the solution used
will obviously have an effect on the number of
ions available.
Iontophoresis
Principle: Ions of drugs introduced in to the body
by using direct current. It is based upon that like
charges repel each other & that ions will move
towards the opposite charge under the influence
of an EMF.
Two electrodes;
Active ELECTRODE
DISPERSIVE OR INDIFFERENT ELECTRODE
Cont…
Current intensity
 Patient’s sensation
 Size of active electrode

It is advisable to keep the intensity low, not

more than 1mA per square inch
Cont…
Duration of Treatment
o Vascularity of the area to be treated
o The type of ions used
o The intensity of current used
DOSAGE
o Current amplitude
o Duration of application
Cont…
Dosage regulation
To achieve the desired effects of the ions dosage
can be regulated using amplitude duration
combinations
Dosage of 40mA/min can be achieved by
various combinations
Cont…
Amount of drug introduced
o It is influenced by the degree of alkalinity or
acidity under the active electrode
DEPTH OF PENETRATION
o Type of drug or ions
o Current intensity
o Skin thickness and skin temperature
Effectiveness of Iontophoresis
• Number of ions transferred
o Current density
o Duration of current flow
o Concentration of ions
• Depth of penetration
Method of application
Assessment
Selection of ion
Explain the procedure
Position
Clean the area to be treated
Preparation of electrodes and placement
Application of treatment
Termination of the treatment
Cont…
• Position: supine lying
• Clean the area to be treated: it is
treated with spirit or normal saline and
cotton swab. It reduces the skin resistance
and removes the dust particles from the
area and thus facilitates iontophoresis
Cont…
• Preparation of electrodes and placement:
Moisten the piece of bath towel in the drug
solution and place it over active electrode and
now place the active electrode over the body part
to be treated or massage the solution in to the
skin and place the active electrode over it. Place
the larger indifferent electrode at least 18inches
away from the active electrode. Secure the
electrode in position with velcro straps
Cont…
• Application of treatment: connect the
electrodes to desired terminals. Increase the
intensity until prickling, tingling or burning
sensation is produced or 0.1-0.5
milliAmpere/cm2 of electrode
• Continue the treatment for 15min. And check the
undersurface of electrodes after every 5min. So
as to prevent electrochemical burn
Cont…
• Termination of the treatment: after 15 min.
reduce intensity gradually and remove the
electrodes
Polarity of active electrode
• Sodium salicylate (salicylate is negative)
• Sodium chloride (chloride is negative)
• Potassium iodide (iodide is negative)
• Acetic acid (acetate is negative)
• Zinc sulphate (zinc is positive)
• Copper sulphate (copper is positive)
 Physiological & Therapeutic effects

• Local anaesthesia
• Relief of idiopathic hyperhidrosis
• Application of antibiotics
• Application of anti-inflammatory drugs
• Neurogenic pain
• Chronic wound healing
• Increase extensibility of scar tissues
• Fungal skin infections
• Relief of pain
 Local Anaesthesia:

• Local cutaneous anesthesia can be achieved by the

iontophoresis of suitable agents such as lignocaine
or procaine.
• The time of anaesthesia can be increased
considerably by the addition of adrenaline.
• This has been used therapeutically in the treatment
of herpes zoster and trigeminal neuralgia.
• It is used sometimes for minor ear or eye surgery in
which hypodermic injection is especially painful.
 Relief of Idiopathic Hyperhidrosis
• Idiopathic hyperhidrosis is a condition in which there
is increased sweating due to unknown reasons.
• This distressing condition usually affects the palms,
soles, and sometimes the axilla. It can be sufficiently
severe to interfere with the patient’s work.
• Topical application of various antiperspirants may be
ineffective so that surgical treatment –sympathectomy
for hands and feet or skin removal for axillary
hyperhidrosis – remains the only other option.
Cont…
• Glycopyrronium bromide iontophoresis is a simple, safe,
and effective treatment particularly for hands and feet.
• Exocrine sweat glands in the palms and soles are
innervated by the sympathetic system but stimulated by
acetylcholine so that the introduction of an
anticholinergic agent (glycopyrronium bromide) into the
skin will suppress sweating immediately.
• Other drug used with same effect is poldine
methylsulphate.
• Using tap water iontophoresis with direct current
(Anode is used as active electrode), sweat-reducing effect
is due to obstruction of the sweat gland by the deposition
of keratin.
 Application of Antibiotics
• The application of antibiotics to avascular areas by
iontophoresis is used therapeutically.
• Ear chondritis following burn injury has been
successfully treated.
• Another method of dealing with chronic infection is
metallic silver iontophoresis.
• Chronic non-healing ulcers have been treated with
xanthinol nicotinate, a capillary dilator, and
histamine diphosphate, which presumably acted
similarly.
Application of Anti-Inflammatory Drugs

• Anti-inflammatory drugs used to treat tendinitis and

bursitis when delivered by iontophoresis.
• Various non-steroidal anti-inflammatory drugs
(NSAID) are used for the treatment of
musculoskeletal pain.
• Treatment of epicondylitis can be done by the
iontophoresis of sodium salicylate and sodium
diclofenac.
• Concentrations of NSAIDs in the tissues have been
found to be greatly increased by iontophoresis
compared with their percutaneous absorption.
Neurogenic Pain
• Iontophoresis of vinca alkaloids (vincristine and
vinblastine) has been used and recommended
for the treatment of , chronic pain syndromes,
notably for patients suffering from post-herpetic
and other neuralgias, and chronic pain in
terminal cancer
Other Uses
• Hyaluronidase has been used for the reduction of local oedema,
but these remains considerable doubt about its stability and
usefulness.
• Zinc iontophoresis in the treatment of ischaemic ulcers and for
allergic rhinitis has been recommended and used.
• The dramatic skin erythema and weal produced by ehtylmorphine
• Hydrochloride (Renotin)or histamine iontophoresis are rarely
used at present.
• Iodine and chlorine have been used to increase the extensibility
of scar tissue in association with passive stretching.
• Copper iontophoresis has been used for the treatment of fungal
infections (tinea pedis).
• Salicylate is used for the relief of pain in rheumatic diseases.
drugs CONDITIONS EFFECTS STRENGTH OF POLARITY
DRUGS CONDITIONS EFFECTS STRENGTH
SOULTION OF POLARITY
SOLUTION

Acetic acid Myositis ossificans Increase soulbility 2 to 5% solution in Negative

of calcium water
Cont…
Calcium chloride Spasm in skeletal Decrease 2% solution in Positive
muscles excitability in water
peripheral nerve

Dexamethasone inflammation Anti-inflammatory 4mg/dl in water Negative

Iodine Adhesive capsulitis, antibiotic 5-10% solution Negative

microbial infections

Lidocaine bursitis Anesthetics effects 4-5% solution Negative

Magnesium Spasm in skeletal Decrease 2% aqueous Positive

sulphate muscles excitability of solution
skeletal muscles

Salicylates Rheumatoid Analgesics, anti- 2-3% sodium Negative

Uses of iontophoresis
• Arthritic and myalgic pain
• Softening of the scar tissues and adhesions
• Gouty and calcium deposits
• Bursitis
• Tendonitis
• Hyperhydrosis
• Wound and ulcer healing
• Allergic rhinitis
Cont…
• Sodium salicylic acid: relief of pain and
muscle spasm in cases of myalgia, arthritis and
sprain
• Sodium chloride: soften the scar tissue and
adhesions
• Acetic acid iontophoresis: gouty deposits or
calcium deposits
• Hydrocortisone iontophoresis: bursitis,
tendonitis
Cont…
• Hyloronidase iontophoresis: hyperhydrosis
• Zinc sulphate: it is used for the acceleration of
wounds and ulcer healing
• Histamine: it is used to increase blood supply
Dangers of Iontophoresis
• Chemical damage to the tissues, a chemical
burn, can occur as a result of the current density
becoming too high. Low skin resistance due to
cuts or abrasions, uneven pressure or thickness
of pads can cause chemical burns.
• There is also danger of a burn if a bare piece of
the metal lead or electrode inadvertently touches
the skin.
Cont…
• A shock can occur if the circuit is broken so that
the current is interrupted, such as would happen
if the current is switched off without being
turned down slowly. This may happen in a
number of ways – such as a lead breaking
• During treatment or the patient removing a
hand from the bath – but with the relatively low
currents employed there is no damage, except
that the patient will suffer an alarming shock.
Cont…
• Some patients experience a skin irritation caused by
hypersensitivity to the chemicals produced by the
current. Washing the treated part after treatment can
usually prevent it.
• Systemic effects can occur, especially if large areas are
treated by iontophoresis. With anticholinergic drugs
these can take the form of headaches, abdominal pains
or mild dryness of the mouth. Patients should be
warned to avoid vigorous exercise immediately after
treatment, and if the symptoms are severe the area of
treatment should be reduced.