Iontophoresis

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 Iontophoresis
The term iontophoresis is simply defined
as ion transfer (ionto = ion; phoresis =
transfer).

Introduction of ions into the body using

direct electrical current

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 Iontophoresis
It is a specialized technique of electrical
stimulation that uses electrical polarity of
continuous direct current to ionize
medicines placed beneath surface
electrodes and transfers them into the
body through the skin

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Iontophoresis vs Phonophoresis
Iontophoresis uses electrical current to
transport ions into tissues

Phonophoresis uses acoustic energy

(ultrasound) to drive molecules into
tissues

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How does it work?

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 Basic Principles
Current Required
Ionic Polarity
Low-level Amplitude
Electrode Size

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 Current Required
In order to 'drive' the ions into the tissues, a DIRECT
(Galvanic) CURRENT needs to be employed

A monophasic pulsed application can also be used

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.

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 Ionic polarity
The basis of successful ion transfer lies in physics principle
like poles repel and unlike poles attract

Ions with a polarity which is the same as that of the

stimulating electrode are repelled into the skin

the electrode under which the ionic solution is placed is called

the ACTIVE electrode

The other electrode, which is used to complete the circuit is

most commonly called the DISPERSIVE, INDIFFERENT,
INACTIVE or RETURN electrode.
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 Low-level Amplitude
low-level amplitude is more effective

The treatment is usually applied with currents

up to 5mA

with low ionic concentrations up to 5%,

Treatment times are typically in the 10 - 30

minute range
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 Electrode Size
the negative electrode should be made
larger than the positive electrode (usually
twice)

enlarging the negative electrode size

lowers the current density on the negative
pad, leading to reduction of irritation.

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 Physiological changes
Ion penetration
Acid / alkaline reactions
Hyperemia
Dissociation

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 Ionic Penetration
penetration does not exceed 1 mm,

subsequent deeper absorption through the

capillary circulation.

The bulk of deposited ions at the active

electrode are stored, to be depleted by the
sweep of circulating blood.

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 Acid / alkaline reactions
Will get ACID accumulation under the POSITIVE
(anode) electrode (weak HCl)

This is because the negatively charged chloride ions

(Cl- from NaCl) is attracted towards the anode.

This is considered sclerotic, which tends to harden

tissues, serving as an analgesic agent due to local
release of oxygen.

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 Acid / alkaline reactions
Will get ALKALINE accumulation under the NEGATIVE
(cathode) electrode

because the positively charged sodium ions (Na+ from NaCl)

will move towards the cathode.

The Na+ ions react with water to form sodium hydroxide

(NaOH).

considered sclerolytic, which is a softening agent due to the

hydrogen release, serving in the management of scars and
burns.
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 Hyperemia

Both the positive and negative electrodes produce

hyperemia and heat due to the resulting vasodilatation.

The cathodal hyperemia is generally more pronounced

and takes more time to disappear than that of the anode.

Generally, hyperemia under both electrodes does not

lasts more than one hour.

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 Dissociation
ionizable substances dissociate in solution
releasing ions,

with the passage of direct current into the

solution migrate toward the other pole.

Gets absorbed through the capillary circulation.

This is the concept of ion transfer.

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 Complications
Chemical burns
Heat burns
Sensitivities and allergic reactions to ions

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 Chemical burns
This is due to excessive formation of the strong sodium
hydroxide at the cathode.

The skin becomes pinkish initially, to be grayish and oozing

wound few hours later.

These burns take a long time to heel

Should be treated with antibiotics and sterile dressings.

Burns under the anode are rare,

Appears as a hardened red area similar to a scab.

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 Heat burns
occurs due to excessive heat buildup in areas
with high resistance

Most of these burns occurs when

the electrodes are not moist enough,
they are not fitting well or
not in good contact with the skin.

Should be treated with antibiotics and sterile

dressings.

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 Allergic reactions to ions
If the patient is allergic to seafood, iodine should not
be used.

Patients with an active peptic ulcer or gastritis, react

poorly to hydrocortisone.

Patients, who have problems with aspirin, react poorly

to salicylates.

Patients sensitive to metals may react to copper, zinc

or magnesium.

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 Indications
Local anesthesia.
Inflammatory conditions.
Relief of pain.
Skin conditions.
Tension headache.
Inhibition of spasticity.

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 Selecting the Appropriate Ion
Inflammation Edema

Dexamethasone (-)
Hyaluronidase(+)

Hydrocortisone (-)
Salicylate (-)

Salicylate (-) Mecholyl (+)
Spasm Scar Tissue

Calcium (+)
Chlorine (-)

Magnesium (+)
Iodine (-)
Analgesia Salicylate (-)

Lidocaine (+)

Magnesium (+)
Hyperhydrosis
Tap Water
Open Skin Lesions
Glycopyrronium

Zinc (+)
Bromide (+)

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Prescription required
 Contraindications
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).

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 Precautions
Dont use two chemicals under the same
electrode, even if they are of the same
polarity.

Dont administer ions with opposite

polarities during the same treatment
session.

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 Current Density

the current density is measured in mA/cm2

If the current density reaches too high a level, tissue
damage, especially skin burn, may ensue.

It is suggested that a Maximum Safe Current Density
of;

0.5mA/cm2 is applicable at the negative(cathode) and

1.0mA/cm2 at the positive(anodal) electrode.

(Belanger, 2010)

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 Current Intensity
Calculated as
Maximum Current (mA) =
Maximum Safe Current Density (mA/cm2)
X Electrode area (cm2)

Recommended current intensity is 3 to

5 mA

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 Treatment Time

Treatment Time: ranges between 10 - 20 min.

Patient
should be comfortable with no
reported or visible signs of pain or burning

Check skin every 3-5 minutes for signs of

skin irritation

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 Formula for iontophoresis

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.

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 Electrodes
Traditional Electrodes
Commercial Electrodes

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 Traditional Electrodes
Older electrodes made of tin, copper, lead, aluminum,
or platinum backed by rubber

Completely covered by sponge, towel, or gauze which

contacts skin

Absorbent material is soaked with ionized solution

(medication)

If medicated ointment is used, it should be rubbed into

the skin and covered by some absorbent material
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 Commercial Electrodes

Sold with most
iontophoresis systems

Electrodes have a
small chamber covered
by a semipermeable
membrane into which
ionized solution may be
injected

The electrode self

adheres to the skin
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 Electrode Preparation
Attach self-adhering active
electrode to skin

Inject ionized solution into

the chamber

Attach self-adhering inactive

electrode to the skin and
attach lead wires from the
generator

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 Application
The skin should be abrasion / cut free and
the area carefully washed (soap & water is fine).
Dry electrodes are inappropriate and should not be used.
If pregelled electrodes are being used, ensure that a good even contact is
achieved.
Adequate fixation of the electrode and pad to the skin needs to be carefully
maintained.
Uneven current distribution can easily lead to skin burns and/or irritation
Explain to the patient what is expected and ensure that they know to report
immediately if any untoward or painful sensations are felt.
Turn the current up slowly to the required amount
At the end of the treatment time, ensure that the current is turned down
slowly.

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 References
1. http://www.electrotherapy.org/modality/iontophoresis?highlight=iontophore
sis , Tim Watson (2012)
2. Iontophoresis from internet, n.p.
3. Jennifer Doherty-Restrepo, Iontophoresis. PET 4995: Therapeutic
Modalities. Ppt presentation
4. Low J, Reed A. Electrotherapy explained, 4th edition, Elsevier, 2006; pp
193 195
5. Foster A, Palastanga N. Claytons electrotherapy,9th edition, AITBS
Publishers, pp 85 86
6. Mitra PK. Handbook of practical electrotherapy,1 edition, Jaypee
publications. 2006; pp 61 64
7. Singh Jagmohan. Textbook of Electrotherapy, 2 edition, 2012;pp 128
129

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