WELCOME TO THE SEMINAR ON Iontophoresis by

1. WELCOME TO THE SEMINARONIontophoresis by

2. Introduction • Iontophoresis is an effective and painless method of delivering medication to a localized tissue area by applying electrical current to a solution of the medication. • The delivered dose depends on the current flowing and its duration • It has proven to be a beneficial treatment for many localized skin disorders such as; nail diseases, Herpies lesions, psoriasis, eczematous, and cutaneous T-cell lymphoma

3. The method of iontophoresis was described by Pivati in 1747. • Galvani and Volta, two well-known scientists working in the 18th century, combined the knowledge that electricity can move different metal ions, and that movements of ions produce electricity • In clinical practice, iontophoresis devices are used primarily for the treatment of inflammatory conditions in skin, muscles, tendons and joints, such as in temperomandibular joint dysfunctions. • More recently, iontophoresis has been used in combination with laser Doppler technology as a diagnostic tool in diseases comprising the vascular bed.

4. Principle of Iontophoresis • An external energy source can be used to increase the rate of penetration of drugs through the membrane. • When a negatively charged drug is to be delivered across an epithelial barrier which is placed under the negatively charged delivery electrode (cathode) from which it is repelled, to be attracted to the positive electrode placed elsewhere on the body. • In anodal iontophoresis (positively charged ions), the electrode orientation is reversed

6. Factors affecting iontophoretic transport • Influence of pH • Current strength • Ionic Competition • Drug concentration • Molecular size • Convective or Electro-osmotic Transport • Current-Continuous vs. Pulsed mode • The physiological factors

7. Optimising iontophoretic transport • Iontophoretic transport can be regulated by varying the applied current density and area of application current density that is too high maybe unpleasant for the patient • The pH of the formulation should be optimised to ensure maximum ionisation of the compound • Before iontophoresis is carried out, carefully clean the skin area to be used with deionised water or preferably 70% alcohol

8. Disadvantages of iontophoresis • Minor reactions such as itching, erythema and general irritation of iontophoretic skin surface are common . • There is an increased risk of minor reactions if the exposure time and/or current are increased, and with some drugs like histamine capsaicin and acetylcholine • Some drugs induce long-lasting skin pigmentation after iontophoretic application, where the intensity of skin discoloration is proportional to exposure time

9. Applications • Hyperhidrosis & Iontophoresis • Hyperhidrosis can occur in many different areas of the body • Hyperhidrosis is also a problem on the facial area, the soles of the feet (Planter hyperhidrosis) and the armpits(axillae).Regardless of where it is located, hyperhidrosis presents an embarrassing problem to those afflicted with it • Hyperhidrosis is also not a temporary condition. Many people who suffer from it have suffered for many years, usually from adolescence

11. Treatment of Acne Scars • Iontophoresis of tretinoin and estriol has been reported for acne scars • The use of Tretinoin in varicella scars is equally successful • For treatment of acne scars, chickenpox scars, pigmentation problems, peeling, stretchmarks; iontophoresis has been combined with the power of sonophoresis to give maximum penetration of the essential vitamins and growth factors that are essential for the restoration of firm, smooth and beautiful skin

12. Iontophoresis treatment of basal cell carcinoma with cisplatin • Iontophoresis in neurons • Iontophoresis for musculo-skeletal inflammation • Iontophoresis for musculo-skeletal inflammation • Iontophoresis of fentanyl for the treatment of pain

13. Transdermal Iontophoresis • Transdermal iontophoresis can be defined as the facilitated transport of drug molecules through the skin under the influence of an external field. • The quantity of direct or pulsed current to be used is determined by multiplying the surface area by the time of exposure. • This current is then passed between the two electrodes. • The charged drug molecule is repelled from the active electrode into the skin and then into the systemic circulation.

14. Tap water iontophoresis • A tap water iontophoresis device uses tap water as a medium to administrate an electrical current to the skin of the hands or feet for treatment of hyperhydrosis (excessive perspiration due to over activity of sweat glands). • Treatment consists of passing a direct current of significant magnitude and duration in to the skin to obstruct the sweat glands. • The current is delivered to skin while the hands or feet are immersed in pair of pans, each of, which has an electrode that is also in the water

15. Safety rules • Be sure that the patients skin sensation is normal; otherwise calculate and control the current strength carefully in accordance with the size of electrodes and milliammeter reading • Do not apply the current over denuded areas and be most careful when over recent scar tissue. • See that the metal plate of the electrode is evenly covered by the padding and that there are no bare edges in contact with the skin • See that the covering pad is evenly soaked with tap water or saline solution • Apply electrodes in good contact, with even pressure

16. Fasten the conducting cords securely to the electrodes; making sure that the metal of the cord tip does not come in contact with the bare skin at any point • Always advance current gently when starting; never close the current sharply while the milliammeter registers current flow • Be sure that the patient understands he is to report undue burning or pain at once • If at any time the patient complaints of annoying symptoms decrease the strength the strength of current; then should this not afford relief turn off the current entirely, take off the electrodes and investigate • After conclusion of treatment do not allow patient to go outdoors with underwear or other clothing wet from the treatment Stigmergy

17. Conclusion • Iontophoresis of fentanyl is a new and effective way of controlling breakthrough cancer pain as well as chronic cancer pain . • Passive transdermal fentanyl is effective term analgesia • Iontophoresis does not require the placement and maintenance of intravenous access, which is associated with significant side effects. • For that reason iontophoresis could be similarly used for long term opioid use

18. References • www.sweathelp.org • www.intota.com • American Journal Of Physical Medicine • www.seminarsonly.com • www.stdpharm.co.uk

19. Thank You