Iontophoresis

Iontophoresis
Intervention
ICD-9-CM 99.27
MedlinePlus 007293

Iontophoresis, also known as Ionization, is a physical process in which ions flow diffusively in a medium driven by the use of an electric current. Iontophoresis is to be distinguished from the carriage of uncharged molecules by diffusive fluxes of other molecules, especially of solvent molecules, for example by electro-osmosis, that is to say by flux of uncharged solvent molecules carried as a cross-effect of iontophoresis.[1][2] These phenomena, directly and indirectly, constitute active transport of matter due to an applied electric current. The transport is measured in units of chemical flux, commonly µmol/cm2h. Iontophoresis has experimental, therapeutic and diagnostic applications.

Uses

Laboratory uses

Iontophoresis is useful in laboratory experiments, especially in neuropharmacology.[2] Transmitter molecules naturally pass signals between neurons. By microelectrophoretic techniques, including microiontophoresis, neurotransmitters and other chemical agents can be artificially administered very near living and naturally functioning neurons, the activity of which can be simultaneously recorded. This is used to elucidate their pharmacological properties and natural roles.[1]

Therapeutic uses

Therapeutically, electromotive drug administration (EMDA) delivers a medicine or other chemical through the skin.[3] In a manner of speaking, it is an injection without a needle, and may be described as non-invasive. It is different from dermal patches, which do not rely on an electric field. It drives a charged substance, usually a medication or bioactive agent, transdermally by repulsive electromotive force, through the skin. A small electric current is applied to an iontophoretic chamber placed on the skin, containing a charged active agent and its solvent vehicle. Another chamber or a skin electrode carries the return current. One or two chambers are filled with a solution containing an active ingredient and its solvent vehicle. The positively charged chamber, called the anode, will repel a positively charged chemical species, whereas the negatively charged chamber, called the cathode, will repel a negatively charged species into the skin.[4]

Common diagnoses treated with iontophoresis include plantar fasciitis, bursitis, lateral and medial epicondylitis (commonly referred to as tennis elbow and golfer's elbow respectively) and some types of palmar-plantar hyperhidrosis.[5]

Iontophoresis is commonly used by physical therapists and occupational therapists for the application of anti-inflammatory medications.

In the treatment of hyperhidrosis, tap water is often the chosen solution for mild and medium forms. In very serious cases of hyperhidrosis, a solution containing glycopyrronium bromide or glycopyrrolate, a cholinergic inhibitor, can be used.[6][7]

Electromotive drug administration (EMDA) is also used in conjunction with mitomycin C to reduce the probability of recurrence of bladder cancer after surgical removal of the tumor. In this application the current is passed between a catheter electrode and patch electrodes applied to the skin in the abdominal region.[8]

Two iontophoretic patches have recently been approved for vaso-active therapeutic use by the FDA - Zecuity (2013) - containing the migraine drug sumatriptan - and Ionsys (2015), indicated for moderate-to-severe acute post-operative pain, delivering a therapeutic dose of the powerful opioid, fentanyl, on-demand. The entry of iontophoretic devices into the therapeutic mainstream will be followed with interest.

Diagnostic uses

Iontophoresis of acetylcholine is used in research as a way to test the health of the endothelium by stimulating endothelium-dependent generation of nitric oxide and subsequent microvascular vasodilation. Acetylcholine is positively charged and is therefore placed in the anode chamber.

Pilocarpine iontophoresis is often used to stimulate sweat secretion, as part of cystic fibrosis diagnosis.[9]

Reverse iontophoresis is a technique by which molecules are removed from within the body for detection. The negative charge of the skin at buffered pH causes it to be permselective to cations such as sodium and potassium ions, allowing iontophoresis which causes electroosmosis, solvent flow towards the anode. Electroosmosis then causes electrophoresis, by which neutral molecules, including glucose, are transported across the skin. This is currently being used in such devices as the GlucoWatch, which allows for blood glucose detection across skin layers.

See also

References

  1. 1 2 Curtis, D.R, (1964). Microelectrophoresis, in Physical Techniques in Biological Research, vol. V, ed. W.L. Nastuk, Academic Press, New York, pp. 144–190.
  2. 1 2 Bryne, John. "Iontophoresis of ACh". University of Texas Medical Center.
  3. ↑ Dhote, V; Bhatnagar, P; Mishra, P. K.; Mahajan, S. C.; Mishra, D. K. (2012). "Iontophoresis: A Potential Emergence of a Transdermal Drug Delivery System". Scientia Pharmaceutica. 80 (1): 1–28. doi:10.3797/scipharm.1108-20. PMC 3293348Freely accessible. PMID 22396901.
  4. ↑ "Iontophoresis". Electrotherapy on the Web. Tim Watson. Retrieved November 4, 2016.
  5. ↑ Caufield, T.G. (2013). Iontophoresis to Treat Hyperhydrosis. Tim Caufield PhD LLC.
  6. ↑ Walling, Hobart W.; Swick, Brian L. (2011). "Treatment Options for Hyperhidrosis". American Journal of Clinical Dermatology. 12 (5): 285. doi:10.2165/11587870-000000000-00000. PMID 21714579.
  7. ↑ Solish, Nowell; Bertucci, Vince; Dansereau, Alain; Hong, H. Chih-HO; Lynde, Charles; Lupin, Mark; Smith, Kevin C.; Storwick, Greg (2007). "A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee". Dermatologic Surgery. 33 (8): 908. doi:10.1111/j.1524-4725.2007.33192.x. PMID 17661933.
  8. ↑ Kos, Bor; Vásquez, Juan Luis; Miklavčič, Damijan; Hermann, Gregers G G; Gehl, Julie (2016). "Investigation of the mechanisms of action behind Electromotive Drug Administration (EMDA)". PeerJ. 4 (e2309). doi:10.7717/peerj.2309. Retrieved 24 August 2016.
  9. ↑ Sam, Amir H.; James T.H. Teo (2010). Rapid Medicine. Wiley-Blackwell. ISBN 1-4051-8323-3.
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