Clinical Applications of Topical Iontophoretic Transport

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Iontophoresis has been successfully used in medicine to achieve topical delivery of drugs and actives. Most of the clinical applications of iontophoresis were developed in physical therapy and dermatology. The key areas include local anesthesia, hyperhidrosis, and local treatment of inflammation. Efficacy has been shown in clinical studies. In some cases, notably for the delivery of cosmetics, the ability of the medication to penetrate the target tissue in sufficient quantities to produce a clinical effect was not studied in controlled clinical trials.

Tap-water iontophoresis has been widely used for the treatment of hyperhidrosis. It is effective in the management of hyperhidrosis for the axillae, palms, and soles by reducing sweat production with only mild and temporary side effects. The exact mechanism of action remains unknown [40,41]. Current is typically applied in a 10 to 20 min session, which needs to be repeated two or three times per week and followed by a maintenance program [9]. Commercial devices have been marketed. Iontophoresis of actives such as anticholinergic agent and aluminium chloride can increase the average remission.

The successful use of iontophoretic delivery of lidocaine for local anesthesia of the skin has been reported in a variety of situations, including painless venipuncture, painless dermatological procedures such as pulsed-dye ablation of port wine stains, and laceration repairs. The advantages of iontophoresis-induced anesthesia include the painless procedure, the adequate local and low systemic concentration, and the quick onset of action as compared with anesthesia using a eutectic mixture of local anesthetics (10 vs. 60 min) [4246]. The first drug-iontophoresis device combination approved by the FDA is Iontocaine.

Iontophoresis can also facilitate the penetration of active molecules in the deep tissue underlying the skin. Iontophoresis of dexamethasone sodium phosphate has been reported to be effective for the treatment of patients with musculoskeletal inflammation such as tendinitis, arthritis, or carpal tunnel syndrome [47,48]. Iontophoretic delivery of pilocar-pine is extensively used for the diagnosis of cystic fibrosis. It enhances sweat secretion, allowing the measure of chloride concentration in the sweat [49]. Cystic fibrosis indicators are commercially available.

Antiviral drugs such as idoxuridine, acyclovir, or vidarabin can be delivered topically by iontophoresis [10,11,39]. Iontophoresis of Ara-AMP or idoxuridine is efficient in treating HSV1 and HSV2 in mice and orolabial HSV in humans [10,11]. Antiviral-drug iontophoresis could also be useful for the treatment of active zoster lesions and postherpetic neuralgia.

Other applications for topical iontophoresis include the treatment of warts with sodium salicylate [50], calcium deposit with acetic acid [51], improvement of peripheral microcirculation by PGE1 [52,53], treatment of acne scars [54], hypertrophic scars [56,57], or photodynamic therapy with 5 aminolevulinic acid [58].

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