Electrophoresis, galvanization and ionotherapy: mechanism of action, technique, indications and contraindications

Electrophoresis is a physiotherapeutic method based on the combination of the action of the galvanic current and the active substance introduced with it.

This is one of the oldest methods in physiotherapy. About 200 years ago, the Italian physicist A. Volta created a continuous current generator, and Luigi Galvani investigated its action for a start on frogs. The current in honor of the researcher is called galvanic. Very soon the galvanic current, as the newest word in the science of the nineteenth century, began to be used in medicine and for about 100 years the galvanic current truly serves cosmetologists

The application of galvanic current is quite diverse. In modern cosmetology, the following procedures are distinguished: galvanization, electrophoresis, disinfestation and ionic mesotherapy.

The galvanic current is a continuous current with low voltage and with a low but constant intensity, which always passes in one direction (does not change polarity, voltage 60-80 W, current strength up to 50 mA). Exposure to the body by galvanic current through various electrodes is called galvanization.

The combination of the action of the galvanic current and the active substance introduced with it is the basis of electrophoresis. Electrophoresis can be performed with a permanent (galvanic) current, as well as using some types of pulse currents. In cosmetology, electrophoresis of medications is often called iontophoresis. This term is not quite accurate (with the help of electrophoresis it is possible to introduce not only ions, but also molecules, their parts that have a charge), but often used. Thus, technically, electrophoresis differs from galvanizing only by the presence of a drug substance under the electrode.

The ability of galvanic current to deliver medicinal substances deep into the skin is used in the procedure of "ion mesotherapy", or ionotherapy.

Ionotherapy is the electrophoresis of medicinal substances with the help of stationary electrodes (both active and passive). The term is of a purely commercial nature, the procedure is carried out according to the classical electrophoresis method (the procedure is performed without injections). The analogy with mesotherapy helps to renew interest in this method. Indications, therapeutic tactics and the formulation of cocktail preparation correspond to those accepted in mesotherapy regimens adjusted for the prandiality of drugs.

Thus, methods using a galvanic current are basically:

1. Galvanization = therapeutic action of direct current.
2. Electrophoresis = galvanization + drug substance.
3. "Ion mesotherapy" = electrophoresis by stationary electrodes.
4. Disincrustation = surface electrophoresis with saponifying agents.

Mechanism of action of galvanization

The action of direct current is based on the process of electrolysis. Substances that are located near the electrodes, decompose into ions. There are 2 kinds of ions: anions and cations. The ions move under the action of a current: the anions (-) tend to the anode, and the cations (+) tend to the cathode. The water molecules decompose into H ⁺ and OH ions . Near the electrodes ions interact with water, forming products of electrolysis - acid and alkali. Electrolysis products can cause chemical burns at the site of application of electrodes - an alkaline burn under the cathode and an acid burn under the anode. This is especially true when stationary electrodes are used. To avoid this, a thick hydrophilic gasket is placed between the electrode and the skin (the electrolysis products accumulate on the gasket and the skin remains intact). After the procedure, the gasket must be washed or replaced. A change in the concentration of ions leads to irritation of the skin receptors, with a slight burning and tingling. The passage of current through the tissues causes polarization - the accumulation of ions on biological membranes.

Electrolysis and polarization have a strong effect on tissues and cells. At a certain concentration of ions, the cells pass into an excited (electrically active) state. The metabolic rate and excitability of the cell vary. This increases the passive transport of large protein molecules and other substances that do not carry a charge (electrodiffusion), and hydrated ions (electroosmosis). This means the acceleration of cellular and intracellular renewal: the rapid arrival of building material, nutrients and regulatory substances, as well as the timely removal of metabolic products from the cell.

Method of galvanization

Galvanization is carried out by stationary, mobile electrodes or by means of trays. In the procedure there are always two electrodes: positive and negative. To carry out the current, a physiological solution or a conductive gel is used. It should be remembered that the negative and positive electrodes have a different effect on the tissue.

The effect of negatively and positively charged electrodes on various tissues

Effects on various tissues	Electrodes of the apparatus
	Cathode I-)	Anode (+)
Receptor response	Increased excitability and sensitivity	Decreased excitability and sensitivity
Secretory activity (sebaceous and sweat glands)	Strengthening of secretion	Decreased secretion
Vascular Reaction	Arterial hyperemia	Arterial hyperemia
Skin pore reaction	Opening the pores	Closing the pores
Change in acidity of skin pH	Alkalinization (increase in pH)	Increased acidity (lower pH)

Mechanism of action of electrophoresis

It is known that an electric current causes ions to move. The direct current can be compared to a wind that blows in one direction and carries small particles. The galvanic current acts continuously, and the pulsed currents advance the substances "by jerks". With the help of direct current, it is possible to introduce both small and larger particles of medicinal substances carrying the electric charge through the skin and mucous membranes. In this case, charged particles repel from the same electrode and go deep into the skin. Thus, negative ions are introduced from the negative electrode, and positively charged ions from the positive electrode. There are also amphoteric (bipolar) substances, they are introduced by an alternative current - it varies from (+) to (-). The greatest mobility is for medicinal substances dissolved in water. Introduced drug ions penetrate the epidermis and accumulate in the upper layers of the dermis, from which diffuse into the interstitium, endothelium of the vessels of the microcirculatory bed and lymphatic vessels.

With electrophoresis, substances go to a depth of up to 1.5 cm. In the area of exposure after the procedure, a "depot" is formed, from which the drug penetrates into the cells gradually. The period of excretion of various substances from the skin "depot" - from 3 to 15-20 hours, which determines the prolonged stay of active substances in the body and prolonged action.

The following parameters influence the amount of the substance introduced and the penetration depth:

1. Current strength.
2. Concentration of the drug.
3. Duration of the procedure
4. Physiological state of the skin.

Electrophoresis procedure

Electrophoresis is performed by both stationary and mobile electrodes. It is necessary to observe a uniform polarity of the electrode and the substance administered throughout the course of the procedures. It should be remembered that the alternate use of electrodes of different polarity can sharply disrupt the process of moving charged particles at the tissue and cellular level. Depending on what medicinal or cosmetic preparations are used for electrophoresis, the procedure can have a resorption, drying, tonic and other actions.

For the procedure always use two electrodes - positive and negative. A negative electrode is called a cathode. Normally, all wires and connections from the negative pole are executed in black. A positive electrode is called an anode and labeled in red.

The electrodes used in the procedure may be equal or unequal in area. At a lower electrode, the current density is higher and its effect is more pronounced. A smaller electrode is called active.

Active electrode affects the problem area. Passive (indifferent) electrode of a larger area. Usually it is in the patient's hand or fixed on the body. A passive electrode can also carry a curative load. You can conduct bipolar electrophoresis - from the negative electrode will enter the skin of the negatively charged ions, and from the positive, respectively, positively charged. If the electrodes are equal in area, more pronounced sensations arise under the negative electrode.

The polarity of matter is the charge of its active particles. From the electrode, the ions of the same name repel and go into the tissues. Therefore, negative ions are introduced from the negative electrode.

Three basic types of electrodes are used for the procedures: labile, stationary and electrodes for galvanic baths.

Labile electrodes are used for sliding processing of the skin of the face, neck, décolleté. These are metal electrodes of different shapes. The form is chosen for convenience of work. Conical electrode is usually used to work out the zone around the eyes. Spherical or electrode-roller - for the cheeks, neck and décolleté. Labile electrodes must necessarily slide on gel or water solution. Drying the solution reduces the conductivity of the skin and the patient feels unpleasant tingling.

Stationary electrodes are current-conducting plates, which are fixed to the skin. Stationary electrodes are metal (lead or other metal plates), rubber (made of conductive latex) and graphite (disposable plates of graphitized paper). The stationary electrode is located on the skin for 10-30 minutes. Therefore, under the electrode, there must necessarily be a liner made of cloth or paper 0.5-1 cm thick. Wet the pad with water or saline solution. During electrophoresis, the pad is moistened with a solution of the drug substance. The purpose of the gasket is to improve current carrying and protect the skin from irritating substances that accumulate under the electrodes. The gasket must be rinsed or disinfected after each procedure. It is more convenient to use disposable gaskets.

Electrodes for galvanic baths are graphite plates, which are placed in a container with water. In this case, all water or solution behaves like an electrode. Absorption of medicinal substances into the skin comes from water.

Current dosing

It is necessary to familiarize the patient with the nature of the sensations during the procedure. Usually feel a uniform, non-painful tingling. When performing procedures on the face appears a slight metallic taste in the mouth. The strength of the current during the procedure must be selected precisely according to subjective sensations, achieving their distinctness and comfort. In physiotherapy, the current is measured in milliamperes (mA). Before the procedure, the target current range is usually set. For procedures on the face use a range from 0 to 5 mA, on the body - from 0 to 50 mA. The sensitivity of the facial skin to the current is different in different areas. The neck, nose, and eyelids are usually more sensitive than the cheeks and forehead. The threshold of sensitivity is individual and can vary throughout the day. If the sensations become painful, the current should be smoothly reduced. When carrying out the iontophoresis procedure, it is important to take into account the electrical conductivity of the tissues. It depends on the concentration of ions and the intensity of the exchange of liquids. The stratum corneum is the main barrier in the path of current flow. Its resistance is not as great as that of electrical insulation, but it is also significant. The conductivity of the skin largely depends on the condition of the stratum corneum.

The above information is applied in practice as follows:

• Before the procedure, it is necessary to degrease the skin;
• skin areas with microtrauma may be more sensitive to electrical shock;
• falling under the labile electrode of the hairs, as well as the place of exit of the nerves can give unpleasant sensations;
• on different parts of the face (and body), the strength of the current for the procedure can be different.

Contraindications to galvanization.

When assigning electroprocedures, it is necessary to take into account the patient's state of health, since there are a number of contraindications to such procedures.

Contraindications to electrophoresis are all contraindications for galvanization and intolerance of the substance being administered.

Methods of conducting procedures

The technique using labile electrodes is used for both electrophoresis and galvanization. Features of the labile electrodes are as follows:

• a large area of coverage - for one procedure you can work the entire face and neck;
• exact dosage of current for different parts of the face;
• visual control of the vascular reaction during the procedure;
• simplicity and ease of use;
• The introduction of a smaller amount of matter, in comparison with stationary electrodes.

Before the procedure, make-up remover, degrease the skin with tonic or lotion. The polarity of the active electrode is selected in accordance with the polarity of the administered substance. The type of electrode is selected depending on the area of action. A conical electrode is usually used around the eyes, a conical electrode for the cheeks and neck, and an electrode for the neck and neck area.

A passive electrode can be fixed on the body, but more often the patient holds it in his hand. The patient is asked to take off his ornaments. It is necessary to wrap the cylindrical electrode with a moist cloth in a layer of 0.5-1 cm, after the procedure, the napkin must be changed or thoroughly rinsed and disinfected. The products accumulate electrolysis products. Therefore, if the thickness of the layer is not sufficient or the tissue is not treated after the previous procedure, the patient may experience unpleasant tingling and irritation at the place of contact with the passive electrode.

The active electrode is moved along the problem zones in small circular motions. It is necessary to make sure that the area under the electrode is well moistened. In a small area the labile electrode "works" 1-2 minutes before the first signs of redness of the skin. Total time of action on face and neck - 10-15 min. After the procedure, it is desirable to make a mask that is appropriate for the type of skin. The effect of the mask after electrophoresis is more pronounced, since the tissues are more active. In addition, the skin with minor redness from the effects of the current for 15-20 minutes has time to calm down.

There are several ways of applying the drug substance to the skin when working with labile electrodes. First of all, this is due to the convenience of work. Gels and aqueous solutions quickly dry out on the skin. To avoid discomfort and more economical use of drugs, recommend the following:

• Substances in the form of gels can be applied on a half-face or in parts
• It is recommended to apply water solutions on the face with a sip. To do this, the contents of the ampoule can be moved to a syringe without needles. The solution is applied to small areas during the procedure.
• Galvanization by labile electrodes can be carried out using a wet gauze mask moistened with an active ampoule concentrate.

Similarly, the procedure is carried out on collagen sheets.

Application of stationary electrodes.

Ionic mesotherapy.

Features of the application of this technique:

• long-term exposure to the problem zone (30-15 min, in contrast to 1 min with a labile technique);
• The depth of penetration and the amount of medicinal substances are large, in comparison with the labile technique;
• limited impact area.

For the procedure, reusable or disposable stationary electrodes are used. Under the electrode must necessarily be a protective hydrophilic gasket thickness of about 1 cm. The main requirements for laying; it must correspond to the shape of the plate and protrude beyond its edges at least 0.5-1 cm from each side. The purpose of the gasket is to protect the skin from burns and irritation with acidic and alkaline products of electrolysis. Before the procedure, the hydrophilic pad is well moistened with warm tap water or a solution of the drug used. After each procedure, the pad is rinsed with running water and sterilized by boiling. It is more convenient to use disposable gauze or paper hydrophilic pads.

The popularity of the method of mesotherapy and long-term experience in the use of galvanic current in cosmetology led to a new approach in the use of the drug phoresis - ionic mesotherapy. As a matter of fact it is electrophoresis of medicinal substances by means of stationary electrodes.

Advantages of this technique are as follows:

• Fabrics are not damaged or deformed. Therefore, there are never consequences in the form of hematomas, pronounced puffiness or pinpoint scratching.
• Painless procedure. The patient can only experience mild burning or tingling under the electrodes.
• Substances in the ionized state are more active. Therefore, the dose of the ionized substance can be significantly less than when injected.
• There is no introduction of a solvent into the tissue, in contrast to the injection method, which excludes tissue deformation and local circulatory disorders. Allergic reactions, often depending on the degree of purification of the drug, are virtually excluded.

Combination of the action of matter and current. Under the influence of galvanic current, the formation of biologically active substances (histamine, serotonin, acetylcholine) is enhanced, oxidative processes in the skin are activated, the recovery of epithelial and connective tissues is accelerated, the permeability of biological membranes is changing. The disadvantages of ionic mesotherapy include the limited area of exposure and the fact that not all substances can be injected with the help of a current. In addition, some patients are contraindicated electroprocedures.

A combination of ionic and classical mesotherapy is quite promising: exposure to direct current before injections. Using this method, it is possible to significantly improve the assimilation of substances in the area of application of electrodes, as well as to conduct preliminary anesthesia.

When carrying out ionic mesotherapy, two (rarely one) active electrode should be placed on the face skin, and the passive one - on the forearm or in the zone between the shoulder blades. The area of the passive electrode must be twice as large as the active area. The first procedure is 10 minutes, the current strength is up to the minimal expressed sensations. Follow-up procedures - 15-20 min.

The polarity of active electrodes does not change during the course of procedures. For an active substance penetrating the body through electrophoresis 5-10% (10-20%), the solution concentration should not be more than 35%.

Plan of procedures on the face:

• make-up remover;
• milk;
• tonic;
• can additionally - mechanical or enzymatic peeling (chemical peelings with electroprocedure are incompatible, except microcurrents);
• disincrustation - (-) by the electrode on a solution-disincrustant;
• electrophoresis on the active substance (the electrode is selected depending on the polarity of the agent);
• mask;
• finishing cream

Some patients may experience unpleasant sensations during the procedure. The main reasons for these sensations are as follows:

1. Too much current.
2. Poor electrode and skin contact:
   • insufficiently densely labile electrodes are pressed against the skin;
   • dried gel or solution under a labile electrode; for a passive electrode - not enough wet or thin tissue;
   • Under the labile electrode, areas with hairs fall (for example, near the eyebrow).
3. Violation of the integrity of the cutaneous barrier:
   • microtrauma (after cleansing, mesotherapy, areas of very cyx skin with microcracks);
   • zones of inflammation (inflamed elements of acne, ultraviolet burns and allergic reactions);
   • thinning of the stratum corneum (after surface and medial peeling, active rossa, mask-film).
4. Accumulation of electrolysis products:
   • for a passive electrode - a thin or untreated tissue;
   • for the active electrode - too long impact on one zone; in a small area labile electrode "works" 1-2 minutes or until the first signs of redness of the skin.

Preparations for electrophoresis

At present, the cosmetic industry offers various preparations for electrophoresis. These can be ampouled substances, gels and solutions. Polarized preparations are marked (+) or (-) on the package. This means that they should be entered from the appropriate pole. In the absence of polarity labeling, it is necessary to check the table of substances for electrophoresis.

In cosmetology ampulated solutions of collagen, elastin, herbal preparations are actively used. These substances do not have mobility in an electric field. Electrophoresis, for example, collagen does not occur. It is recommended to use collagen solution as a conductive substance during galvanization.

Substances that can not be introduced by current are successfully used in galvanization procedures. The cosmetic effect of such procedures is much higher than the effect of a simple application of the substance to the skin by activating the vessels and increasing the permeability of the cell membranes. When carrying out ionic mesotherapy (as well as classical), one can use one ready-made drug (monotherapy) or make cocktails. With the simultaneous administration of substances often have a more pronounced effect. This effect is called potentiation.

There are certain rules for making cocktails for ionotherapy:

• in the form of water, salt, less often drugs are used in weak alcohol solutions;
• solvents in the cocktail should be the same;
• the concentration of the substance in each solution does not exceed 10%;
• The cocktail is made up of ions of the same polarity.

The main substances used are the following:

• Lidase is a preparation containing the enzyme hyaluronidase.
• Hyaluronidase causes an increase in the permeability of tissues and facilitates the movement of fluids in interstitial spaces. The main indications for the use of lidase are scars after burns and operations, hematomas; scars, adhesions, fibrotic changes in tissues.
• Biogenic stimulators used in medical practice - preparations from:
  • plants (aloe extract);
  • animal tissues (placenta suspension);
  • limnic mud (FBS, peloidin, humisol).
• Ascorbic acid. One of the important physiological functions of ascorbic acid is its participation in the synthesis of collagen and procollagen and in the normalization of the permeability of capillaries.
• Acid is nicotinic (vitamin PP). Has a stimulating and vasodilating effect. Hyperemia promotes intensification of regeneration processes and resorption of products of tissue decay. Reveals the reserve capillaries, increases the permeability of their walls.
• Acid is salicylic. Applied as antiseptic, distracting, irritating and keratolytic. It is used to treat seborrhea
• Inorganic iodides are potassium and sodium iodide. Dissolving agent. Promotes resorption of infiltrates and scars.
• Zinc. It is used as an antiseptic and astringent.