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

Electrophoresis is a physiotherapeutic method based on the combined action of galvanic current and the active substance introduced with its help.

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 studied its effect on frogs first. The current is called galvanic in honor of the researcher. Very soon, galvanic current, as the latest word in science in the 19th century, began to be used in medicine and for about 100 years galvanic current has faithfully served cosmetologists

The use of galvanic current is quite diverse. In modern cosmetology, the following procedures are distinguished: galvanization, electrophoresis, desincrustation and ion mesotherapy.

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

The combination of the action of galvanic current and the active substance introduced with its help is the basis of electrophoresis. Electrophoresis can be carried out using direct (galvanic) current, as well as using some types of pulsed currents. In cosmetology, electrophoresis of medicinal preparations is often called iontophoresis. This term is not entirely accurate (with the help of electrophoresis, it is possible to introduce not only ions, but also molecules, their parts that have a charge), but it is often used. Thus, technically, electrophoresis differs from galvanization only by the presence of a medicinal substance under the electrode.

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

Ionotherapy is electrophoresis of medicinal substances using stationary electrodes (both active and passive). The term is purely commercial in nature, the procedure is carried out using the classical electrophoresis method (the procedure is carried out without injections). The analogy with mesotherapy helps to renew interest in this method. Indications, treatment tactics and recipes for making cocktails correspond to the schemes accepted in mesotherapy, adjusted for the phoreticity of the drugs.

Thus, the methods that use galvanic current as their basis are:

1. Galvanization = the healing effect of direct current.
2. Electrophoresis = galvanization + medicinal substance.
3. "Ionic mesotherapy" = electrophoresis with 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 located near the electrodes disintegrate into ions. There are 2 types of ions: anions and cations. Ions move under the action of current: anions (-) tend to the anode, and cations (+) tend to the cathode. Water molecules disintegrate into ions H ⁺ and OH. Near the electrodes, ions interact with water, forming electrolysis products - acid and alkali. Electrolysis products can cause chemical burns at the site of application of the electrodes - an alkaline burn under the cathode and an acid burn under the anode. This is especially true when using stationary electrodes. To avoid this, a thick hydrophilic pad is placed between the electrode and the skin (electrolysis products accumulate on the pad and the skin remains intact). After the procedure, the pad must be washed or changed. A change in the concentration of ions leads to irritation of the skin receptors, causing a slight burning and tingling sensation. The passage of current through tissue causes polarization - the accumulation of ions on biological membranes.

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

Galvanization technique

Galvanization is performed with stationary, movable electrodes or with the help of baths. The procedure always involves two electrodes: positive and negative. A physiological solution or conductive gel is used to conduct the current. It should be remembered that negative and positive electrodes have different effects on tissues.

Effect of negatively and positively charged electrodes on various tissues

Effects on different fabrics	Electrodes of the device
	Cathode I-)	Anode (+)
Receptor response	Increased excitability and sensitivity	Decreased excitability and sensitivity
Secretory activity (sebaceous and sweat glands)	Increased secretion	Decreased secretion
Vascular reaction	Arterial hyperemia	Arterial hyperemia
Skin pore reaction	Opening of pores	Closing pores
Changes in skin pH acidity	Alkalization (increasing pH)	Increased acidity (decreased pH)

Mechanism of action of electrophoresis

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

During electrophoresis, substances penetrate to a depth of 1.5 cm. A "depot" is formed in the area of action after the procedure, from which the preparation gradually penetrates the cells. The period of elimination of various substances from the skin "depot" is from 3 to 15-20 hours, which ensures a long stay of active substances in the body and prolonged action.

The amount of substance introduced and the depth of its penetration are influenced by the following parameters:

1. Current strength.
2. Drug concentration.
3. Duration of the procedure
4. Physiological state of the skin.

Electrophoresis technique

Electrophoresis is performed using both stationary and movable electrodes. It is necessary to maintain a single polarity of the electrode and the substance being administered throughout the entire course of procedures. It should be remembered that the alternate use of electrodes of different polarity can dramatically disrupt the process of movement of charged particles at the tissue and cellular level. Depending on what medicinal or cosmetic preparations are used in electrophoresis, the procedure can have resolving, drying, toning and other effects.

To perform the procedure, two electrodes are always used - positive and negative. The negative electrode is called the cathode. Usually, all wires and connections from the negative pole are made in black. The positive electrode is called the anode and is marked in red.

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

The active electrode affects the problem area. The passive (indifferent) electrode is a larger area. It is usually in the patient's hand or attached to the body. The passive electrode can also carry a therapeutic load. Bipolar electrophoresis can be performed - negatively charged ions will enter the skin from the negative electrode, and positively charged ions from the positive electrode. If the electrodes are equal in area, more pronounced sensations arise under the negative electrode.

The polarity of a substance is the charge of its active particles. Ions of the same name are repelled from the electrode and go deep into the tissues. Therefore, negative ions are introduced from the negative electrode.

Three main types of electrodes are used to carry out the procedures: labile, stationary and electrodes for galvanic baths.

Labile electrodes are used for sliding treatment of the skin of the face, neck, and décolleté. These are metal electrodes of different shapes. The shape is selected for ease of use. A conical electrode is usually used to treat the area around the eyes. A spherical or roller electrode is used for the cheeks, neck, and décolleté. Labile electrodes must slide over a gel or aqueous solution. Drying of the solution reduces skin conductivity and the patient feels an unpleasant tingling sensation.

Stationary electrodes are conductive plates that are attached to the skin. Stationary electrodes can be metal (lead or other metal plates), rubber (conductive latex) and graphite (disposable graphitized paper plates). The stationary electrode is on the skin for 10-30 minutes. Therefore, there must be a 0.5-1 cm thick pad made of fabric or paper under the electrode. The pad is moistened with water or saline. When performing electrophoresis, the pad is moistened with a solution of a medicinal substance. The purpose of the pad is to improve current conduction and protect the skin from irritants that accumulate under the electrodes. The pad must be washed or disinfected after each procedure. It is more convenient to use disposable pads.

Electrodes for galvanic baths are graphite plates that are placed in a container with water. In this case, all the water or solution acts as an electrode. The absorption of medicinal substances into the skin occurs from the water.

Current strength dosing

It is necessary to familiarize the patient with the nature of the sensations during the procedure. Usually, a uniform, painless tingling is felt. When performing procedures on the face, a slight metallic taste appears in the mouth. The current strength during the procedure must be selected based on subjective sensations, achieving their clarity and comfort. In physiotherapy, current strength is usually measured in milliamperes (mA). Before the procedure, the target range of current strength is usually set. For procedures on the face, the range from 0 to 5 mA is used, on the body - from 0 to 50 mA. The sensitivity of the skin of the face to current differs in different areas. The neck, nose, and eyelids are usually more sensitive than the cheeks and forehead. The sensitivity threshold is individual and can change during the day. If the sensations become painful, the current strength should be gradually reduced. When performing an 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 fluid exchange. The stratum corneum of the skin is the main barrier to the passage of current. Its resistance is not as high as that of electrical insulation, but it is still significant. Skin conductivity 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;
• areas of skin with microtrauma may be more sensitive to the effects of current;
• getting hairs under the labile electrode, as well as the place where nerves exit, can cause unpleasant sensations;
• The current strength for the procedure may be different on different areas of the face (and body).

Contraindications to galvanization.

When prescribing electrical procedures, it is necessary to take into account the patient’s health condition, as there are a number of contraindications to such procedures.

Contraindications to electrophoresis are all contraindications to galvanization, as well as intolerance to the administered substance.

Methods of carrying out procedures

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

• large coverage area - the entire face and neck can be treated in one procedure;
• precise dosage of current for different areas of the face;
• visual control of the vascular reaction during the procedure;
• simplicity and ease of use;
• introduction of a smaller amount of substance, compared to stationary electrodes.

Before the procedure, remove makeup and degrease the skin with a toner or lotion. The polarity of the active electrode is selected in accordance with the polarity of the substance being administered. The type of electrode is selected depending on the area of exposure. A conical electrode is usually used around the eyes, a conical electrode is used for the cheeks and neck, and a roller electrode is used for the neck and décolleté area.

The passive electrode can be fixed on the body, but more often the patient holds it in the hand. The patient is asked to remove jewelry from the hands. It is necessary to wrap the cylindrical electrode with a wet napkin with a layer of 0.5-1 cm, after the procedure the napkin must be changed or thoroughly washed and disinfected. Electrolysis products accumulate in the tissue. Therefore, if the layer thickness is insufficient or the napkin is not treated after the Previous procedure, the patient may experience unpleasant tingling and irritation at the point of contact with the passive electrode.

The active electrode is moved over the problem areas with small circular movements. It is necessary to ensure that the area under the electrode is well moistened. On a small area, the labile electrode "works" for 1-2 minutes until the first signs of skin redness. The total exposure time on the face and neck is 10-15 minutes. After the procedure, it is advisable to make a mask that matches the skin type. The effect of the mask after electrophoresis is more pronounced, since the tissues are more active. In addition, skin with minor redness from exposure to current has time to calm down in 15-20 minutes.

There are several ways to apply a medicinal substance to the skin when working with labile electrodes. First of all, this is due to the convenience of work. Gels and aqueous solutions dry quickly on the skin. To avoid unpleasant sensations and use drugs more economically, the following is recommended:

• Substances in the form of gels can be applied to half the face or in parts
• It is recommended to apply aqueous solutions to the face drop by drop. For this purpose, the contents of the ampoule can be transferred to a syringe without a needle. The solution is applied to small areas during the procedure.
• Galvanization with labile electrodes can be carried out on a damp gauze mask soaked in active ampoule concentrate.

A similar procedure is carried out on collagen sheets.

Application of stationary electrodes.

Ionic mesotherapy.

Features of the application of this technique:

• long-term impact on the problem area (30-15 minutes as opposed to 1 minute with the labile method);
• greater penetration depth and quantity of medicinal substances compared to the labile method;
• limited area of impact.

Reusable or disposable stationary electrodes are used for the procedure. There must be a protective hydrophilic pad about 1 cm thick under the electrode. The main requirements for the pad: it must match the shape of the plate and protrude beyond its edges by at least 0.5-1 cm on each side. The purpose of the pad is to protect the skin from burns and irritation by acidic and alkaline products of electrolysis. Before the procedure, the hydrophilic pad is thoroughly moistened with warm tap water or a solution of the drug used. After each procedure, the pad is washed with running water and sterilized by boiling. It is more convenient to use disposable gauze or paper hydrophilic pads.

The popularity of the mesotherapy method and many years of experience using galvanic current in cosmetology have led to a new approach to the use of phoresis of medicinal substances - ion mesotherapy. In essence, this is electrophoresis of medicinal substances using stationary electrodes.

The advantages of this method are as follows:

• The tissues are not damaged or deformed. Therefore, there are never any consequences in the form of hematomas, severe swelling or pinpoint scratches.
• The procedure is painless. The patient may experience only a slight burning or tingling sensation under the electrodes.
• Substances in an ionized state are more active. Therefore, the dose of an ionized substance can be significantly less than when administered by injection.
• Unlike the injection method, no solvent is introduced into the tissue, which eliminates tissue deformation and local circulatory disorders. Allergic reactions, often dependent on the degree of purification of the preparation, are practically excluded.

Combination of the action of a substance 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 restoration of epithelial and connective tissues is accelerated, and the permeability of biological membranes changes. The disadvantages of ion mesotherapy include a limited area of action and the fact that not all substances can be administered using current. In addition, some patients are contraindicated for electrical procedures.

A combination of ion and classical mesotherapy seems quite promising - exposure to direct current immediately before injections. Using this method, it is possible to significantly improve the absorption of substances in the area where the electrodes are applied, as well as to perform preliminary anesthesia.

When performing ion mesotherapy, two (rarely one) active electrodes must be placed on the skin of the face, and the passive one on the forearm or in the area between the shoulder blades. The area of the passive electrode must be twice as large as the area of the active ones. The first procedure is 10 minutes, the current strength is until minimal pronounced sensations. Subsequent procedures are 15-20 minutes.

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

Plan of procedures on the face:

• make-up removal;
• milk;
• tonic;
• additionally, mechanical or enzymatic peeling is possible (chemical peelings are incompatible with electrical procedures, except for microcurrents);
• desincrustation - (-) with an electrode on a desincrustation solution;
• electrophoresis of the active substance (the electrode is selected depending on the polarity of the agent);
• mask;
• finishing cream

Some patients may experience discomfort during the procedure. The main reasons for this discomfort are:

1. Current too high.
2. Poor contact between electrode and skin:
   • the labile electrodes are not pressed tightly enough against the skin;
   • the gel or solution under the labile electrode has dried out; for the passive electrode - the napkin is not wet enough or is thin enough;
   • The labile electrode covers areas with hairs (for example, near the eyebrow).
3. Violation of the integrity of the skin barrier:
   • microtraumas (after cleaning, mesotherapy, areas of very dry skin with microcracks);
   • areas of inflammation (inflamed acne lesions, ultraviolet burns and allergic reactions);
   • thinning of the stratum corneum of the skin (after superficial and medium peeling, active brushing, film mask).
4. Accumulation of electrolysis products:
   • for the passive electrode - a thin or untreated napkin;
   • for an active electrode - too long an effect on one area; on a small area, a labile electrode "works" for 1-2 minutes or until the first signs of skin redness.

Preparations for electrophoresis

Currently, the cosmetic industry offers various preparations for electrophoresis. These can be ampoules, gels and solutions. Polarized preparations are marked (+) or (-) on the packaging. This means that they should be introduced from the corresponding pole. If there is no polarity marking, it is necessary to check the table of substances for electrophoresis.

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

Substances that cannot be introduced by current are successfully used in galvanization procedures. The cosmetic effect of such procedures is significantly higher than the effect of simply applying the substance to the skin due to the activation of blood vessels and increased permeability of cell membranes. When conducting ion mesotherapy (as well as classical mesotherapy), one can use one ready-made preparation (monotherapy) or make cocktails. When administered simultaneously, 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, and less often medicinal preparations are used in weak alcohol solutions;
• the solvents in the cocktail must be the same;
• the concentration of the substance in each solution does not exceed 10%;
• The cocktail is composed of ions of the same polarity.

The main substances used include the following:

• Lidase is a drug containing the enzyme hyaluronidase.
• Hyaluronidase increases tissue permeability and facilitates fluid movement in interstitial spaces. The main indications for the use of lidase are scars after burns and operations, hematomas; scars, adhesions, fibrous changes in tissues.
• Biogenic stimulants used in medical practice are preparations made from:
  • plants (aloe extract);
  • animal tissues (placenta suspension);
  • liman mud (PhiBS, 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 capillary permeability.
• Nicotinic acid (vitamin PP). Has a stimulating and vasodilatory effect. Hyperemia promotes the intensification of regeneration processes and the resorption of tissue decay products. Reserve capillaries open, the permeability of their walls increases.
• Salicylic acid. Used as an antiseptic, distracting, irritant and keratolytic agent. Used to treat seborrhea
• Inorganic iodides - potassium and sodium iodide. Absorbent. Promotes the absorption of infiltrates and scars.
• Zinc. Used as an antiseptic and astringent.