Galvanotherapy: treatment with electricity

Galvanotherapy is the use of low-intensity direct electrical current for therapeutic tissue effects. Classically, it includes skin galvanization, medicinal electrophoresis of ionic solutions, water treatments with direct current, and invasive methods where direct current is delivered through needle electrodes. This method should be distinguished from pulsed currents, transcranial direct current stimulation, and pain-relieving techniques based on pulsed currents, as their goals, parameters, and evidence base differ. [1]

The most compelling clinical niche for direct current today is the treatment of primary hyperhidrosis with water iontophoresis. Clear protocols, predictable effects, and long-term maintenance therapy regimens have accumulated here. Iontophoresis of anti-inflammatory drugs is used in a number of musculoskeletal conditions, but the evidence is limited to acute treatments and short-term outcomes. Electrotherapy is being studied for wound healing, but recommendations vary depending on the type of current and clinical scenario. [2]

How does direct current affect tissue?

Direct current causes directed ion movement, membrane polarization, changes in microcirculation, and a local inflammatory response. On the skin's surface, this can temporarily block the secretory activity of eccrine glands, which is used for hyperhidrosis. In a wound healing model, low-level electric fields simulate "damage current," directing the migration of keratinocytes and fibroblasts, enhancing angiogenesis, and modulating inflammation. [3]

Microcurrent and low-intensity direct current are discussed as adjunctive treatments for accelerating chronic wound closure and reducing pain. Mechanistically, they are described as reducing edema, stimulating cellular metabolism, and altering growth factor expression, but the precise dose-dependent effects and optimal protocols remain a subject of research. [4]

Basic methods of galvanotherapy

1) Iontophoresis for hyperhidrosis. Hands and feet are placed in water baths, or wet pads are used for the underarms and face. A weak direct current is applied with alternating polarity, with several treatments per week followed by maintenance. Long-term efficacy and safety are well documented, and the method is included in information materials from specialized dermatological societies. [5]

2) Medicinal iontophoresis for pain and inflammation. Ionic forms of drugs, most commonly dexamethasone phosphate, are administered through the active electrode. Doses in the range of approximately 40-80 mA min are used; clinical studies have used dexamethasone phosphate solutions in concentrations from 0.4% to 4%. The effect has been confirmed primarily for the acute stage of certain tendinopathies and plantar fasciitis, primarily in terms of short-term outcomes. [6]

3) Invasive options based on direct current. Percutaneous electrolysis therapy and related techniques are promoted as minimally invasive interventions for chronic tendinopathies and tunnels in purulent dermatoses. According to modern reviews, this method is gaining popularity; however, the evidence base is still limited by the small number of studies and heterogeneity of protocols. [7]

4) Low-level current electrotherapy for wounds. Various modes are being studied for chronic wounds, including low-intensity direct current and pulsed forms. Some guidelines report potential benefits as an adjuvant, but for diabetic foot, specialized international recommendations advise against physiotherapy, including electrical stimulation, which is important to consider when choosing a treatment strategy. [8]

Where the method helps: clinical indications and strength of evidence

Hyperhidrosis

Iontophoresis is a basic first-line treatment option for palms and soles, with a clinical response rate of up to 85% after an induction course and the need for maintenance sessions every few days or weeks. The response rate for the armpits is somewhat lower, and for the face, it is the most modest. This method is available for home use after training, and some centers add glycopyrrolate to the water to enhance the effect. [9]

Modern reviews confirm the moderate effectiveness of iontophoresis with good tolerability, emphasizing that maintenance procedures are essential to maintain the results. Compared to botulinum toxin and sympathectomy, the method is less invasive and safer, although it requires patient discipline. [10]

Tendinopathy and plantar fasciitis

For acute medial Achilles tendonitis, current clinical guidelines for orthopedic and sports physiotherapy recommend the use of dexamethasone iontophoresis to reduce pain and improve function, in combination with weight-bearing exercises. Data from randomized trials show short-term benefits in patients with an acute course. [11]

For plantar fasciitis, dexamethasone iontophoresis may accelerate pain relief in the early stages compared to placebo and some conservative treatments, but long-term benefits over exercise programs and shoe interventions are limited. In newer studies, short-term effects are often inferior to shockwave therapy, so iontophoresis is considered an adjunctive component rather than a stand-alone solution. [12]

Chronic wounds

Review publications and professional society reports describe the potential of microcurrents and low-intensity currents to accelerate healing and reduce pain in "difficult-to-heal" lower extremity ulcers. However, the 2023 edition of the formal diabetic foot guidelines does not recommend physical therapy, including electrical stimulation, as a means of improving healing outside of clinical trials. Solutions for other types of chronic wounds remain individualized and depend on local protocols. [13]

Neurology and Psychiatry: An Important Distinction

Transcranial direct current stimulation is a separate discipline, applied according to specific protocols under the supervision of specialists. For depression and some neurological conditions, the general evidence indicates moderate benefits and good tolerability, but it is not a "cosmetic" galvanization or a home treatment. It is inappropriate to include it as a home treatment option in general galvanotherapy literature. [14]

Contraindications and safety

Absolute contraindications for iontophoresis include the presence of a pacemaker or other implantable electronic devices. The procedure is not recommended during pregnancy due to a lack of safety data. Jewelry should be removed, and the passage of current through large metal implants should be avoided; suitability is discussed on an individual basis, taking into account the location. [15]

Common side effects include tingling, skin irritation, microbubbles, and dryness under the electrodes; at too high a current density, superficial burns are possible. Risks are minimized by careful skin preparation, the use of adequately moistened pads, monitoring the total charge, and strict adherence to the protocol. In cases of skin hypersensitivity, cracks, or dermatitis in the contact area, the procedure is postponed. [16]

How is the procedure performed and what doses are used?

Standard iontophoresis for hyperhidrosis: 20-30 minute sessions, 2-3 times a week for 3-4 weeks, followed by "maintenance" sessions every 7-30 days. The current is increased to a subjectively tolerable level, and the polarity is periodically reversed to prevent irritation. The effect is reversible and requires regular maintenance. [17]

Medicinal iontophoresis for pain syndromes is typically calculated based on the total charge per session. Studies have used a range of 40-80 mA min; for dexamethasone phosphate, concentrations ranging from low concentrations closer to 0.4% to higher concentrations around 4% have been described, depending on the device and protocol. The decision on the drug and parameters is made by the treating physician, taking into account the diagnosis and concomitant therapy. [18]

Table 1. Terms and methods of electrotherapy: what relates to direct current

A brief summary of the classification; an explanation is given before the table. The data are summarized from modern reviews and guidelines. [19]

Method	Current type	Target	Where it is applied
Skin galvanization	Constant	Trophic, analgesic, anti-edematous effect	Rehabilitation, cosmetology
Iontophoresis of drugs	Constant	Transdermal ion delivery	Tendinopathy, fasciitis, local inflammation
Iontophoresis for hyperhidrosis	Constant	Temporary blockade of sweat secretion	Palms, feet, armpits, face
Microcurrent stimulation	Low intensity constants	Wounds, pain	Chronic ulcers, postoperative wounds
Transcranial direct current stimulation	Constant	Neuromodulation	Depression, neurorehabilitation

Table 2. Indications and strength of evidence

Rating based on the nature of recommendations and the quality of research; wording is simplified for the reader. [20]

Indication	The role of direct current	Quality of evidence
Primary palmoplantar hyperhidrosis	First line in home and clinical regimens	Moderate, with real practical benefits
Achilles tendinopathy, acute stage	Exercise supplement, short effect	Limited, recommendations allow
Plantar fasciitis	Adjunctive for early pain relief	Limited, mostly short-term
Chronic wounds, non-diabetic foot	Adjuvant according to local protocols	Variable, depends on the current mode
Diabetic foot	Not recommended	Negative recommendation of the relevant regulations

Table 3. Contraindications and precautions

Based on specialized dermatological materials and clinical guidelines. [21]

Category	Points
Absolute	Pacemaker and other implantable electronic devices
Relative	Metal implants along the current path, active dermatoses in the contact zone, pronounced skin cracks
Special situations	Pregnancy - generally avoided; breastfeeding is acceptable for water iontophoresis
Preparation	Removing jewelry, moistening pads, checking the integrity of the skin

Table 4. Iontophoresis parameters: dosing guidelines

Ranges are based on clinical reviews and studies; selection of parameters is made by a specialist. [22]

Parameter	Landmark
Total session charge	About 40-80 mA min
Session duration	15-30 minutes, as tolerated
Frequency at induction	2-3 times a week for 3-4 weeks
Maintenance	From 1 time per week to 1 time per month
Example of a solution	Dexamethasone phosphate aqueous in concentrations from 0.4% to 4% according to research data

Table 5. Side effects and their prevention

Frequency and severity are usually low when technique and dosage are followed. [23]

Adverse event	What to do
Tingling, burning sensation	Reduce current, check electrode moisture
Irritation, erythema	Reduce the duration, change the polarity, use protective gels
Dryness, hyperkeratosis	Reduce the frequency of maintenance sessions, use emollients
Microburns	Review the current density and eliminate damage to the gaskets.

Table 6. Comparison with alternatives for pain syndromes

The assessment is based on current clinical literature and research on plantar fasciitis and Achilles tendinopathy. [24]

Method	Pros	Cons	Where appropriate
Dexamethasone iontophoresis	Early pain relief, local action	The effect is short-term and requires equipment and courses.	Acute phase as a supplement to exercise
Shock wave therapy	Significant short-term effect in fasciitis	More expensive, unpleasant sensations	Moderate plantar fasciitis
Load therapy	Basic component, improves function	It takes time and discipline.	All stages of tendinopathies

Table 7. Iontophoresis for hyperhidrosis: schedule and expectations

Based on materials from the specialized dermatological society. [25]

Stage	What to do	What to expect
Induction	2-3 sessions per week for 3-4 weeks	Decreased sweating by the end of the course
Transition	Gradually increase the intervals	Maintaining the effect if you follow the regimen
Support	Once every 7-30 days	Stable symptom control
In case of relapse	Return to induction for 1-2 weeks	Repeated suppression of secretion

Practical advice for patients

The method and parameters are selected by a specialist, based on the diagnosis and associated risk factors. For home treatments, it is essential to strictly follow the device instructions, not exceed the recommended current, avoid treatments on damaged skin, and always remove metal objects from the area being treated. If pain, severe burning, or persistent irritation occurs, discontinue treatments and consult a doctor. [26]

In musculoskeletal pain, the key to sustainable results is not the device itself, but a program of exercise therapy, correction of overload factors, and maintenance of activity. Electrophoresis in such scenarios should be considered a supportive tool for early symptom control, with an understanding of the limited long-term benefits. [27]

Conclusion

Galvanotherapy is an umbrella term for direct current-based techniques. The most mature and predictable application is aqueous iontophoresis for primary hyperhidrosis. In musculoskeletal practice, drug iontophoresis can be helpful in the acute phase of certain conditions as part of a comprehensive program. In the treatment of chronic wounds, the role of electrotherapy depends on the nosology and current regimen; in diabetic foot, specialist recommendations advise against it. Decisions are made individually, taking into account contraindications and safety priorities. [28]