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Phonophoresis Description Use of therapeutic ultrasound to assist in diffusion of medication through the skin Increases the diameter of skin portals to allow the medication to pass Pores Hair follicles Sweat glands © 2005 – FA Davis Biophysical Effects Medication is introduced over a large area Relative to an injection Noninvasive Medication may not be filtered by the liver Reducing metabolic elimination of the medicine © 2005 – FA Davis Transdermal Application Medication must diffuse through: Enzymatic barrier of the epidermis Stratum corneum Rate-limiting barrier to absorption Medications must be able to diffuse across this barrier Medication is stored in subcutaneous tissues for some time before being diffused deeper © 2005 – FA Davis Skin Influences Medication uptake is improved when the skin is: Well hydrated Has a high density of skin portals Highly vascularized Relatively thin “Younger” skin tends to have better diffusion characteristics than “older” skin. © 2005 – FA Davis Ultrasound Influences on Diffusion Thermal Effects Increase kinetic energy Increase portal cross-section Increase circulation Increase capillary permeability Nonthermal Effects Altered cell resting potential Increased cell membrane permeability Increased molecular permeability © 2005 – FA Davis Phonophoresis Medications Either prescription or nonprescription Low molecular size and weight Most medications used can be applied transdermally without ultrasound Controlled medications require a prescription for the patient being treated Medication is often mixed in an inert base Base must be able to transmit ultrasonic energy © 2005 – FA Davis Common Medications Type Corticosteroid Indications Inflammation Salicylates Inflammation Pain Pain Trigger points Anesthetic © 2005 – FA Davis Example Hydrocortisone Dexamethasone Lidocaine Application Tips Moist heat pack prior to application: Increase blood flow Increase kinetic energy Increase skin portals Following treatment Leave medication on skin Cover with an occlusive dressing Moist heat pack re-application may assist in further absorption © 2005 – FA Davis Low-frequency US Phonophoresis Parameters: 20 kHz output frequency 125 mW/cm2 Pulsed output Benefits: Allows medications with a larger size and weight to diffuse More efficient medication delivery © 2005 – FA Davis