Gangarosa L P, Ozawa A, Ohkido M, Shimomura Y, Hill J M
Department of Oral Biology-Pharmacology, School of Dentistry, Medical College of Georgia, Augusta 30912-1128, USA.
J Dermatol. 1995 Nov;22(11):865-75. doi: 10.1111/j.1346-8138.1995.tb03937.x.
Iontophoresis is the process of introducing ionic drugs into the body for therapeutic purposes. Although iontophoresis has the potential for systemic therapy, it has mainly been used for local therapy at body surfaces. Many ionic drugs are available including lidocaine, epinephrine, methylprednisolone succinate, dexamethasone phosphate, several antivirals, various antibiotics, and other specific drugs. The use of an indicated ionic drug by iontophoresis offers a broad potential for promoting the development of more effective therapies in dermatology. Iontophoresis of ionized drugs provided a 20-60 fold increase in penetration over topical application. Iontophoresis for dermatological use requires that: a) a charged drug be placed at an electrode having a polarity the same charge as the drug, b) the condition or disease under treatment be at or near the body surface, and c) a modern, sophisticated source of direct current, with appropriate accessories, be used. The current source must have features that make it not only effective, but also safe for application to the patient. Modern systems for application of drugs by iontophoresis have features that make the process simple and efficient for use in practice. Iontophoresis has a long history of use, having been suggested for various therapies for many years in medicine, physical therapy and dentistry. Pilocarpine iontophoresis is a preferred method for cystic fibrosis detection. Also, lidocaine iontophoresis has been advocated to anesthetize the tympanic membrane before myringotomy. Anesthesia of the skin to a depth of 1.0 cm or more has been reported in double-blind studies of human volunteers. Local anesthesia by iontophoresis was reported to be effective for: 1) cutaneous cutdowns in patients requiring kidney dialysis, 2) delicate eyelid surgery, as the sole anesthetic, 3) preinjection topical anesthesia, and 4) shave biopsies of skin lesions. The use of iontophoresis for treating difficult cases of hyperhydrosis is quite popular among dermatologists. The present report emphasizes uses of iontophoresis in dermatology and is divided into discussion of studies using iontophoresis for postherpetic neuralgia, local anesthesia, antiviral therapy, and for corticosteroid therapy of nonspecific inflammatory lesions. Over 1250 patients have been treated for postherpetic neuralgia by corticosteroid iontophoresis at 6 medical centers with 60-80% of patients showing a major therapeutic response with return to a tolerable pain level. Double-blind studies of varicella zoster (active and postherpetic) and herpes simplex have proven that iontophoresis is a valuable modality for treating viral diseases of the skin. Many other uses for iontophoresis have been proposed in the literature that involve several hundred research papers, several textbooks and many book chapters. Review of the literature supports the concept that iontophoresis provides an optimal method for drug application in therapy of surface tissues.
离子导入法是将离子型药物引入体内用于治疗目的的过程。尽管离子导入法有进行全身治疗的潜力，但它主要用于体表的局部治疗。有许多离子型药物可供使用，包括利多卡因、肾上腺素、琥珀酸甲泼尼龙、地塞米松磷酸钠、几种抗病毒药物、各种抗生素以及其他特定药物。通过离子导入法使用特定的离子型药物为促进皮肤科更有效治疗方法的发展提供了广阔的潜力。与局部应用相比，离子化药物的离子导入法使渗透率提高了20至60倍。皮肤科用离子导入法要求：a）将带电荷的药物置于与药物电荷极性相同的电极处；b）所治疗的病症或疾病位于体表或靠近体表；c）使用配备适当附件的现代、精密的直流电源。电流源必须具有使其不仅有效而且对患者应用安全的特性。现代的离子导入法给药系统具有使该过程在实际应用中简单高效的特性。离子导入法有着悠久的使用历史，在医学、物理治疗和牙科领域，多年来一直被用于各种治疗。毛果芸香碱离子导入法是检测囊性纤维化的首选方法。此外，利多卡因离子导入法已被提倡用于在鼓膜切开术前麻醉鼓膜。在对人类志愿者的双盲研究中，已报道皮肤麻醉深度可达1.0厘米或更深。据报道，离子导入法局部麻醉对以下情况有效：1）需要进行肾脏透析的患者的皮肤切开术；2）精细的眼睑手术，作为唯一的麻醉方法；3）注射前局部麻醉；4）皮肤病变的剃刀活检。离子导入法用于治疗多汗症的疑难病例在皮肤科医生中相当普遍。本报告重点介绍离子导入法在皮肤科的应用，并分为使用离子导入法治疗带状疱疹后神经痛、局部麻醉、抗病毒治疗以及非特异性炎性病变的皮质类固醇治疗的研究讨论。在6个医疗中心，已有超过1250名患者接受了皮质类固醇离子导入法治疗带状疱疹后神经痛，60%至80%的患者显示出主要治疗反应，疼痛恢复到可耐受水平。对水痘带状疱疹（活动期和带状疱疹后）和单纯疱疹的双盲研究已证明，离子导入法是治疗皮肤病毒性疾病的一种有价值的方法。文献中还提出了离子导入法的许多其他用途，涉及数百篇研究论文、几本教科书和许多书籍章节。对文献的综述支持了这样一种观点，即离子导入法为表面组织治疗中的药物应用提供了一种最佳方法。
