The Challenge in Combining Pelotherapy and Electrotherapy (Iontophoresis) in One Single Therapeutic Modality

Abstract

Pelotherapy and electrotherapy are therapeutic methodologies with proven success in physical medicine and rehabilitation (PMR) and dermatology fields. The main purpose of these therapeutic modalities is to reduce pain, accelerate wound healing, alleviate muscle spasms, and improve mobility, and muscle tone. Their main challenge is in the passage of some ionic species through the skin barrier. The use of drugs, such as diclofenac, corticosteroids or steroids, has gained widespread efficacy recognition in physical therapy and the therapeutic action of these drugs is widely studied in experimental and clinical trials. Unlike pharmaceutical and cosmetic clays, peloids are not subject to any prior quality control or subject to any specific European regulation. The dermal absorption values are an integral part of the risk assessment process for peloids. This work explores the converging points between these two transdermal drug delivery systems (TDDS) and the presentation of methodologies to achieve peloid safety compliance, especially concerning the potential and degree of toxicity arising from ion exchange and trace elements. TDDS is applied to the pharmaceuticals industry and drug is the generic term for the active substances released into skin tissues. The transdermal delivery of drugs or clay components with therapeutic properties is limited due to the excellent barrier function of the stratum corneum. The transdermal drug delivery of pelotherapy is enhanced by temperature and electrically by iontophoresis. The low voltage of iontophoresis and sweat phenomena with pore dilation driven by pelotherapy allows the use of the same pathways: hair follicles and sweat pore. The therapeutic integration of iontophoresis and pelotherapy focused on patient benefits and low safety-related risk may contribute to the outstanding physiological performance of pelotherapy, specifically, in the way the essential elements and exchange cations pass through the skin barrier. The validation of an innovative iontophoretic systems applied to pelotherapy can also promote future challenges in the obtaining of the ideal therapeutic control of peloids and the clinical validation of results with physiological efficacy recognition.

Iontophoresis in dermal delivery: A review of applications in dermato‐cosmetic and aesthetic sciences

“…Finally, in 2022, Bastos et al speculated about the combination of pelotherapy and iontophoresis and how to overcome the inherent challenges in order to benefit from the individual merits of the two approaches [83].…”

“…Finally, in 2022, Bastos et al speculated about the combination of pelotherapy and iontophoresis and how to overcome the inherent challenges in order to benefit from the individual merits of the two approaches [83]. According to the authors, the delivery of clays through the skin could be enhanced by iontophoresis, as well as by temperature.…”

“…The authors also suggested that the combination of pelotherapy and iontophoresis could be further enhanced by temperature, ideally 40–45°C, and referred to a device and a skin electrode, currently awaiting approval for clinical use, designed specifically to store and heat the peloid. Such therapeutic integration would open up many possibilities in medical, but also cosmetic applications, including acne management [83].…”

“…Based on the need for topical use of sildenafil to avoid side effects, but also on the need to increase skin permeability, the authors suggest that iontophoresis could be considered as an auxiliary method to increase the local drug concentration [88]. Finally, the combination of pelotherapy and iontophoresis, as recently discussed by Bastos et al, would also be useful for cosmetic body treatments, because clays are used to combat lipodystrophies and cellulite [83].…”