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The Impact Electrotherapy has on skin cells and the function it has as a delivery system.
Electrotherapy is a general term for the use of electric current to stimulate tissue healing and restore function. As many processes in the human body rely on electrochemical mechanisms, electrotherapeutic techniques complement what the biological system is already doing. In the cosmetic industry, electrotherapy involves a range of devices that use low-level electric currents passed through the skin to produce several therapeutic effects. Some devices include microdermabrasion, galvanic desincrustation, galvanic iontophoresis, micro-current, sonophoresis, ultrasound and direct high frequency to name a few. Specialised facials incorporating these modalities offer a safe method of treatment for effectively working active ingredients into the deeper layers of the dermis that cannot be reached with a basic facial. Currently, electrotherapy is widely used in the clinical and spa setting by estheticians and beauty therapists as it has proven results in skin rejuvenation, skin refining, improving overall tone and texture, as well as stimulating the production of new skin cells, regenerating collagen and elastin, essentially reversing signs of aging.
When implemented correctly, electrotherapy effectively manipulates the structure of a cell to increase transdermal delivery. The surface charge density of a typical cell is negative. Long chain glycoprotein structures extending beyond the cell’s plasma membrane, contribute to the negative surface charge as well as glycolipids, phosphoglycerides, and phospholipids. Phospholipids are known as one of the key components of the cell membrane consisting of charged polar heads and nonpolar tails that have no charge. Phospholipids are amphipathic and allow only small, uncharged particles to move through the cell membrane such as oxygen and carbon dioxide. In order to allow substances to permeate through the stratum corneum, disruption of the phospholipid bilayer must occur. Considering the cell as an electrically conductive and responsive unit, made up of a variety of molecules that are involved in ion and electron transport; it is no surprise that electrotherapy has the ability to influence cell function, shape, polarity and growth. Exogenous electric currents, provided by electrotherapeutic devices can move or stimulate cell membrane receptors, have an effect on membrane ion channel characteristics and can significantly influence the cell structure as well as movement across the membrane, cellular metabolism, replication, differentiation, and proliferation. As ions form, accumulate, move, and bond with other substances in the cellular environment, these ionic processes can influence many local electrical transport transfer mechanisms in cells (O'Clock, 2007).
The delivery of galvanic current works by attaching a passive electrode to the client whilst the esthetician works over the skin with the active electrode. The active electrode delivers a negative electrical charge causing hydrogen to be released which reacts with the sodium solution on the skin. Sodium and hydrogen convert to form sodium hydroxide that reacts with the sebum in the skin causing a soaping activity known as saponification, making extractions easy. The other effect of this galvanic desincrustation process is proteolysis which is the breakdown of protein, whereby excess keratin is broken down resulting in increased desquamation, thus stimulating the regeneration of new cells, resulting in improved appearance, tone, and texture. The skin is left in an unsafe, alkaline state following desincrustation, therefore it is important that the therapist switches the current over to the positive pole. When using the active positive pole, oxygen is released as well as a small amount of hydrochloric acid which balances the pH, restoring the acid mantle.
Galvanic current on the positive pole is known as Iontophoresis. Iontophoresis utilises a small amount of direct electric current to push the products into the skin. It has a calming, soothing and vasoconstrictive effect on the skin, restores critical moisture, regenerates the epidermis and improves skin vitality making ideal for aging skin (The International Dermal Institute, n.d). Iontophoresis can work alone or in conjunction with another electric enhancement technique known as electroporation. Electroporation is the term used to describe a microbiology technique in which an electrical field is applied to cells in order to increase the permeability of their membrane. Electroporation enhances transdermal transport in three ways; diffusion, electrophoresis, and electro-osmosis. This technique involves the application of a high voltage pulse for a very short duration where cells are exposed to a brief electrical pulse that opens new pores in the skin, allowing DNA or other macromolecules to enter the cell. Electroporation leads to a reversible increase in permeability of the lipid bilayer and possibly involves the creation of aqueous pores during the application of an electric pulse (Prausnitz et al., 1993. The use of electroporation in conjunction with iontophoresis can expand the scope of transdermal delivery to larger molecules such as therapeutic proteins and oligonucleotides. While iontophoresis acts primarily on the product, electroporation acts on the skin with some driving force on the product during a pulse (Prausnitz et al., 1993). The application of a single pulse prior to iontophoresis increased the flux by 5–10 times over that achieved by iontophoresis alone (Bommannan et al., 1994).
Sonophoresis implies the transport of molecules under the influence of ultrasound. Products are delivered from a coupling agent which transfers ultrasonic energy from the ultrasonic device to the skin. The enhancement of transdermal delivery in this instance is presumably a result of the thermal, mechanical and chemical alterations in the skin induced by ultrasonic waves (Nyborg, 2006). Cavitation occurs in the keratinocytes of the stratum corneum upon ultrasound exposure and the oscillations of the cavitation bubbles possibly enhance transdermal transport by inducing disorder in the stratum corneum lipids (Banga, 1998). It has been suggested that low frequency ultrasound can even transdermally deliver therapeutic doses of proteins such as insulin, interferon and erythropoietin (Mitragotri et al., 1995). Iontophoresis or sonophoresis can be applied following microdermabrasion for accelerated anti-ageing results because the effects of microdermabrasion leave the skin more permeable to the penetration of products. Microdermabrasion also triggers a healing response that occurs naturally when the skin is traumatised. The healing response triggers the epidermis to regenerate itself at a faster rate, ultimately renewing the otter most layer revealing a more youthful complexion.
Despite the positive benefits and fabulous results of using electrotherapy, there are some precautions and several contraindications to be aware of. Loss of tactile sensation is an important contraindication to be considered when utilising electrotherapy as there is the risk of burning the client. It is imperative that a tactile sensation test is carried out prior to commencing treatment to ensure the client can detect sensations of pain and pressure to avoid injury/burns. Skins with infection, irritation, active acne, rosacea or any barrier issues are typically contraindicated to procedures, particularly microdermabrasion because it is likely to cause further irritation, spreading or bleeding. Pregnancy is a contraindication to all electrotherapy treatments. While it may be arguably safe to proceed in some instances and there is little evidence to prove that electrotherapy effects foetal development, exogenous current and muscle stimulation could possibly lead to miscarriage or premature labor. The presence of excess metal fillings or any metal pins or plates in the face or body can restrict or prevent treatment for the obvious reason that metal conducts electricity.
Prior to electrotherapy treatment, a written consultation that complies with industry standards is required and to be signed by both the therapist and client. It is the responsibility of the therapist to ensure they are working within their scope of practice at all times and that all workplace health and safety policies and procedures are adhered to. With a professional and thorough consultation, even the most sensitive skin is likely to be able to receive the therapeutic effects and benefits of an electrical facial. With adequate knowledge of the various modalities available, the therapist can make an informed decision as to the appropriate device to select depending on the client’s concerns and skin condition. Knowing the electrical properties and characteristics of biological systems can help us to further understand biochemistry, biophysics, genetics, molecular biology, cell biology, anatomy, physiology, neurology, sensory systems, pulmonary and cardiovascular systems, endocrinology, reproduction, microbiology, and immunology in a more complete and complementary manner (O'Clock, 2007). Using appropriate treatment protocols, electrotherapy is known to provide excellent therapeutic efficacy, with minimal patient discomfort, minimal side effects, and consistent results with repeat treatment (O'Clock, 2007). The overall impact on the skin by applying the use of electricity is remarkable and the popularity of such treatments in the cosmetic industry is understandable.