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Iontophoresis with acetic acid

So, recently I found this article - https://www.ncbi.nlm.nih.gov/pubmed/24373451, and as I work in Hand surgery unit and I like to try this method. The problem is how to prepare 5% acetic acid solution. So, my question is what you use for acetic acid iontophoresis - regular vinegar (which is 6% in Bulgaria) or you prepare the solution with destilled water? I have 100% acetic acid but as far as I know the solution should be based not on volumetric measures (e.g mililiters), but on mols... Thank you in advance.

Georgi Petrov

11 months ago

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gvpetrov223
gvpetrov223

Wendy, can you imagine the smell of a bath full of acetic acid..:)) Though I like pickles, it's still too much for me. And here --> https://www.researchgate.net/publication/305317105_A_Review_on_Ultrasound_Parameters_and_Methods_of_Application_in_Transdermal_Drug_Delivery is a review of the US parameters for transdermal drug delivery, which I find interesting. Anyway, some updates about the iontophoresis - I try it on two patients. The first is 8 months after nasty conquasation of the fingers of the hand. 3rd 4th and 5th proximal phalanges had comminuted fractures, reduced with ORIF, but probable because of the extensive soft tissue trauma there is a lot of internal scarring and the fingers are extremely stiff. With two weeks of acetic acid iontophoresis, together with long periods of splinting there is qute big increase of the passive ROM. Since the fracture was in the zone 2 of the flexor tendons and there was also a big cut on the palmar skin, we beleive that for active motion this patient will need extensive tenolysis. Will see. The other patient had some small bone spur in the PIP joint of the 5th finger, after a trivial sprain 2 and a half months ago. His improvement is that the feeling of compression in the joint, while flexing dissapeared and he started to feel the restriction of the sticked extensor aparatus on the dorsal side of the finger. The ROM also increased. After some more time we'll check for the bone spur with US sonography. Hopefully he will be good without surgery. That's it for now. If anyone is interested I will report what is happening after some more time. Happy new year!

wendy226
wendy226

Phonophoresis would involve submerging the patient's hand into a small bath containing the weak acetic acid and ultrasounding effectively under water - so no need for gel etc. I would use 3MHz at 0.25w/sq cm. Are there any thoughts on what frequencies and intensities work better than others in this situation? We still use this technique with ordinary water to ultrasound hands anyway ie areas where the ultrasound head is too large for the body area we want to treat. interestingly, we have a patient on treatment at the moment who has just had both hands operated on for Dupytrens and while we are getting good results with US and IFT etc, I was fascinated to understand what the rationale and evidence is for using acetic acid as this is not mentioned in the research paper. Has anyone tried any other solution?

gvpetrov223
gvpetrov223

I made a solution - 95 ml distilled water and 5 ml acetic acid. Tried it on me - no adverse effects. It just smells kind of unpleasant. Cliff, when acetic acid, CH3COOH, is added to water, it will ionize to form the acetate anion, CH3COO− . I also spoke to a chemistry engineer and he told me that this kind of making the solution is good enough and safe. Wendy, how to do it with phonophoresis? The solution is liquid....

wendy226
wendy226

i wonder why the research was done with iontophoresis and not phon phoresis as this would be a far easier technique. the last time I did any of either technique was more than 40 years ago. Amazing how techniques go round and then come back again!

Cliff Eaton
Cliff Eaton

Dear Georgi As a Physio I do not have full prescription rights so I do not administer Iontophoresis. However, my understanding is that you require negstively charged Acetic Acid placed under the negative electrode of your machine in order to drive it into the tissue. Hence why I do not think the acetic acid you have purchased, however, mixed (3-5% in the lierature) will work As the Prof suggests you are better to discuss this with your pharmacist Cliff

gvpetrov223
gvpetrov223

Unfortunatelly, prof Ronzio, that is not the case in my country and that is why I ask. Here, I bought from a industrial chemistry shop a liter of 100% acetic acid. But does 95 ml distilled water + 5 ml pure acetic acid makes 5% solution? Anyway here is what I found http://screening.iarc.fr/viaviliappendix5.php

Last updated 11 months ago

Prof Oscar Ronzio
Prof Oscar Ronzio

Dear Georgi. In most of the countries you can go to the pharmacy and ask the drug and the concentration that you want. This is an easy formula but in general the excipients are also very important. Best Oscar

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