The procedure of phonophoresis with hydrocortisone, what is it?

What is hydrocortisone?

Hydrocortisone is a hormone produced by the adrenal glands. In medical practice, its natural concentrate or acetate is used. The use of phonophoresis in combination with a drug is a fairly common practice. Hydrocortisone-based products have anti-inflammatory, antiallergic, immunosuppressive, antipruritic, antishock, antiexudative, and glucocorticoid effects.

Under the influence of ultrasound, the medicine penetrates into tissues much faster and deeper than what happens with cutaneous applications. With standard use, for example, applying the drug externally to a sore spot, it is impossible to provide an intense effect. It is in combination with physiotherapy that the best effect is achieved, thanks to the combination of physical effects and the properties of the drug, which is why the phonophoresis procedure became widespread many years ago. Although there are also disadvantages.

Therapeutic effect of hydrocortisone

In terms of its composition, it is a hormonal drug. Like any hormonal drug, it requires strict adherence to the instructions and is prescribed by a doctor only when indicated. The scope of application of hydrocortisone is quite wide. It is used in the following cases:

• inflammatory and autoimmune joint pathologies - arthritis and arthrosis;
• respiratory diseases - sinusitis, allergic rhinitis, chronic tonsillitis;
• scars and scars - especially after burns and extensive operations;
• enuresis - bedwetting in children;
• chronic gastritis;
• autoimmune progressive Sjögren's disease;
• dermatological diseases - eczema and neurodermatitis;
• trophic ulcers;
• spurs on the heels;
• fracture of a tubular bone (during the period of fusion);
• malnutrition and muscle atrophy;
• one of the forms of mastitis;
• inflammatory uterine process;
• chronic prostatitis;
• adhesions in the pelvic organs in women, provoked by the inflammatory process due to sexually transmitted infections.

GLUCOCORTICOID DRUGS

Toolkit

Procedure

The sensor for physiotherapy is similar to that used for ultrasound diagnostics. The only difference will be that the conductor for ultrasound is not a gel, but an ointment based on hydrocortisone. The stages of the session are no different:

• disinfection of the skin area that will be affected;
• applying hydrocortisone ointment and distributing it evenly;
• exposure to ultrasound of a certain power within different frequencies.

This approach ensures rapid penetration of hydrocortisone into tissues. And alternating different frequencies gives good results in the long term, despite the short duration of the session. After completing the phonophoresis procedure with hydrocortisone, you should not remove the ointment from the body for another 2-3 hours. To obtain a positive effect, a course of 10–14 daily procedures is required. Please note that re-treatment is possible no earlier than after 3-5 months.

Mechanism of action

Transport of any drug through the skin is limited by its ability to penetrate the epidermis (top layer of skin) and dermis (deep layer). The easiest and surest route is through the sebaceous glands and hair follicles, so warming the skin before the procedure significantly increases the rate and percentage of drug transfer.

Warming up immediately after phonophoresis significantly increases the time of absorption of hydrocortisone by the body’s vascular system. Sensors and devices used in physical therapy have many modes of operation at different frequencies and intensities. When choosing a device, the doctor focuses on solving the main problem without damaging the skin. And only then, he sets the pace and frequency of the impact, taking into account the patient’s sensations and the characteristics of his body, excluding contraindications and pathologies.

Side effect

Hyperemia, swelling and itching in areas where the ointment is applied. With long-term use, it is also possible to develop secondary infectious skin lesions, atrophic changes in the skin, and hypertrichosis. With prolonged use of the ointment or the use of an occlusive dressing, especially in large areas of the lesion, the development of symptoms of hypercortisolism (hyperglycemia, glucosuria, reversible inhibition of adrenal cortex function, manifestation of Itsenko-Cushing syndrome), as a manifestation of the resorptive effect of hydrocortisone, is possible.

Overdose

Acute overdose is unlikely, however, with excessive or prolonged use of the drug, chronic overdose is possible, accompanied by signs of hypercortisolism: hyperglycemia, glycosuria, reversible inhibition of adrenal function, manifestation of Itsenko-Cushing syndrome.

Treatment. Appropriate symptomatic treatment is indicated. In case of chronic toxic effects, gradual withdrawal of the drug is recommended.

Advantages of phonophoresis

Based on most clinical pictures, it is noted that physiotherapy has a positive effect on the dynamics of treatment, thus, the patient’s rehabilitation and recovery are many times faster. This happens for a number of reasons:

1. ultrasound promotes accelerated and deep penetration of medicinal substances into the skin and tissues, targeting the affected area;
2. there is no need to endure painful procedures and expose the body to stress;
3. affordable session cost and ease of use.

You need to know that phonophoresis will not give instant results. It will take several sessions to notice the effect of use. The medicine must accumulate in the skin within 5–7 days and reach the required therapeutic value. However, being developed quite a long time ago and being an old-generation drug, hydrocortisone has a number of serious contraindications.

Directions for use and doses

Externally. The ointment is applied in a thin layer to the affected areas of the skin 2 - 3 times a day. The duration of treatment depends on the nature of the disease and the effectiveness of therapy, usually ranging from 6 to 14 days; if the disease persists, it can be extended to 20 days. On limited lesions, occlusive dressings can be used to enhance the effect. When using the ointment in children aged 2 years and older, the total duration of treatment should be limited to no more than two weeks and measures leading to increased absorption of hydrocortisone (warming, fixing and occlusive dressings) should be excluded.

Contraindications to the use of phonophoresis with hydrocortisone

• it is forbidden to carry out during pregnancy, because ultrasound and hormonal drugs have a negative effect on the formation of the fetus and the woman’s well-being in general;
• Oncological diseases at different stages, even during remission, are grounds for refusal to take a course of physiotherapy. This is based on excessive stimulation of cancer cells;
• cardiovascular diseases, including supraventricular tachycardia and atrial fibrillation are a contraindication to the use of phonophoresis;
• inflammation of the skin and mucous membranes at the sites of exposure to the device can provoke an exacerbation of diseases;

But the main contraindication in some cases remains hydrocortisone itself, which is a hormonal drug, with all the ensuing consequences and complications for patients. It is not recommended for children under two years of age, as well as for patients who have:

1. individual hypersensitivity to the components of the drug;
2. recent vaccination;
3. damage to the skin in the affected area;
4. bacterial and viral eye diseases;
5. dermatitis of various forms;
6. acne and blackheads.

Carefully:

• pregnancy and lactation;
• tuberculosis;
• diabetes;
• arterial hypertension;
• diverticulitis and osteoporosis;
• postoperative period in the acute phase;
• fungal diseases;
• acute endocarditis and nephritis;
• renal failure;
• tendency to form blood clots;
• herpetic fever;
• AIDS and HIV infection;
• myasthenia gravis.

In addition, the following adverse reactions to phonophoresis with hydrocortisone may be observed, even when performing the procedure at home:

1. Endocrine system - hyperglycemia, increasing the required dose of insulin, renal failure, obesity due to excess hormones, growth retardation.
2. Musculoskeletal system - osteoporosis, vertebral fractures, aseptic necrosis, arthropathy, steroid myopathy, arthralgia.
3. Gastrointestinal tract - intestinal perforation, bleeding in the stomach, ulcers, dyspepsia, pancreatitis.
4. Skin - wound healing worsens, allergic reactions appear and skin color changes.
5. Central nervous system and visual organs - mental disorders, intracranial pressure, glaucoma and cataracts.

special instructions

In cases of use of the drug in children, on the face area under occlusive dressings, the duration of the course of treatment should be reduced to two weeks. In childhood, suppression of adrenal function may develop more quickly. In addition, a decrease in the secretion of growth hormone somatropin may be observed. For children from 2 to 12 years of age, the drug should be used only after consultation with a doctor and then under medical supervision.

Avoid contact of the ointment with the eyes and mucous membranes.

If after 7 days of use there is no improvement or worsening of the condition, the use of the drug should be stopped and consult a doctor. If symptoms recur a few days after stopping the drug, you should consult your doctor.

For long-term treatment and/or application to large surfaces, it is recommended to prescribe a diet with limited sodium and high potassium content; introduce a sufficient amount of protein into the body. It is necessary to monitor blood pressure, blood glucose, blood clotting, diuresis, the patient’s body weight, and plasma cortisol concentration.

To prevent infectious lesions, the drug is recommended to be prescribed in combination with antibacterial and antifungal agents.

Impact on the ability to drive vehicles and operate machinery

During treatment with the drug, caution should be exercised when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Interaction with other drugs

Barbiturates, antiepileptics and antihistamines reduce effectiveness.

Paracetamol promotes the development of hepatotoxicity.

Reduces the activity of salicylates and hypoglycemic agents, and increases the activity of anticoagulants.

Cardiac glycosides and non-potassium-sparing diuretics increase hypokalemia, anabolic steroids increase tissue hydrophilicity.

When combined with amphotericin B, the development of dilated myocardial damage and heart failure is possible.