Sonophoresis also known as phonophoresis, is a method that utilizes ultrasound to enhance the delivery of topical medications through the stratum corneum, to the epidermis and dermis. Sonophoresis allows for the enhancement of the permeability of the skin along with other modalities, such as iontophoresis, to deliver drugs with lesser side effects. Currently, sonophoresis is used widely in transdermal drug delivery, but has potential applications in other sectors of drug delivery, such as the delivery of drugs to the eye and brain.
Historical advancements Sonophoresis, also known as phonophoresis, was dated back all the way to the 1950s in its first mention in a published report. This report showcased that a hydrocodone injection yielded better outcomes for bursitis when combined with an ultrasound massage. Following this, a series of publications from several investigators showed the increased therapeutic effect when combining ultrasound with hydrocortisone injections for various other disease states, further demonstrating the novelty of sonophoresis. However, while some researchers provided evidence that ultrasound had a positive effect on the transdermal permeation of drugs, others contradicted this information by displaying research that showed no quantitative effect using ultrasound. These early studies mainly investigated the combination of therapeutics with high-frequency sonophoresis (HFS), which can be categorized into frequencies greater than 0.7 MHz. High frequency sonophoresis usually includes a range between 0.7 – 16 MHz. Studies evolved and HFS was continually studied for four decades until a greater understanding of a mechanism of action, cavitation, was discovered. Cavitational effects are inversely proportional to the frequency of the ultrasound applied, which led to further studies of low-frequency sonophoresis (LFS) for use in transdermal drug delivery due to studies showing greater efficacy in enhancing skin permeability in comparison to HFS. Low-frequency sonophoresis usually includes a range between 20 and 100 kHz. For this reason, currently HFS focuses on topical applications for penetration through the stratum corneum, whereas LFS focuses on transdermal drug delivery applications.
Background Ultrasonic sonicators generate ultrasound waves, which is a longitudinal compression wave, by converting electrical energy into mechanical energy by deformation of piezoelectric crystals in response to an electric field. The frequency of the waves generated by this method can range from 20 kHz up to 3 MHz. The ultrasound waves generated from this device allow for penetration through biological tissue by molecular oscillation of the biological tissue they travel through. The amplitude of the wave can be modified by manipulating the displacement of the ultrasound horn for each half cycle as they are proportional. The primary purpose of phonophoresis is to assist in transdermal drug delivery, usually with the help of a coupling agent or medium. Transdermal drug delivery sometimes does not permeate the skin to reach a targeted area within the body because of the stratum corneum layer of the skin, a layer that prevents foreign substances from penetrating the body. Transdermal drug delivery is patient-compliance, usually avoids digestive system degradation, and has the ability to use drugs with short half-lives.
Mechanisms of action
While increased skin permeability is seen through sonophoresis, the precise mechanisms to describe sonophoresis are yet to be fully discovered. However, there are several important mechanisms that have been identified that contribute to the phenomenon of sonophoresis.
Cavitation Cavitation is generally determined to be the dominant mechanism that drives sonophoresis. It can be described as the distortion, expansion, and contraction of gas bubbles in a liquid medium. The frequency of the ultrasound waves helps determine the bubble parameters, such as size and shape. There exist two types of cavitation, stable and transient. Stable cavitation is when cavitation bubbles persist over many acoustic pressure cycles without collapsing. On the other hand, transient cavitation is where these cavitation bubbles uncontrollably and rapidly grow and decay over many acoustic pressure cycles. However, while cavitation is considered the primary mechanism for sonophoresis, the gas bubbles that contribute to cavitation are generated by a process termed rectified diffusion.
Rectified diffusion Rectified diffusion is the process where cavitation bubbles experience growth. The growth of these bubbles occurs by encountering a negative pressure half cycle, expanding the gas inside the bubble. Similarly, the gas bubble will dramatically decay in size when encountering the other positive half of the pressure cycle. There are further factors that manipulate the oscillation of the bubbles' size, such as temperature and composition of the gas and liquid phases. Depending on the dramatization of the oscillation from previously mentioned factors, stable or transient cavitation occurs. A rapid process will lead to transient cavitation bubbles, whereas a slower process will lead to stable cavitation bubbles.
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