ArticlePDF Available

Consider of Micro-Current's effect to variation of Facial Wrinkle trend, Randomized Clinical Trial Study

Authors:

Abstract

Beauty is one of the important today's people concerns; the facial wrinkles are including problems of beauty. Today, new non-invasive treatments such as using micro currents in treatment of wrinkles and skin renewal have been used. This study is aimed to determine the effect of Micro-Current in the treatment of facial wrinkles. in this before and after clinical trial, thirty women with three requirements; 1.having less than 45 years of age 2.wrinkles and 3.no skin problems have participated. The cases were treated with micro current for twenty minutes on their face areas, for thirty consecutive sessions. Photos were taken from patients faces at the beginning, end and one month after treatment. Three independent blinded reviewers have rated wrinkles in photos. Also patients have evaluated their treatment. The best results belonged to forehead 18.37% in first step (before and after treatment) and 21.18% in second step (after treatment and one month later) and the lowest rate in treatment belonged to nose and mouth region; 7.61% in first step and 5.85% in second step . Micro current, recovers facial wrinkles, this recovery was better in the frontal area comparing the nose and mouth. Also comparing the scores of photos, immediately after treatment and one month later shows that not only the effect of treatment has been stable but also the started recovery procedure has been continued after treatment. Treatment satisfaction among patients was over 70%.
Life Science Journal 2012;9(3) http://www.lifesciencesite.com
1184
Consider of Micro-Current's effect to variation of Facial Wrinkle trend, Randomized Clinical Trial
Study.
Fatemeh Saniee 1, Hamid Reza Ghafarian Shirazi 2, 3, Khosroo Khademi Kalantari4, Parviz Yazdanpanah5,
Asghar Reza Soltani6, Nader Dabiri7, Nazanin Ghafarian Shirazi4, Farzad Karimpour1.
1- Social Determinants of Health Research Centre, Yasouj University of Medical Sciences. Yasuj, I.R. Iran
2- School of Public Health, Tehran University of Medical Sciences. Tehran, I.R.Iran
3- School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran
4- MA. Yerevan State Linguistic after V. Brusov, Yerevan, Armenia.
Gshr3@yahoo.com
Abstract: Beauty is one of the important today’s people concerns; the facial wrinkles are including
problems of beauty. Today, new non-invasive treatments such as using micro currents in treatment of
wrinkles and skin renewal have been used. This study is aimed to determine the effect of Micro-Current in
the treatment of facial wrinkles. in this before and after clinical trial, thirty women with three requirements;
1.having less than 45 years of age 2.wrinkles and 3.no skin problems have participated. The cases were
treated with micro current for twenty minutes on their face areas, for thirty consecutive sessions. Photos
were taken from patients faces at the beginning, end and one month after treatment. Three independent
blinded reviewers have rated wrinkles in photos. Also patients have evaluated their treatment. The best
results belonged to forehead 18.37% in first step (before and after treatment) and 21.18% in second step
( after treatment and one month later) and the lowest rate in treatment belonged to nose and mouth region;
7.61% in first step and 5.85% in second step . Micro current, recovers facial wrinkles, this recovery was
better in the frontal area comparing the nose and mouth. Also comparing the scores of photos, immediately
after treatment and one month later shows that not only the effect of treatment has been stable but also the
started recovery procedure has been continued after treatment. Treatment satisfaction among patients was
over 70%.
[Saniee F. Ghafarian Shirazi H.R. . Khademi Kalantari K. Yazdanpanah P. Soltani A.R. Dabiri N.
Ghafarian Shirazi N, Karinpour F. Consider of Micro-Current's effect to variation of Facial Wrinkle
trend. Life Sci J 2012;9(3):1184-1189]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 166
Keywords: skin, beauty, Facial, Wrinkle, Micro-Current
1. Introduction
Beauty is one of most common concerns
among human, especially women. Facial
wrinkles are one of beauty problems which is
produced due to aging or some other factors such
as stress, improper diet, smoking, sun damage,
fat culmination, and harmful inflammation, and
is accelerated due to some other factors including
gravity, broking of Collagen and Elastin
constitutive materials caused by sunshine, air
pollution, smoking, and not to exercise, and
signs of aging begin to appear. Passing time, the
thin epidermis and connect tissue become weak ,
facial muscular firmness diminishes, epidermis
begin to loose and dropping, natural fold change
to cheek , neck , and chin unnatural fat, small
vessels tights and blood circulation decreases
and lead to decrease of facial brightness (1,2).
There are many therapeutic methods to
remove and reduce facial wrinkles and for
rejuvenation which can be divided into three
group of invasive, semi-invasive, and non
invasive methods.
The invasive methods such as facelift treatment or
the cosmetic surgery are intended to remove facial
wrinkles. These methods require hospitalization, and
besides being expensive and having long recovery
period and may cause side effects.
Among semi -invasive methods ,there is use of
laser to skin exfoliation , which requires special care
after treatment and long recovery period, it also cause
respective problems , costs , and side effects(3).
Injection of botulunim toxin also known as Botox
is another semi invasive method to remove facial
wrinkles. The method may have many dangers
associated with misuse, but under supervision of
practitioner and use of healthy Botox the side effects
reduce. Also the treatment effects are not long
standing.
Non-invasive methods include preservative
creams, booster creams, and anti wrinkles creams.
These are contain of, antioxidant, preservatives, or
booster ingredients such as vitamin A, hydroxy acid,
α-lipoic acid, Q-10 coenzyme, cu peptides, growth
factors, So y Isoflavones, Tea extract, vitamin C,
Life Science Journal 2012;9(3) http://www.lifesciencesite.com
1185
vitamin E, or collagen. However the
effectiveness of the creams has not been proved
yet.
In recent years, the use of micro current has
been proposed which enjoys many advantages
including: being non –invasive, inexpensive,
and having no side effects. It is also argued to be
effective in removing facial wrinkles, skin
dropping and reducing facial surface spots. It
also has been proved that micro currents are very
effective in improving of malunion or nonunion
bone fractures and curing of resistant ulcers and
bed sore .This occurs due to activation of
collation system in skin layers. Collagen is a
group of naturally occurring proteins found in
animals. They are made from fishia strings,
making up about 40% of the whole-body protein
content. Collagen protects brain nerve system
and provides good tensile strength .It also leads
to sore recovery through a complex process.
During maturation and ulcer recovery, collagen
is arranged in line with tensile lines and the
unneeded cells are removed by fagositosis,
thereby the ulcer recovers (10). Micro current is
an electric current delivered at a rate of 1
microampere which equals 1 millionth of an
ampere .They are harmless and have recovery
effects on damaged tissues and enjoy capacity of
toxic trapping. They made blood circulation
faster and lead to stimulation of collagen
production. Several studies have proven benefits
of micro currents for recovery of persistent and
chronic ulcers (12).Micro currents are at low
level and patient feel comfortable.
Stimulator current above 20 mille ampere,
stimulate and contract the muscles leading to
strength and firmness of damaged muscles.
Common electrodes such as TENS and EMS are
reliable and nonallergic. These currents can be
used as interferential with sine and square waves ,
and are more effective because they allow a
deeper and softer penetration (13).Currents'
effect lead to increase of the amount of ATP in
cells (14) , increase of cell protein duplication
and DNA transcription (15) , horn cell growth
and duplication , increase of blood flow,
exchange of oxygen , ions , antioxidants , and
nutrients among epidermal , subcutaneous and
fat layers , and subcutaneous and lymph
capillaries .This lead to release of energy in
tissues and stop decreasing elasticity and protein
degradation which had been caused by intake of
free radicals and to increases collagen I ,II
production. (17) By contracting the old and
unhealthy collagens, these changes lead to
firmness and toning of facial skin.
It seems that the ability of micro currents in
resurfacing of thin layer of skin, filling wrinkles and
lifting dropping skin is related to stimulation of cells
growth and tissues revivals. (18). This study aims to
determine the effect of micro current on removing
and reducing patient's facial folds and wrinkles.
2. Material and Methods
In this before and after clinical trial, every
volunteer participated in the research after being
informed about the trial and it was conducted in
second half of 2010. Sampling was as available goal
oriented sample with volume of 15
subjects .Regarding to a similar study (21-19),
limitation of the research, and because of some
consideration like possible fail due to time period,
and respective problems, 30 women were participate
in the research. At the first, at the end and one month
after treatment, in the same conditions, photos were
taken from areas of right /left eye pro files, forehead
front, nasolabial, and eyes feet views. The photos
were taken using Canon 5D camera with lens 24105
macro while the participant was sitting in a free mode
relying on her head back on chair. The treatment
process was as follows: first the person washed her
face with soap and water, and then lied on bed and
every half of her face was treated for 10 minutes.
Facial areas going under treatment include
forehead around eyes, nasolabial area, cheeks and
chin. The treatment method is as follow: a positive
electrode is fixed and the negative one is sliding.
These movements are repeated five times for each
point. These electrodes are thin with a tip covered
with cotton that are wetted with water to be
conductive. For every case, treatment proceeds for 30
consecutive sessions except for vacations, Thursdays
and Fridays .The used apparatus A6 is made in China
with CE license from England and Europe and
United states. The current used in the study are
square micro pulse between 70-80 Hertz with
amperage range of 0-640 microampere. At the end of
the treatment, the consent assessment form about
treatment effectiveness, health care center quality
staff services and treatment environment was filled
by the patients. The questionnaire was prepared using
standard form (25) and enjoyed acceptable validity
and reliability. At the end of the plan all photos were
numbered and each photo was graded between 0-10
by two dermatologists and one plastic surgery
specialist b y size numbers and depth of folds. The
referee was blind on which one is before or after
photo and about the related person. The assessment
method enjoys acceptable validity and reliability (26).
Inclusion Criteria: being below 45 years old,
having facial wrinkles, being free of skin problems
diagnosed by dermatologist.
Life Science Journal 2012;9(3) http://www.lifesciencesite.com
1186
Exclusions Criteria: If any case of
complication happens the patient is referred to
the practitioner and then leaves out the study.
During the study patient should avoid anti-
wrinkle cream or any other wrinkle therapy.
Data analysis: To describe data central and
dispersion indices and for data analysis the
paired student's t- test were used. To assess the
improvement rate or treatment effectiveness on
each stage and area we used ratio of difference of
before/after wrinkles scores to before score on that
stage and area.
Ethics consideration: The aim of the study was
explained for the volunteers and they were informed.
The micro current is in common use in physiotherapy
and their harmlessness has been confirmed. The
unanimous photos were coded and evaluated by the
referees. The confidentiality of collected information
was observed and patients feel comfortable and didn't
incur any expenditure.
Table 1: Compare Wricle Scores of Patients faces area In the first stage( Before and after treatment) and
second stage( After treatment and one month later) of trteatment.
P
Value
The recovery
rate
After
mean±SD
Before
mean±SD
Number
Stage of
Treatment
Face Area
Row
0.0001
18.37%
1.55± 3.20
1.80± 3.92
25
Stage 1
Forehead
0
.0001
21.18%
1.68± 2.53
1.59± 3.21
19
Stage 2
0.0001
18.09%
1.49± 3.08
1.56± 3.76
25
Stage 1
Half the right
eye
0.0001
10.29%
1.32± 2.79
1.58± 3.11
19
Stage 2
0.001
13.48%
1.54± 3.08
1.58± 3.56
25
Stage 1
Half the left eye
0.028
7.31%
1.46± 2
.79
1.67± 3.01
19
Stage 2
0.032
7.61%
1.38± 3.40
1.41± 3.68
25
Stage 1
Mouth and nose
0.104
5.85%
1.40± 3.22
1.43± 3.42
19
Stage 2
0.001
11.11%
1.69± 3.52
1.77± 3.96
25
Stage 1
The eyes front
the face
0.055
8.42%
1.64± 3.37
1.70± 3.68
19
Stag
e 2
10
0.0001
7.12%
1.69± 3.52
1.77± 3.79
25
Stage 1
Face area
(Totally)
11
0.021
5.86%
1.64± 3.37
1.70± 3.58
19
Stage 2
12
Table 2: Patients satisfaction of their treatment results and treatment center factors
very
satisfaction %
Not very
satisfact
ion %
Mean±SD
Discution
Row
63
37
3.95±1.05
Your satisfaction about decreasing the depth
of wrinkles
50
50
3.60
±1.04
Your satisfaction about reduce the length of
wrinkles
56
44
3.85±0.74
Your satisfaction about diminish wrinkles
away
63
37
3.90±0
.91
Your satisfaction about loss of skin spot
48
52
3.45±1.36
Your satisfaction about skin tightness
69
31
3.95±0.83
Your satisfaction about lighting skin
43
57
3.35±0.87
Your satisfaction, about loss of acne and
acne scars on the skin
60
3.35
±0.87
Your satisfaction about the loss of scar
54
46
3.95±0.82
Your satisfaction about closing the pores on
your face
89
11
4.30
±0.73
Your satisfaction about soften of your skin
10
79
21
4.2±0.76
Your satisfaction about Fluoresce of your
skin
11
41
59
3.35±0.74
Your satisfaction about rejuvenating
12
Life Science Journal 2012;9(3) http://www.lifesciencesite.com
1187
2 1
After treatment Before treatment
3
One month later.
Figure 1: Wrinkles, a patient before treatment - after treatment and one month later.
Before treatment after treatment
Figure 2: Significant improvement in treatment acne and infectious acne
Before treatment After treatment
Figure 3: significant improvement in scaring
Life Science Journal 2012;9(3) http://www.lifesciencesite.com
1188
3. Results
This study aims to investigate the effects of
micro currents on removing facial wrinkles and
was conducted as a before /after trial study. This
study consists of 30 women residing in Yasuj and
suburbs which last 7 months beginning from 23th
Oct 2010.Due to length of the study, 25 women
completed the therapy period and despite of our
follow up, only 19 women referred for
photography, one month after treatment. Age mean
and standard deviation of patients were 37/5
_+4/6(25-45). Evaluation of wrinkles of forehead
areas, right/left eyes' profiles, eyes front and
nasolabial area and face as a whole, indicated the
significance of the study. The forehead area show
the greatest improvement(%18/37) in the first
stage (before treatment and after completion of the
study) and %21/18 in the second stage (after
treatment one month later).The nasolabial area
constituted 7/61 percent of improvement
(minimum improvement) in the first stage and 5/85
percent in the second stage(table 1).
Also 70% of patients were satisfied with their
treatment results (table 2).
4. Discussions
In this study, the effect of micro currents on
removing and reduction of facial wrinkles after 30
treatment sessions was significant .The
improvement rate was greatest in the forehead area
and was the least in nasolabial area .This was
perhaps due to possibility of more effective use of
the apparatus in the forehead area than the other
areas .On the other hand, the tissue texture of
forehead has more improvement capability. On the
forehead after one month improvement continues
significantly. In the right eye and left eye of the
profile and eyes of the face both of them t
treatment’s affect is significant, But, the second
stage is less effective. Overall, the treatment effect
was significant in both stages.
Also, comparing scores after treatment and
one month later shows that not only effect of
treatment was sustained but also recovery in the
face of the subjects started and has continued.
An important finding in this study was
improvement of scars, acnes (especially infectious
acnes) and skin rashes in the face of subjects.
Limitation: Regarding problems and
limitation of the study and its being novelty in Iran,
there was no chance to compare the results with
studies of domestic ones. The therapy period (30
sessions) and length of every session (equal 40
minutes with preparation of the patient) caused the
slow progress of the research execution.
1-Regarding cultural bound photography of
the intended areas b y a professional photographer
was not possible, so the photos were taken by the
researcher.
Acknowledgment: The study was extracted
from M.A physiotherapy thesis results with
collaboration and support of Yasouj University of
medical science and international branch of Shahid
Beheshti University of Medical Science.
We appreciate: Members of the Council on
Medical Ethics, members of Council, faculty
advisors, officials, experts also experts of
collaborating universities, who helped us in
conducting this research. Especially, Dr Stuart
Titus, that helped us in collection of academic
texts and also, patients who were intolerant of
treatment.
Conflict of interest: The authors, certify that
there is no actual or potential conflict of interest in
relation to this article.
Corresponding Author:
Hamid Reza Ghafarian Shirazi
Social Determinants of Health Research Centre
Yasouj University of Medical Sciences,
Yasouj, I.R. Iran
E-mail: gshr3@yahoo.com
References
1- Oikarinen A.; Connective tissue and aging;
International Journal of Cosmetic Science
2004, Volume 26 Issue 2, Pages 107 – 107.
2- Berson D. Lupo, M. Cosmeceuticals: Practical
ApplicationsDermatologic Clinics; 2009,
Volume 27, Issue 4, Pages 401-416.
3- Thomas T. Microbial Toxin, Current Research
and Future Trends, illustrated, Horizon
Scientific Press, 2009; ISBN; 1904455441,
9781904455448, page 15-41.
4- Huang. C, Miller. T, The truth about over-the-
counter topical anti-aging products: A
comprehensive review, Aesthetic Surgery
Journal, 2009 Volume 27, Issue 4, Pages 402-
412.
5- Grinnell F. Fibroblast mechanics in three-
dimensional collagen matrices. Journal of
Bodywork and Movement Therapies, 2009;
Volume 12, Issue 3, Pages 191-193,
6- Nguyen, D.T., Orgill D.P., Murphy G.F.: The
pathophysiologic basis for wound healing and
cutaneous regeneration. Biomaterials for
Treating Skin Loss. CRC Press (US) &
Woodhead Publishing (UK), Boca
Raton/Cambridge 2009; Chapter 4, p. 25-57.
7- Stadelmann W.K., Digenis A.G. and Tobin
G.R. Physiology and healing dynamics of
chronic cutaneous wounds. The American
Journal of Surgery 1998; 176 (2): 26S-38S
Life Science Journal 2012;9(3) http://www.lifesciencesite.com
1189
8- Midwood K.S. Williams L.V. and
Schwarzbauer J.E. Tissue repair and the
dynamics of the extracellular matrix. The
International Journal of Biochemistry & Cell
Biology, 2004; 36 (6): 1031–1037.
9- Chang H.Y., Sneddon J.B., Alizadeh A.A.,
Sood R., West R.B., Montgomery K., Chi J.T.,
van de Rijn M, Botstein D., Brown P.O. Gene
Expression Signature of Fibroblast Serum
Response Predicts Human Cancer Progression:
Similarities between Tumors and Wounds.
Public Library of Science, 2004; 2 (2). PMID
14737219.
10- Porter. Stuart B. Tidy's Physiotherapy
Physiotherapy essentials. Elsevier Health
Sciences, 2008, ISBN 0443103925,
9780443103926, Edition: 14, illustrated, page
465.
11- Watson, T. Electrotherapy: evidence-based
practice. Elsevier Health Sciences, 2008,
ISBN 0443101795, 9780443101793, 12,
illustrated, 336-344.
12- Mueller J, Kapeller B, Losert U and Karin M;
Electrical Microcurrent Application Modifies
the Inflammatory Response in the Failing
Myocardium. Clinical Immunology, 2006,
Volume 119, Supplement 1, Page S128.
13- Odell, Robert H., and Sorgnard nRichard E.
Anti-inflammatory Effects of ElectronicSignal
Treatment. Pain Physician Journal; 2008;
11:891-907; ISSN 1533-3159;
www.painphysicianjournal.com.
14- Most B. A Prospective Examination of the
Efficacy of 2 Noninvasive Devices for
Treatment of the Aging Face. Arch Facial
Plast Surg. 2006; Vol. 8 No. 1, 8:66-68.
15- Mueller J, Kapeller B, Losert U and Macfelda
K; Electrical Microcurrent Application
Modifies the Inflammatory Response in the
Failin. Myocardium. Clinical Immunology,
2006, Volume 119, Supplement 1, Page 128.
16- Lin, YL, Moolenaar, H, van Weeren, PR, van
de Lest, CHA. Effect of microcurrent
electrical tissue stimulation on equine
tenocytes in culture. AMERICAN JOURNAL
OF VETERINARY RESEARCH, 2006;
Volume: 67 Issues: 2 Pages: 271-276.
17- Lenox, A, L. Shafer J. Pilot Study of
Impedance- Controlled Microcurrent Therapy
for Managing Radiation Induced Fibrosis In
head-And- Neck Cancer Patient. International
Journal of Radiation Oncology. 2002; Vol 54,
No 1
18- Poltawski L; Watson T, Bioelectricity and
microcurrent therapy for tissue healing - a
narrative review. Maney Publishing, Physical
Therapy Reviews, Volume 14, Number 2,
2009, pp. 104-114(11).
19- Bok Y. Lee, Noori AL-Waili , Dean Stubbs ,
Keith Wendell, Glenn Butler , Thia AL-Waili ,
Ali AL-Waili; Ultra-low microcurrent in the
management of diabetes mellitus,
hypertension and chronic wounds: R eport of
twelve cases and discussion of mechanism of
action; Int. J. Med. Sci. 2010, 7(1); 29-35.
20- Ghaibi Mehmandost F., Torkaman G.,
Firozabadi M.; Effects of cathodic and anodic
direct current stimulation on the withdrawal
process of wound healing in guinea pigs;
Daneshvar, 2005,vol12, no58; P 37-44.
21- Ricanek A.Patterson K. A review of the
literature on the aging adult skull and face:
Implications for forensic science research and
applications.Forensic Science International,
2007, Volume 172, Issue 1, Pages 1-9.
22- Simon J and Simon B; Electrical Bone
Stimulation. Humana Press, 2008, Pages 259-
287.
23- Barker AT, Jaffe LF, and Vanable JW: The
glabrous epidermises of cavies contain a
powerful battery. Am J Physiol 1982; 242:
R355-366.
24- Cheng N, Van Hoff H, Bockx E. Hoogmartens
MJ, Mulier JC, Dedijacker FJ, Sansen WM,
Deloecker MJ, Mulier of electric current on
ATP generation, proteinsynthesis and
membrane transport in rat skin. Clin
Ortopedics and Rel Res 1982; 171: 264- 272.
25- Moolenaar, Lin, YL, Weeren, H, van, CHAPR,
van de lest. Effect of microcurrent electrical
tissue stimulation on equine tenocytes in
culture. AMERICAN JOURNAL OF
VETERINARY RESEARCH, FEB 2006, vol
67 Issue: 2 Pages: 271-276.
26- Lambert MI. Marcus P, Burgess T, Noakes
TD. Electro-membrane microcurrent therapy
reduces signs and symptoms of muscle
damage. LIPPINCOTT WILLIAMS &
WILKINS, 530 WALNUT ST,
PHILADELPHIA, PA 19106-3621 USA,
2002; Volume: 34 Issue: 4, Pages: 602-607.
7/2/2012
... The lethal LEC effect mentioned in many researches is due to two factors; (i) the direct energy effect of high voltage pulses on the cell membranes causing electroporation and (ii) the release of toxic ions from the used electrodes due to the oxidation of the metal ions of the anode resulting in the dissolution of the anode [19]. Furthermore, many researches study the effect of electro current or/and electromagnetic on bacterial biofilm forming, and they concluded that the electrical current is a potential strategy to decrease the formation of biofilm on medical biomaterial and killing of bacteria in biofilm, mediated at least in part, by formation of radical reactive oxygen species [20,21,22,23,24,25,26,27]. Bacterial quantities decrease after exposure to 200 μA DC which are primarily due to death of the bacteria within biofilm. ...
Article
Full-text available
Background: Microcurrent therapy (MCT) uses electric currents similar to those produced by the body during tissue healing. It may be a particularly beneficial where endogenous healing has failed. Aim: To review evidence regarding microcurrent in tissue healing and the application of MCT. Methods: All peer-reviewed studies concerning microcurrent and MCT were sought, and representative literature was synthesised to indicate the scope and weight of current evidence. Results: Microcurrent appears to play a significant role in the healing process, and MCT can promote healing in a variety of bone and skin lesions. The evidence for other tissues is encouraging but presently scant. Conclusion: MCT may have unrealised potential in the treatment of dysfunctional tissue healing and deserves greater attention by researchers and clinicians.
Article
Full-text available
Inflammation often plays a key role in the perpetuation of pain. Chronic inflammatory conditions (e.g. osteoarthritis, immune system dysfunction, micro-circulatory disease, painful neuritis, and even heart disease) have increased as baby boomers age. Medicine's current anti-inflammatory choices are NSAIDs and steroids; the value in promoting cure and side effect risks of these medications are unclear and controversial, especially considering individual patient variations. Electricity has continuously been a powerful tool in medicine for thousands of years. All medical professionals are, to some degree, aware of electrotherapy; those who directly use electricity for treatment know of its anti-inflammatory effects. Electronic signal treatment (EST), as an extension of presently available technology, may reasonably have even more anti-inflammatory effects. EST is a digitally produced alternating current sinusoidal electronic signal with associated harmonics to produce theoretically reasonable and/or scientifically documented physiological effects when applied to the human body. These signals are produced by advanced electronics not possible even 10 to 15 years ago. The potential long-lasting anti-inflammatory effects of some electrical currents are based on basic physical and biochemical facts listed in the text below, namely that of stimulating and signaling effective and long-lasting anti-inflammatory effects in nerve and muscle cells. The safety of electrotherapeutic treatments in general and EST in particular has been established through extensive clinical use. The principles of physics have been largely de-emphasized in modern medicine in favor of chemistry. These electrical treatments, a familiar application of physics, thus represent powerful and appropriate elements of physicians' pain care armamentaria in the clinic and possibly for prescription for use at home to improve overall patient care and maintenance of quality of life via low-risk and potentially curative treatments.
Chapter
In this chapter, essential aspects of cutaneous wound repair/scar formation, including the early response and the cellular phase, will be covered. Fundamental differences between wound repair and regeneration, with emphasis on fibroblast and endothelial cell contribution to respective dermal architecture, will be discussed. 'Essential ingredients' for cutaneous regeneration will be explored in detail. Lastly, issues regarding stem cells, progenitors and cellular 'plasticity', as they relate to cutaneous wound healing, will be examined.
Article
Human skin is composed of epidermal and dermal layers, each of which has its own functional importance. Dermis consist of a fine network of collagen fibers, elastic fibers, and other components of the extracellular matrix (ECM). ECM consist primarily of proteins and complex sugars, which form fibrillar networks and a ground substance. Collagen is an important structural component of skin connective tissue and provides the tensile strength of skin. Approximately 70–80% of the dry weight of skin consists of collagen. The most abundant collagen types in skin are types I and III; the former accounts for 80% of the total collagen content of skin and the latter for approximately 15%. The other collagen types present in skin include type IV collagen, which is abundant in the basement membrane (BM); type V collagen, which is located pericellularly; type VI collagen, which plays a role in matrix assembly and is present as microfibrils between collagen fibers; and type VII collagen, which is a structural component of anchoring fibrils. Elastin accounts for only about 1–2% of the dry weight of skin but is important for the maintenance of skin elasticity and resilience. Glycosaminoglycans are of central importance for the maintenance of a water balance in skin, even though the quantities in ECM are small (0.1–0.3% of the dry weight of skin). In the dermis fibroblasts are responsible for the synthesis of ECM proteins. The fibroblasts in the dermis spend majority of time in quiescent state. However in response to activation, the fibroblasts can be reactivated, and certain pool of cell is able to differentiate into myofibroblasts which have important role in repairing skin defects such as during wound healing. During aging the number of fibroblasts is markedly reduced. Also the response of fibroblasts to various growth factors and mechanical or pathological stimulates (wound healing) is diminished. Skin collagen synthesis declines with aging and as the result of such external factors as long-term sun exposure and medications, for example, topical corticosteroids. In aging skin, collagen fibers become thicker and less soluble and the synthesis of collagen declines. Skin thickness remains quite constant between 20 and 70 years of age, after which a marked decrease in skin thickness occurs. During aging the expression of collagenases are increased and inhibitors of collagenases are reduced leading to increased proteolysis of connective tissue. Recent studies have shown that collagen synthesis is declined in the skin of heavy smokers, while collagenases are increased inducing premature skin aging. The elastic properties of skin are also affected by aging. Along with increasing age, dermal elastic fibers become thicker and fragmented and oxytalan fibers appear fragmented and shortened. Disintegration of elastic fibers is already seen in a minority of fibers between ages 30 and 70, but the changes become more profound after the age of 70 years, affecting a majority of the fibers. As a result of the decreased number of elastic fibers in aged skin, the elastic recovery of skin decreases in elderly people. Even though the content of GAGs and proteoglycans is relatively small, they have significant role in collagen fibril formation, water content of dermis and in mechanical properties. During aging there are marked alterations in different proteoglycans. The amount and synthesis of versican (high molecular size) is decreased and small molecular size decorin is increased. In photoaged skin versican is increased and is closely associated to elastin while decorin is decreased.
Chapter
Delayed unions and nonunions of long bone fractures are common complications encountered in orthopaedic medicine. Five to 10 percent (300,000 to 600,000) of the 6 million fractures occurring annually in the United States develop some form of compromised union, amounting to an estimated economic loss of 3 billion to3 billion to 6 billion annually. Electrical stimulation modalities have been employed for decades to promote the healing of delayed unions and nonunions. Although the positive clinical benefi ts of these treatments have been widely reported, electrical stimulation was largely regarded as a “black box” technology. Today, the black box can be replaced with a mechanism of action. This chapter compiles a basic mechanism of action for the effects of electrical stimulation on bone healing. In short, electrical stimulation up-regulates production of mRNA from DNA, which leads to up-regulated expression of growth factors that are benefi cial to the bone healing cascade. Stimulation of cells by these growth factors causes them to proliferate and differentiate, and these events lead to better callus formation, mineralization and vascularization, which in turn provide a better clinical outcome in the form of a faster healing rate, or any healing rate at all, in an area that would not normally heal on its own. KeywordsElectrical stimulation–bone stimulator–EBI–nonunion–delayed union–bone healing–growth factor–osteoinduction
Article
Oxidative stress plays a major role in the pathogenesis of both types of diabetes mellitus and cardiovascular diseases including hypertension. The low levels of antioxidants accompanied by raised levels of markers of free radical damage play a major role in delaying wound healing. Ultra-low microcurrent presumably has an antioxidant effect, and it was shown to accelerate wound healing. The purpose of the study is to investigate the efficacy of ultra-low microcurrent delivered by the Electro Pressure Regeneration Therapy (EPRT) device (EPRT Technologies-USA, Simi Valley, CA) in the management of diabetes, hypertension and chronic wounds. The EPRT device is an electrical device that sends a pulsating stream of electrons in a relatively low concentration throughout the body. The device is noninvasive and delivers electrical currents that mimic the endogenous electric energy of the human body. It is a rechargeable battery-operated device that delivers a direct current (maximum of 3 milliAmperes) of one polarity for 11.5 minutes, which then switched to the opposite polarity for another 11.5 minutes. The resulting cycle time is approximately 23min or 0.000732 Hz and delivers a square wave bipolar current with a voltage ranging from 5V up to a maximum of 40 V. The device produces a current range of 3 mA down to 100 nA. Twelve patients with long standing diabetes, hypertension and unhealed wounds were treated with EPRT. The patients were treated approximately for 3.5 h/day/5 days a week. Assessment of ulcer was based on scale used by National Pressure Ulcer Advisory Panel Consensus Development Conference. Patients were followed-up with daily measurement of blood pressure and blood glucose level, and their requirement for medications was recorded. Treatment continued from 2-4 months according to their response. Results showed that diabetes mellitus and hypertension were well controlled after using this device, and their wounds were markedly healed (30-100%). The patients either reduced their medication or completely stopped after the course of treatment. No side effects were reported. The mechanism of action was discussed.
Article
One of the main objectives for an aesthetic surgery patient seeking consultation is a desire to look younger and reverse the appearance of aging. Most of these patients also use topical creams in addition to undergoing surgical procedures. Over-the-counter (OTC) anti-aging products are a billion-dollar industry to which even young patients who wish to prevent the aging process contribute. Many OTC products advertise dramatic results, but there have been relatively little scientific data to support these claims. We reviewed the literature on ingredients commonly found in OTC anti-aging creams. We conclude that although many different compounds are marketed as anti-aging products, studies proving their efficacy are limited. Vitamin C and alpha-hydroxy acids have been the most extensively researched products, and their anti-aging capabilities have been demonstrated in the literature. There have also been some promising studies on vitamin A and vitamin B derivatives. Moisturizers have been shown to increase skin hydration and improve the overall appearance of skin. Studies also indicate that pentapeptides can be effective in decreasing facial wrinkles and roughness. However, botanicals, which have become popular over the last few years, require significantly more research to formulate any positive conclusions for their topical application. As aesthetic surgeons, it behooves us to educate ourselves on the most common ingredients found in topical anti-aging products and their efficacy. The authors have no financial interest in and receive no compensation from the manufacturers of any of the products mentioned in this article.
Article
Fascia provides mechanical support and frameworks for the other tissues of the body. Type 1 collagen is the major protein component of fascia, and fibroblasts are the cell type primarily responsible for its biosynthesis and remodeling. Research on fibroblasts interacting with collagen matrices provides new insights regarding how cell-matrix tension state and growth factor specificity regulate cell migration and matrix remodeling.
Article
Voltages across various glabrous (and gland-free) regions of cavy skin range from 30 to 100 mV, inside positive; across hairy ones, 0 to 10 mV. (moreover, hairy areas also tend to maintain lower transcutaneous voltages in man.) When an incision is made through the glabrous epidermis of the cavy, a microampere flows through each millimeter of the cut's edge. These wound currents generate lateral, intraepidermal voltage gradients or fields of about 100-200 mV/mm near the cut; fields which decline with distance from the cut with a space constant of 0.3-0.4 mm. It is deduced from these data that the epidermis near a cut drives up to 300 microA/cm2 across itself; moreover, these currents and potentials can be grossly, rapidly, and (to some extent) reversibly reduced by amiloride. It is concluded that the hair and gland-free skin of cavies has a battery comparable in power and character to that of frogs; but it is suggested that this mammalian battery may primarily subserve epidermal wound healing rather than salt uptake.
Article
In the last few decades, a great deal of progress has been made in understanding the cellular and biochemical interplay that comprises the normal wound healing response. This response is a complex process involving intricate interactions among a variety of different cell types, structural proteins, growth factors, and proteinases. The normal wound repair process consists of three phases--inflammation, proliferation, and remodeling--that occur in a predictable sequence and comprise a series of cellular and biochemical events. A review of the biochemical and physiologic processes that regulate wound healing and the cascade of cellular events that gives rise to the healing process is presented here.