Wednesday, November 3, 2010

Iontophoresis and Genital Herpes

Several research articles have been published over the years about the effectiveness of iontophoresis for inflammatory conditions. One particular condition for which iontophoresis with dexamethasone has been researched extensively is shoulder tendonitis. Studies have shown this to be an effective treatment in the presence of a true inflammatory condition. As we all know, the contraindications for iontophoresis typically include those similar to electrical stimulation. Other contraindications include prolonged erythema, tingling, burning, and pulling sensations which usually occur when the current has been turned up too quickly.


Recently, I had a patient with supraspinatus tendonitis/impingement for whom iontophoresis seemed to be a valid treatment. He had been referred by his PCP, a local internist who I have dealt with previously. I called the office and requested a prescription for dexamethasone and iontophoresis. His PA told me that she would speak with the physician and send the script over as soon as she was able. When I received the prescription it said “use only if genital herpes is not active.” I called the physician to clarify that I would be using the medication topically on the shoulder. His response was the same. He said that during treatments dexamethasone may enter the blood stream and increase the active herpes virus.

I have been unable to find any research that studies at the effects of topical dexamethasone on active genital herpes infections however, it is something to consider. Most PTs are not inclined to question their patients about their sexual history/diseases especially when they are being seen for a shoulder injury. Even if a PT is thorough in their history taking, patients may be reluctant to share this information. Until further research is done regarding the use of dexamethasone and the contraindications associated with it, perhaps we should be more careful to communicate with referring physicians regarding the patient’s overall health.

Has anyone else seen this? Please comment.

Adreienne Zeiler

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