role of physiotherapy in dermatology

1. BY :
Dr DAULAT RAM DHAKED

2. Physiotherapy
>> Merriam-Webster’s definition
• Preservation, enhancement, or restoration of
movement and physical function
• Impaired or threatened by disability, injury, or disease
• That utilizes therapeutic exercise, physical modalities,
assistive devices, and patient education.
• Has a very important role in encouraging patient to
remain positive and in control of their condition.

3. • Although physiotherapy techniques may not change
underlying pathological changes, or prevent all
disability, may improve function by minimizing
– Contracture,
– Loss of strength and
– Decreased skin compliance.
(Askew et al 1983, Br J Rheum 22, 224-32)

4. A physiotherapeutic approach
Stiffness
Pain
Fatigue / sleep
Patient’s Knowledge
Nutritio
n
Skin
Body image
Mobility
Self-care
Self esteem,
Limitations in insight

5. Advantages of physiotherapy treatment
• Quick – results are achieved in a rapid fashion
• Efficient – addresses both aetiology and pathogenesis to
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eliminate cause not just symptoms
Safe – causes minimum adverse reactions
Specific – drugs or treatment delivered to affected organs
or tissues
Painless – uses non-invasive procedures
Stressless – avoids unnecessary surgical procedures and use
of general anaesthetics

6. • Dermatological patients are often polymorbid
• During hospitalization, especially older patients are
compromised
• Physiotherapeutic care can prevent complications such
as pulmonary affection or joint contractures

7. Major physiotherapy techniques:
• Therapy by mechanical treatment (Exercise, Massage,
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and Pressure therapy)
Non-electric thermotherapy – (Heating and Cooling,
Hydrotherapy)
Electrotherapy (Electrostimulation, Interferential,
Ultrasound, Magnetotherapy, Pharmacological
phoresis, SCENAR)
Ozonetherapy
Vacuum therapy
Balneotherapy
Phototherapy

8. Clinical effects of electrotherapy
Electrostimulation
 Anti-inflammatory
 Analgesic
 Sedative
 Tranquilising
 Spasmolytic
 Vasodilating
 Trophic
 Stimulation of secretion
function
 Metabolic
Interferential
 Analgesic
 Trophic
 Spasmolytic
 Defibrosing
Ultrasound
 Anti-inflammatory
 Analgesic
 Spasmolytic
 Metabolic
 Defibrosing

9. Magnetotherapy
 Sedative
 Trophic
 Spasmolytic
 Vasoactivating
 Antiedemic
 Hypocoagulating
 Myorelaxation
 Metabolic
SCENAR (Self Controlled
Energo-Neuro Adaptive
Regulator) therapy
 Metabolic
 Immunostimulating
 Vasoactivating
 Endorphine and
encephaline release
 Correction of DNA
spontaneous structural
changes
 Neurotransmitters release

10. Advantages of pharmacological phoresis
 Effectively enhances delivery of topically applied drugs,
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specifically to the affected organ or tissue
Avoids or minimises adverse reactions
Maintains local drug effect for a prolonged period
Avoids potential gastrointestinal degradation
Reduces dose
Suitable for various drug groups (corticosteroids, NSAIDs,
analgesics, vasodilators, hormones, anticoagulants,
antibiotics, vaccines, antfungal, antimicrobial etc.)
Eg : Iontophoresis for hyperhidrosis

11. Indications for electrotherapy
•Throphic ulcers,
•Hyperhidrosis and
bromidrosis,
•Eczema,
•Neurodermitis,
•Herpes,
•Neuralgia,
•Varicose veins,
•Atherosclerotic
occlusions,
•Phlebitis,
•Thrombophlebitis,

12. Reduction of itch in allergic dermatitis following electrical
cutaneous field stimulation
(J. Wallengren, Allergy, 2002)
1 – reactions after 1 h of CSF treatment administered 30 min prior to
provocation (n = 12)
2 – reactions after 4 daily (CSF) treatments, the last treatment given 1
day before provocation (n = 10)

13. Use of electrotherapy which demonstrated effective
clinical results (PubMed database)
Pathology
Treatment
Chronic wounds
Ultrasound
Peripheral arterial
occlusive disease
Prostaglandin E1
iontophoresis
Hyperhidrosis
Iontophoresis
with tap water
Author
Source
W.J. Ennis et al.
Advances in Skin
and Wound Care,
2008
K. Yamamura
The Annals of
Pharmacotherapy
, 2003
M. Connolly and
D. de Berker
American Journal
of Clinical
Dermatology,
2003

14. Therapy by mechanical treatment
Massagesmanual or instrumental
changes in blood
circulation, muscular
relaxation
Rehabilitative exercises
increase of body strength
and mobility, psychical
effects, improvement of
body posture

15. Thermotherapy
• Application of heat is an intervention in body thermoregulation.
• Positive or negative thermotherapy
• body response depends on:
• Way of application
• Intensity, penetration ability and duration of the heat stimulus.
• Size and geometry of the application area
• Mainly packs and compresses
Compresses can
be dry (blankets,
bottles), peloids
(mud)
and
paraffin.
peloids (mud)
paraffin.
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16. Hydrotherapy
 Acts mainly on cardiovascular
system, vegetative nerves and
psychology.
 Heat helps muscles to relax,
reduces
pain,
accelerates
resorption of oedemas.
Whirling baths
Alternative
application of
sharp hot and cold
water jets – a
method with
outstanding
activation effect.
For upper and
lower limbs
moderately
hyperthermic –
increasing blood
supply and
metabolism skin
receptors
activated
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17. Sauna
Effects of hot (80 - 100°C) air of low relative humidity (1030%) are utilised, followed by cooling in cold water.
Outstanding tonic action.
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18. Magnetotherapy
 Interactions of magnetic
fields with human tissues
are utilised in both
diagnostics and therapy.
 Magnetotherapy is an
example of healing
procedure

19. IR lamps
• Radiation is absorbed mainly in body surface.
• Skin receptors are stimulated,
• Subjective feeling of heat, reflex vasodilatation and
muscular relaxation takes place.

20. Systemic Changes A/W Immobility
• Metabolic
• Respiratory
• Atelectasis, Hypostatic Pneumonia, and Decrease
oxygenation,
• Cardiovascular
• Orthostatic hypotension, Increased workload of heart, Risk
for thrombus
• Musculoskeletal
• muscle atrophy, osteoporosis, contractures and foot drop
• Integumentary
• skin breakdown, skin hygiene

21. Management
• Respiratory System
• Promote lung expansion
• Deep breathing and coughing exercises
• Chest physiotherapy
• Positioning every 2 hours
• Cardiovascular System
• Prevention of oedema and thrombus formation
• TED Stockings
• Calf pumping exercises
• Sequential compression stockings
• Musculoskeletal System
• Passive ROM for all immobilized joints
• Prevent foot drop and contractures

23. LEPROSY

31. Foot wear
• Crutches are good alternative
• Felt pad to take the weight off
• Plaster of Paris boot
• Molded double rocker boot
• Curative foot wear

33. Commonly used footwear
• Flat soled Microcellular-padded slippers (MCR
chappals)
• Low molded shoe with arch support & metatarsal pad
(ASMP)
• Metatarsal bar
• Molded boot

36. Deformity Prevention
• Rest, body position and POP cast
• Prevent/Reduce swelling : Elevation, active and passive
exercise
• Providing hand, eye and foot protection.
• Prevention of contractures
• Exercises
• Active exercises
• Passive exercises

37. Systemic sclerosis
• For Raynaud's phenomenon:
• Prevention - avoid cold and trauma; use warm clothing or
heated clothing.
• For an attack - warm the body, hands and feet gently (skin
may be numb and unable to feel if heat source is too hot);
• Use gentle arm movements or gentle massage to help restore
circulation.
• Promote joint mobility and muscle strength.
• Exercises and stretches for hands, face and feet are
essential.
• Exercise for lungs and respiratory muscles should also be
taught concentrating on lung expansion.

38. • Aerobic activities to induce deeper breathing could be
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suggested, e.g. swimming and walking.
Application of wax to hands and feet has been found to be
beneficial by some patients.
Oils in wax and warmth serve as a useful preparation for
exercise.
Massage of skin helps to mobilize stiff connective tissues
Have beneficial effect on circulation and nutrition of skin
Hot water bottles, electrically heated pads, hot bath or
shower also beneficial.

39. Hand exercise
Hips, Knees and
Ankles
Inner thigh stretch
Wrist extension
stretch
Calf stretch
Elbow stretches Quadriceps stretch
Wrist flexion
stretch

40. Psoriatic arthritis
Acute phase
• Encourage rest.
• Splints may be used for rest and pain relief, especially
for hands, wrists, knees, or ankles.
• Cold modalities should be used to decrease
inflammation and assist with pain relief.
• Joints should not be moved beyond limit of pain;
• passive movements should be limited
• Education about disease itself, importance of rest,
exercise program, joint protection, energy
conservation, and weight loss

41. Subacute and long-term phase
• Isometric exercises are begun, with progression to
active movement.
• Gradual range-of-motion (ROM) exercises include
passive and active exercises;
• areas with subluxation should not be forced passively.
• Heating modalities, including moist heat packs,
paraffin wax, diathermy, and ultrasound, can be used
to decrease pain;
• heat therapy should be performed just prior to
performance of ROM exercises.

42. • Institute gait activities, with patient bearing weight as
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tolerated, with or without an assistive device.
Gentle stretching should be gradually introduced.
If pain persists beyond 2 hours after therapies, then
intensity should be decreased.
If a joint is swollen, then no resistive exercises should
be performed through full ROM.
Axial spine involvement, spine extension exercises
help with flexibility and strength.
Sausage toes, use extra-depth shoes with a high toe
box.

43. Dermatomyositis
• Activity should be maintained as much as possible
• Vigorous physical training should be avoided when
myositis is active.
• Strengthening to prevent atrophy
• Range of motion exercises to prevent contractures
• Passive stretching and splinting

44. Lymphedema
• Interventions include:
• Manual lymph drainage (to help improve flow of lymph
from affected arm or leg from proximal to distal).
• Short/low stretch Compression garment wear following
lymphatic drainage.
• Skin Hygiene and care (such as cleaning skin of arm or
leg daily and moisten with lotion).
• Exercise to improve cardiovascular health and help
decrease swelling in some cases.
• Compression pumps
• Garment fitting.

45. • Complex Decongestive Therapy:
• Phase 1:
• Skin care
• Light manual massage (manual lymph drainage)
• ROM
• Compression (multi-layered bandage wrapping,
highest level tolerated 20-60 mm Hg)
• Phase 2:
• Compression by low-stretch elastic stocking or
sleeve
• Skin care
• Exercise
• Light massage as needed
• Contraindications:- arterial disease, painful postphlebitic
syndrome, and occult visceral neoplasia

46. Venous insufficiency
• Leg elevation;
• Elevating leg above level of right atrium decreases venous
hypertension and edema,
• Done minimum of 3 times/day for ≥ 30 min
• Compression
• Bandages, stockings, and pneumatic devices;
• Intermittent pneumatic compression (IPC) uses a pump to
cyclically inflate and deflate hollow plastic leggings.
• External compression, squeezing blood and fluid out of lower
legs.
• Treats severe postphlebitic syndrome and venous stasis ulcers
• Topical wound care; and surgery,
• Weight loss, regular exercise, and reduction of dietary
sodium.

47. Bedsore or pressure ulcer
DO
• Change position 2 hourly to
relieve pressure.
• Use pillows, sheepskin, foam
padding, to reduce pressure
• Exercise daily, including
range-of-motion exercises
for immobile patients.
• Keep skin clean and dry.
DO NOT
•Do NOT massage the
area of the ulcer.
Massage can damage
tissue under the skin.
•Donut-shaped or ringshaped cushions are
NOT recommended.
They interfere with
blood flow

48. THANK YOU