No abstract

Introduction Cold atmospheric plasma (CAP) has been clinically demonstrated to be an effective treatment for actinic keratosis (AK) in a number of case series. In this study, we evaluated the efficacy of CAP in the treatment of multiple AKs and assessed morphological changes induced on the skin field of cancerization both clinically and by high-frequency ultrasound (HFUS). Methods Patients with multiple grade I–II AKs of the scalp and/or face who were resistant or intolerant to conventional field-directed treatments were enrolled. CAP treatments were performed using a microwave-driven argon plasma jet. At baseline and 3 months after the last CAP session, performance indexes were determined using three-dimensional digital pictures and HFUS investigations were performed on a representative Olsen grade II AK and a small spot of clinically unaffected skin within the test area. Results Twelve patients were enrolled in the study. All clinical variables showed a statistically significant reduction after CAP. HFUS evaluation revealed that the total, epidermal and dermal thicknesses of the target AKs had not changed with treatment. CAP therapy significantly increased dermal density in both the target AK and the surrounding photodamaged skin and signficantly decreased the thickness of the subepidermal low-echogenic band in the perilesional skin, which is an ultrasound sign of photodamage. Conclusions Cold atmospheric plasma was found to be an effective treatment for patients with multiple AKs. CAP was not followed by skin atrophy. HFUS examiniation showed the CAP improved features of chronic photodamage of the dermis of the skin underlying and surrounding the AK spots.

remain high on the differential diagnosis. 2,8 Notably, peristomal skin complications are reported as high as 67%, and almost all patients with an ostomy experience some degree of irritant dermatitis. 2,9 Applying proper wound care principles to address devitalized tissue, infection and moisture imbalance are vital in the treatment of these other conditions. 10 We believe our patients' symptoms initially developed as an irritant dermatitis but were further exacerbated by poor wound healing and chronic irritation. If the clinical suspicion for PPG is low, we encourage an initial trial of aggressive wound care. After initiating proper wound care, clinical improvement without the use of immunosuppressants should raise suspicion for other common aetiologies of peristomal ulceration.