Medical applications of nonthermal atmospheric pressure plasma in dermatology

Abstract

SummaryPlasma is an ionized gas that consists of positively and negatively charged particles, neutral atoms, and photons. Recent developments in plasma sources have made it possible to generate room-temperature plasma in the "open air", thus enabling the application of plasma in vivo. Using nonthermal plasma, active agents can be efficiently delivered to target cells without creating thermal damage. Also known as cold atmospheric pressure plasma (CAP), nonthermal atmospheric pressure plasma offers innovative medical applications. In this context, it has also gained wide attention in the field of dermatology. The complex and variable mixture of active agents in plasma -predominantly reactive oxygen and nitrogen species (ROS, RNS) -can control or trigger complex biochemical reactions, achieving the desired effects in a dose-dependent manner. The objective of the present review is to present potential applications of plasma in dermatology and analyze its potential mechanisms of action.

Cold atmospheric pressure plasmas in dermatology: Sources, reactive agents, and therapeutic effects

“…[ 52 ] Penetration of the plasma into the cavity of biofilm indicates the ability of the plasma to penetrate deep into the pore of the skin, which is quite important to sterilization or cuticle hyperplasia disease treatment. [ 59 ]…”

“…Due to its complexity and multiple phases, wound healing is easily influenced by internal or external disturbances, which may eventually result in chronic wounds. [ 59 ] These chronic/nonhealing wounds not only cause medical problems but also represent a worldwide economic burden. [ 15,157 ] For example, many people suffer from chronic wounds on the lower legs (ulcus cruris), the main cause of which are varicosis and other venous diseases (80%) besides arterial diseases (15%) or diabetes (5%), in particular, old people are affected by venous ulcers and their treatment take‐up a sizeable proportion of the health care budget.…”

“…(e) Skin cancer: CAP can induce lethal DNA damage and cell‐cycle arrest in malignant proliferative cells, cause apoptotic cell death and triggers immune systemic responses. [ 59 ] CAP, cold atmospheric pressure plasma; RONS, reactive oxygen/nitrogen species…”

“…Psoriasis is an immune‐mediated, relapsing disease that primarily affects the skin and joints. [ 59,157 ] Until now, there are still no effective treatment methods that can cure or completely control the illness. The main pathological features of psoriatic lesions are aberrant terminal differentiation and hyperproliferation of epidermal keratinocytes marked inflammatory infiltration, and pathological angiogenesis.…”

“…[ 126 ] Although the treatment of psoriatic plaques with CAP showed no significant advantages over conventional treatments, in this case, the higher concentration of RONS by increasing discharge power and the addition of O 2 or H 2 O in the working gas can improve the treatment effect of CAP. [ 59 ]…”