Cold Atmospheric Plasma

Just as a liquid can be excited into a gas state, plasma is created by adding energy to a gas.

Plasma energy is considered the fourth state of matter and defined as an ionized gas. In fact, it is an ionized gas consisting of ions, electrons, reactive oxygen species (OH, H2O2,…), reactive nitrogen species (NO, NO2,…), electric field, heat, etc.

Nowadays, cold atmospheric plasma (CAP) shows interesting results in dermatology. It can be used for sterilization or disinfection, treatment of various skin infections, and also for plasma skin rejuvenation (PSR).

Unlike lasers, which use light energy to target a specific component of the skin, such as water, hemoglobin, or pigment, CAT devices actually alter structures below the surface of the skin, creating conditions for regeneration and improvement in wrinkles, acne scarring, skin texture, tone, and discoloration. This technique preserves the skin’s outer layers, which act as a protective biological dressing until new skin regenerates.

Some studies showed that using CAP can improve the underneath tissue’s oxygenation. This may happen because of increasing the temperature (between 30 and 40) and NO that is formed directly or indirectly by CAP. Nowadays, some therapies use oxygenation for skin-rejuvenation. Also, it seems that pressurized oxygen can protect the skin from UVB-induced photoaging in the PSR method. In addition, NO spices have a wide range of biological functions, including neurotransmission, response to immunogens, and smooth muscle relaxation. In addition, some studies showed that NO plays an important role in skin, especially in the proliferation of keratinocytes and fibroblasts.

Cold plasma can induce an epidermal thickening probably by keratinocyte proliferation. It can be because of reactive nitrogen spices and reactive oxygen spices on the different cytokines and subsequent cell proliferation in the treated areas. Also, Suschek et al. demonstrated that plasma could improve dermal microcirculation because of the vasodilator effect of NO without specific side effects. So, an influx of inflammatory cells and subsequent production of different growth factors and cytokines and stimulation of cell proliferation, including fibroblasts, can be seen because of the increased dermal blood flow.

Generally, the plasma hits the skin area after leaving the device and causes sudden warming of the area due to heat transfer to the skin by the excited gas. The activity of fibroblasts increases during dermal regeneration, and by maintaining necrotic epidermis, we have a biological dressing that can promote and decrease the period of recovery. Initial studies have shown that PSR can effectively treat facial skin and non-facial areas with minimal complications.

Comparison between the PSR method and a carbon dioxide laser on an animal specimen shows that all treatment areas regenerated epidermis after 7 days in the PSR-treated skin. An active cellular response below the dermis and epidermis junction is also noticeable. Therefore, PSR can be an excellent alternative to CO2 lasers with the appropriate deformation to the skin structure.

Also, using a PSR device to improve the facial skin showed the production of a new collagen band at the junction of the dermis and epidermis with low-density elastin in the upper layers of the dermis 3 months after treatment. There were no signs of ulceration or hypopigmentation. Skin erythema was ultimately improved on average 6 days after treatment.

In addition, PSR was used to treat the skin of hands, neck, and chest with photo damaging. Clinical evaluation of the skin, pigmentation, wrinkle severity, and side effects were performed on different days after treatment. The results indicated significant clinical improvement in treatment areas, considerable reduction of wrinkles and hyperpigmentation, and increased skin softness. The key point is that PSR was associated with moderate improvement in sun-induced skin changes in the neck, chest, and back of the hands with minimal side effects

Therefore, PSR is an effective and safe method with minimal side effects, and it can be used with other methods; for example, the use of PSR along with cosmetic surgery plays a significant role in promoting healing in the skin of the forehead, eye area, mouth area and middle half of the face. Moreover, This method has shown good potential in wound healing with no hypopigmentation and wound effect.

According to these information, plasma can be considered a suitable method for skin rejuvenation due to its high safety and effectiveness.

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