Table 3.

Cold atmospheric plasma applications in dermatology

Application	Description
1. CAP’s suppressive effect on microbial skin infection	With advantages over traditional antibiotics, CAP effectively inhibits infections on diverse surfaces. Studies demonstrate its safety and efficacy in sterilizing bacteria, disrupting biofilms, and reducing bacterial loads in diabetic foot ulcers. CAP’s broad-spectrum mechanism challenges bacterial resistance, making it promising for combating infectious diseases
1.1 Effects of CAP on bacteria	Research confirms CAP’s efficacy against bacteria and biofilms, including common strains like Escherichia coli. Plasma-activated liquids, especially plasma-activated water (PAW), show promise by generating reactive species, disrupting biofilms, and modulating inflammation, offering a novel approach to address biofilm-related infections
1.2 Effects of CAP on fungi	CAP has shown efficacy in treating nail fungal infections, inhibiting the growth of causative agents in pathogen models and clinical trials. A pilot study and a cohort of 40 patients demonstrated overall clinical cure rates exceeding 70%, establishing atmospheric pressure cold plasma as a safe and promising alternative therapy for skin fungal infections
1.3 Effects of CAP on viruses and parasites	CAP shows potential antiviral effects, with positive outcomes reported in treating viral warts and lower but measurable results on HSV-1. It also demonstrates efficacy against parasites like Demodex mites and head lice, suggesting its possible use in dermatology pending further exploration and studies
2. CAP promotes tissue proliferation and wound healing	CAP is effective in wound healing by promoting antiseptic properties, pro-angiogenic effects, tissue proliferation, and the expression of growth factors and chemokines. CAP accelerates wound healing by reducing bacterial load, stimulating cell proliferation, and inducing gene expression, offering a promising approach for improved wound treatment, including the use of plasma-activated liquids like plasma-activated water (PAW) and plasma-activated hydrogel (PAH)
3. CAP for the treatment of inflammatory skin diseases	CAP regulates the formation of stratum corneum cells by modulating the redox balance and activating the NRF2 pathway. Clinical studies show that CAP can alleviate skin inflammation, restore normal cell differentiation, and may represent a novel therapeutic approach for inflammatory skin disorders by regulating cell viability, proliferation, migration, and inflammatory responses
3.1 Psoriasis	CAP demonstrated therapeutic effects on psoriasis in cellular and animal studies, reducing epidermal hyperplasia and improving symptoms by inducing apoptosis and regulating reactive species. Atmospheric pressure cold plasma patches also showed promise in treating psoriatic skin lesions by mitigating electric field effects and inducing calcium ion channel opening in keratinocytes
3.2 Atopic dermatitis	CAP has shown positive effects in alleviating atopic dermatitis (AD) in mouse models by reducing skin inflammation, oxidative stress, and dermatitis severity. Clinical studies on AD patients revealed improvements in skin lesions, itching, and a reduction in Staphylococcus aureus proportion after plasma treatment
3.3 Vitiligo	CAP shows promise in treating vitiligo by stimulating repigmentation in affected areas. Studies, including one by Zhai et al., demonstrate CAP’s efficacy and safety in enhancing melanocyte activity, reducing inflammation, and achieving partial or complete pigmentation in vitiligo skin lesions without adverse events [84]
4. CAP suppresses tumor cell proliferation and migration	CAP demonstrated therapeutic efficacy in tumor treatment, inducing apoptosis in melanoma and skin cancer cells, with potential applications in various cancers. Plasma-activated hydrogel (PAH) is a carrier for CAP, enhancing treatment response, and a novel plasma-activated biological hydrogel demonstrates efficacy in eliminating residual tumor tissue without systemic toxicity after surgical resection
5. Cosmetic and skincare applications of CAP	Microplasma radiofrequency treats scars, while CAP benefits beauty. Suwanchinda’s studies show improvements in striae and hypertrophic scars with high satisfaction. Plasma’s reactive oxygen species offer a novel approach to skin barrier regulation. Combining cold plasma with vitamin C boosts collagen and skin elasticity, promoting skin beauty
6. CAP’s role in treating immune-mediated skin diseases	CAP has demonstrated therapeutic effects on immune skin diseases. It showed positive results in reducing inflammation and oxidative stress and improving skin lesions. Additionally, CAP, delivered through a plasma-activated hydrogel, proved effective and safe in mouse models and vitiligo patients, enhancing melanin distribution and reducing inflammatory factors. Overall, CAP presents a promising and safe approach for managing immune skin diseases, supported by laboratory and clinical evidence