The effect of nitrogen plasma on the skin and hair follicles: a possible promising future for the treatment of alopecia

Cold atmospheric plasma (CAP) treatment increased reactive oxygen and nitrogen species (RONS) levels in tumor samples obtained from patients with low-grade glioma

Low-grade gliomas (LGGs) are a heterogeneous group of tumors with an average 10-year survival rate of 40%-55%. Current treatment options include chemotherapy, radiotherapy, and gross total resection (GTR) of the tumor. The extent of resection (EOR) plays an important role in improving surgical outcomes. However, the major obstacle in treating low-grade gliomas is their diffused nature and the presence of residual cancer cells at the tumor margins post resection. Cold Atmospheric Plasma (CAP) has shown to be effective in targeted killing of tumor cells in various glioma cell lines without affecting non-tumor cells through Reactive Oxygen and Nitrogen Species (RONS). However, no study on the effectiveness of CAP has been carried out in LGG tissues till date. In this study, we applied helium-based CAP on tumor tissues resected from LGG patients. Our results show that CAP is effective in promoting RONS accumulation in LGG tissues when CAP jet parameters are set at 4 kV voltage, 5 min treatment time and 3 lpm gas flow rate. We also observed that CAP jet is more effective in thinner slice preparations of tumor as compared to thick tumor samples. Our results indicate that CAP could prove to be an effective adjunct therapy in glioma surgery to target residual cancer cells to improve surgical outcome of patients with low-grade glioma.

The FEDBD plasma's quantitative investigation of skin parameters: Skin elasticity, thickness, density, tissue oxygenation, perfusion, and edema

This study used the FEDBD plasma device for skin rejuvenation in animal samples. There were two groups of six male Wistar rats. Before starting the treatment, immediately after the treatment, the fourth week, and the tenth week of follow-up, biometric tests were performed, including moisture level, evaporation from the skin surface, erythema and melanin, skin elasticity and firmness with an MPA9 device and cutometer. The thickness and density of the epidermis and dermis, an essential indicator in rejuvenation, were evaluated with a skin ultrasound device. Also, the level of oxygen, perfusion, and interstitial water (edema) was checked using a Tivita tissue hyperspectral camera at a depth of 6 mm of the skin.

Atmospheric pressure plasma treatment of skin: penetration into hair follicles

Sterilization of skin prior to surgery is challenged by the reservoir of bacteria that resides in hair follicles. Atmospheric pressure plasma jets (APPJs) have been proposed as a method to treat and deactivate these bacteria as atmospheric plasmas are able to penetrate into structures and crevices with dimensions similar to those found in hair follicles. In this paper, we discuss results from a computational investigation of an APPJ sustained in helium flowing into ambient air, and incident onto a layered dielectric similar to human skin in which there are idealized hair follicles. We found that, depending on the location of the follicle, the bulk ionization wave (IW) incident onto the skin, or the surface IW on the skin, are able to launch IWs into the follicle. The uniformity of treatment of the follicle depends on the location of the first entry of the plasma into the follicle on the top of the skin. Typically, only one side of the follicle is treated on for a given plasma pulse, with uniform treatment resulting from rastering the plasma jet across the follicle over many pulses. Plasma treatment of the follicle is sensitive to the angle of the follicle with respect to the skin, width of the follicle pocket, conductivity of the dermis and thickness of the underlying subcutaneous fat layer, the latter due to the change in capacitance of the tissue.

The quantitative investigation of spark plasma on skin parameters with skin elasticity, thickness, density, and biometric characteristics

Cold atmospheric plasma has been developed and utilized as a novel technique for skin rejuvenation because of its various effects on cells and living things. This study investigated the accuracy of this claim and any possible side effects of using spark plasma to rejuvenate skin. The present work is the first quantitative investigation using animal models. 12 Wistar rats were divided into two groups for this investigation. To compare the skin's natural process with the treated skin, the first group underwent a single session of plasma therapy, while the second group served as the control group. The back of the necks of the samples was shaved for 20 cm. Before beginning treatment, the MPA9 multifunctional skin tester was used to determine the melanin index, erythema index, and transepidermal water loss (TEWL). The skin's thickness and density were assessed using sonography, and its elasticity index was calculated using a Cutometer. The samples were exposed to plasma radiation in the designated area (in a triangular pattern). The abovementioned signs were examined immediately after the following therapy and at the weekly appointment 2-4 weeks later. Optical spectroscopy was also used to demonstrate the presence of active species. In this study, we found that a plasma spark therapy session significantly boosts skin elasticity, and the ultrasound results revealed a significantly increased skin thickness and density. The plasma increased the amount of skin surface evaporation, erythema, and melanin immediately following the treatment. However, 4 weeks later, it recovered to its former state and did not differ significantly from before the therapy.

Split-face comparison of hydroquinone 4% plus nitrogen plasma vs. hydroquinone 4% alone in the treatment of melasma

Treatment of skin diseases is important yet challenging. One of the most common skin diseases in women is melasma, which features acquired facial hyperpigmentation. We studied the effect of cold atmospheric nitrogen plasma on this disease. To characterize the nitrogen plasma, we obtained the relative intensity of the species and the plasma temperature and skin temperature during processing at different input powers and gas flows. Patients complaining of melasma were treated with hydroquinone on both sides of the face, and one side was randomly selected for additional nitrogen plasma therapy. Eight treatment sessions of plasma processing were provided 1 week apart, and one follow-up session was scheduled 1 month after the end of treatment. The rate of improvement was scored by a dermatologist in the eighth session and 1 month following the last session using the modified Melasma Area Severity Index (mMASI). Skin biomechanical characteristics such as melanin, cutaneous resonance running time (CRRT), transepidermal water loss (TEWL), and hydration were measured at baseline and during the fourth, eighth, and follow-up sessions. On both sides, we observed a significant decrease in both CRRT and melanin (P < 0.05). TEWL did not change on both sides, while hydration decreased significantly only on the side to which hydroquinone was applied in isolation (P < 0.05). According to clinical scores, on both sides, we had significant improvement. On the side that plasma was not applied, the percentage reduction of pigmentation (mMASI) in the eighth and follow-up sessions in comparison with the baseline was 5.49 ± 8.50% and 33.04 ± 9.17%, respectively, while on the other side, these figures were 20.57 ± 6.64% and 48.11 ± 11%. For melanin, these figures were 13.84 ± 4.84% and 18.23 ± 7.10% on the hydroquinone side and 21.56 ± 3.13% and 23.93 ± 3.02% on the other side. According to these results, nitrogen plasma can safely complement topical hydroquinone to improve clinical outcomes when treating melasma without causing stratum corneum damage or skin discomfort, though confirmatory studies are needed.

Cold Atmospheric Plasma Inhibits Lipogenesis and Proliferation of Human Sebocytes and Decreases Sebum Production in Human Facial Skin

Background. Although several energy devices targeting sebaceous glands have been developed, an effective and safe therapeutic tool for hyperseborrhea is still needed. Nonthermal atmospheric-pressure plasma (NTAPP) induces microscopic tissue reactions in sebaceous glands of rat skin. Objective. The aim of the study is to investigate the effects of NTAPP on sebum production in human skin in vivo followed by an experimental study of human sebocytes. Methods. Fourteen healthy volunteers with oily facial skin underwent three sessions of argon- and nitrogen-NTAPP treatment at a 1-week interval and were followed up for 8 weeks. The casual sebum level, sebum excretion rate, and porphyrin index were evaluated. Histological analysis was performed using skin biopsy specimens taken from two subjects at the baseline and week 2. SZ95 sebocytes were stimulated with testosterone and linoleic acid (T/LA) with or without treatment with NTAPP. BODIPY and Nile red staining were used for qualitative lipids analysis. Proliferation and differentiation markers were also assessed. Results. Casual sebum levels and sebum excretion rates in facial skin decreased by 26 and 24%, respectively, at week 4 compared to those of the baseline. Porphyrin index also decreased by 38% at week 2. Histologically, NTAPP-treated human skin showed no obvious thermal injury, but the number of Ki67+ cells in the sebaceous glands decreased at week 2. Argon- and nitrogen-NTAPP attenuated T/LA-induced increases in neutral lipid accumulation, Ki67+ cells, and peroxisome proliferator-activated receptor-ɣ transcription in human sebocytes at energy settings that did not induce apoptosis. Conclusion. Argon- and nitrogen-NTAPP can be a safe and effective therapeutic tool for hyperseborrhea-associated diseases such as acne. This trial is registered with NCT04917835.

Effects of Human Fibroblast-Derived Multi-Peptide Factors on the Proliferation and Migration of Nitrogen Plasma-Treated Human Dermal Fibroblasts

Background

Human fibroblast-derived multi-peptide factors (MPFs) promote wound repair by playing crucial roles in cell recruitment, adhesion, attachment, migration, and proliferation.

Methods

Cultured human dermal fibroblasts (HDFs) were directly treated with non-contact low- and high-energy nitrogen plasma and further cultured in various conditioned media. Cell proliferation and wound-healing properties were evaluated.

Results

In Opti-modified Eagle’s medium + GlutaMAX culture, reduced HDF viability was observed 24 h after 2-J/pulse plasma treatment and 12 and 24 h after 3-J/pulse treatment. Meanwhile, in dermal fibroblast-conditioned medium (DFCM) containing MPF culture, reduced HDF viability was observed only 24 h after 3-J/pulse treatment. Under DFCM-MPF culture, the wound area percentage was significantly decreased after 12 and 24 h in untreated HDFs; at 9, 12, and 24 h after 1-J/pulse plasma treatment; at 3, 6, 9, 12, and 24 h after 2-J/pulse plasma treatment; and at 9, 12, and 24 h after 3-J/pulse plasma treatment. Greater migration of HDFs with or without plasma treatment was found in DFCM-MPFs than in other conditioned media.

Conclusion

Low-energy nitrogen plasma treatment promotes HDF proliferation and wound repair. DFCM-MPFs enhanced cell proliferation and improved the wound healing properties of HDFs treated with low- and high-energy plasma.

Plasma Dermatology: Skin Therapy Using Cold Atmospheric Plasma

Cold atmospheric plasma-based plasma medicine has been expanding the diversity of its specialties. As an emerging branch, plasma dermatology takes advantage of the beneficial complexity of plasma constituents (e.g., reactive oxygen and nitrogen species, UV photons, and electromagnetic emission), technical versatility (e.g., direct irradiation and indirect aqueous treatment), and practical feasibility (e.g., hand-held compact device and clinician-friendly operation). The objective of this comprehensive review is to summarize recent advances in the CAP-dominated skin therapy by broadly covering three aspects. We start with plasma optimisation of intact skin, detailing the effect of CAP on skin lipids, cells, histology, and blood circulation. We then conduct a clinically oriented and thorough dissection of CAP treatment of various skin diseases, focusing on the wound healing, inflammatory disorders, infectious conditions, parasitic infestations, cutaneous malignancies, and alopecia. Finally, we conclude with a brief analysis on the safety aspect of CAP treatment and a proposal on how to mitigate the potential risks. This comprehensive review endeavors to serve as a mini textbook for clinical dermatologists and a practical manual for plasma biotechnologists. Our collective goal is to consolidate plasma dermatology’s lead in modern personalized medicine.

Applications of Plasma-Activated Liquid in the Medical Field

Much progress has been made since plasma was discovered in the early 1900s. The first form of plasma was thermal type, which was limited for medical use due to potential thermal damage on living cells. In the late 1900s, with the development of a nonthermal atmospheric plasma called cold plasma, profound clinical research began and ‘plasma medicine’ became a new area in the academic field. Plasma began to be used mainly for environmental problems, such as water purification and wastewater treatment, and subsequent research on plasma and liquid interaction led to the birth of ‘plasma-activated liquid’ (PAL). PAL is currently used in the fields of environment, food, agriculture, nanoparticle synthesis, analytical chemistry, and sterilization. In the medical field, PAL usage can be expanded for accessing places where direct application of plasma is difficult. In this review, recent studies with PAL will be introduced to inform researchers of the application plan and possibility of PAL in the medical field.

In vivo study of the effects of a portable cold plasma device and vitamin C for skin rejuvenation

Nowadays, cold atmospheric plasma shows interesting results in dermatology. In the present study, a new portable cold plasma was designed for plasma skin rejuvenation (PSR) purposes. This device is safe and easy to use at beauty salons and homes. The effects of this device were investigated on the rat skins. Also, as a new method to improve PSR results, vitamin C ointment was combined with plasma. In this study, there were four groups of 5 Wistar rats. The first group received vitamin C ointment, the second received 5 min of high-voltage plasma, and the third and the fourth groups received 5 min of high- and low-voltage plasma and vitamin C ointment. This process was done every other day (3 sessions per week) for 6 weeks. To evaluate the thermal effect of plasma, the skin temperature was monitored. Also, the presence of reactive species was demonstrated by the use of optical spectroscopy. In addition, mechanical assays were performed to assess the effect of plasma and vitamin C on the tissue's mechanical strength. The mechanical assays showed a positive impact of plasma on the treated tissue compared to the control group. Also, changes in the collagen level and thickness of the epidermal layer were examined in histological studies. The results indicated an increase in collagen levels after using plasma alone and an accelerated skin reaction after using vitamin C combined with plasma therapy. The epidermal layer's thickness increased after applying high-voltage plasma, which indicates an increase in skin elasticity. This study demonstrates the positive effect of using the portable plasma device with vitamin C ointment on effective parameters in skin rejuvenation.

Evaluation of the efficacy and safety of plasma exeresis in periorbital rejuvenation using the Reviscometer®

BACKGROUND

Periorbital rejuvenation is performed through various methods. Recently, plasma exeresis has been suggested for the treatment of dermatochalasis and periorbital wrinkles.

AIMS

To evaluate the clinical efficacy and safety of plasma exeresis in periorbital rejuvenation and palpebral laxity and assess its effectiveness using the Reviscometer^® .

PATIENTS/METHODS

Fifty-six women with mild-to-severe dermatochalasis and periorbital wrinkles volunteered to participate in this clinical trial. They received plasma exeresis thrice at one-month intervals. The efficacy of the intervention was evaluated according to the Cutaneous Resonance Running Time (CRRT) value changes, photographic changes, patients' satisfaction, and clinical side effects.

RESULTS

This study showed significant clinical improvements in dermatochalasis and palpebral laxity after treatment compared with the baseline (p < 0.001). Most of the participants had relative satisfaction, and no significant or permanent side effects were observed.

CONCLUSION

The findings of this study suggest that plasma exeresis is a safe and effective nonsurgical method for periorbital rejuvenation. Furthermore, the procedure has no serious adverse effects if performed correctly and for the right patient.

Non-thermal atmospheric pressure plasma activates Wnt/β-catenin signaling in dermal papilla cells

There is an unmet need for novel, non-pharmacological therapeutics to treat alopecia. Recent studies have shown the potential biological benefits of non-thermal atmospheric pressure plasma (NTAPP), including wound healing, angiogenesis, and the proliferation of stem cells. We hypothesized that NTAPP might have a stimulatory effect on hair growth or regeneration. We designed an NTAPP-generating apparatus which is applicable to in vitro and in vivo experiments. The human dermal papilla (DP) cells, isolated fresh hair follicles, and mouse back skin were exposed with the NTAPP. Biological outcomes were measured using RNA-sequencing, RT-PCR, Western blots, and immunostaining. The NTAPP treatment increased the expression levels of Wnt/β-catenin pathway-related genes (AMER3, CCND1, LEF1, and LRG1) and proteins (β-catenin, p-GSK3β, and cyclin D1) in human DP cells. In contrast, inhibitors of Wnt/β-catenin signaling, endo-IWR1 and IWP2, attenuated the levels of cyclin D1, p-GSK3β, and β-catenin proteins induced by NTAPP. Furthermore, we observed that NTAPP induced the activation of β-catenin in DP cells of hair follicles and the mRNA levels of target genes of the β-catenin signaling pathway (CCND1, LEF1, and TCF4). NTAPP-treated mice exhibited markedly increased anagen induction, hair growth, and the protein levels of β-catenin, p-GSK3β, p-AKT, and cyclin D1. NTAPP stimulates hair growth via activation of the Wnt/β-catenin signaling pathway in DP cells. These findings collectively suggest that NTAPP may be a potentially safe and non-pharmacological therapeutic intervention for alopecia.

Efficacy and safety of non-thermal nitrogen plasma versus long-pulsed Nd:YAG laser for hand rejuvenation

This randomized controlled study aimed to investigate the efficacy and safety of multiple treatment sessions of pulsed non-thermal atmospheric pressure nitrogen plasma compared with long-pulsed Nd:YAG laser for hand rejuvenation. To optimize the nitrogen plasma mode for rejuvenation, the relative intensity of reactive species and skin temperature was compared at different input powers and time periods. Twenty-five patients with mild-moderate photodamaged skin were recruited; one hand was randomly selected for eight weekly treatment sessions with plasma (two passes), while the other was subjected to three monthly treatments with laser (until erythema became obvious). A blinded dermatologist scored the mean wrinkle and dyschromia improvement at 1 and 2 months after the first treatment and 1 and 3 months after the last treatment. The patients' satisfaction and the biomechanical characteristics of the skin including cutaneous resonance running time (CRRT), melanin, transepidermal water loss (TEWL), and hydration were evaluated. Clinically, both methods gave rise to a similar, significant improvement in wrinkles (49.09 ± 19.18% and 39.32 ± 18.21% after plasma and laser, respectively) and dyschromia (45.00 ± 26.32% and 30.62% ± 24.99% after plasma and laser, respectively) (P < 0.05). A significant decrease in CRRT and melanin was seen following treatment with either method (P < 0.05). Notably, plasma therapy led to a significant decrease in TEWL and boosted skin hydration. This is while laser therapy augmented the TEWL and reduced skin hydration. Our findings corroborate that cold plasma is as effective and safe as long-pulsed Nd:YAG laser, with less discomfort and dryness during treatment. The protocol was approved by the Iranian Registry of Clinical Trials. IRCT20160320027109N4. Registered 9 April 2019 (This manuscript is only a part of this registered project.).

Cold atmospheric pressure (physical) plasma in dermatology: where are we today?

Cold atmospheric pressure plasma is physical plasma (essentially ionized gas) created at room temperature and atmospheric pressure, and it has complex effects on cells, tissues, and living organisms. These effects are studied extensively for medical and dermatological use. This article reviews current achievements and new trends in clinical dermatological cold plasma research, discusses the basics of plasma physics and plasma engineering, and describes the most important areas of laboratory plasma research to provide a well-rounded understanding of the nature, present applications, and future promise of this exciting, emerging technology.