In recent years, cold atmospheric plasma has been successfully used for wound treatment. The cold plasma can be applied painlessly to wounds with a pen. Studies show antimicrobial effects and acceleration of wound healing. The guideline published this year is intended to help better exploit the potential of this forward-looking technology.
Der therapeutische Einsatz von Kaltplasma (Kasten) hat sich inzwischen insbesondere bei chronischen und infektionsgefährdeten Wunden zu einem etablierten Verfahren entwickelt [1,8]. Studien zeigen, dass Plasmabehandlung mit einer signifikanten Keimreduktion assoziiert ist und sehr gut vertragen wird, so Prof. Dr. med. Steffen Emmert, Klinikdirektor, Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock [1]. In einer multizentrischen Studie zum diabetischen Fussulcus konnte ausserdem eine schnellere Wundheilung im Vergleich zu Standardtherapie nachgewiesen werden [2].
| What is cold plasma and how does it work?The plasma device generates an ionized gas composed of electrons, ions, ozone and other reactive compounds (Fig. 1). This plasma is then cooled to body temperature for painless application to wounds [4]. The plasma components inactivate bacteria, multi-resistant pathogens, fungi and also viruses [6]. During treatment, the plasma creates micropores in the cell membrane of the pathogens, penetrates the cell and inactivates the pathogen. Human cells are not damaged by plasma because they are protected by the cell membrane and cell biological protective mechanisms. It is a well effective treatment method with few side effects, summarizes Prof. Dr. med. Steffen Emmert, Clinic Director, Clinic and Polyclinic for Dermatology and Venerology, University Medical Center Rostock [1]. |
Accelerated wound healing has been demonstrated several times
In the multicenter study published in 2020, cold plasma was applied to the wound surface with a pen for 30 seconds per cm² of wound area in 62 diabetic foot ulcers from 43 hospitalized patients [2]. This procedure was initially performed daily and later every two days. The control group received placebo treatment with inactivated plasma. After 14 days, the wound surface area decreased to a mean of 30.5% of the original size under cold plasma treatment (vs. 55.2% in the placebo group; p=0.03). Wound healing started earlier in those treated with cold plasma, which contributed to a decrease in infections. A study published this year confirmed the great potential of the cold plasma pen to promote the healing of chronic wounds [3]. A pilot study also published in 2020 suggests that lower treatment frequencies may be sufficient. In this, both once-weekly and thrice-weekly treatment proved superior in placebo comparisons. Significant reduction in wound area (63.0% and 46.8%, respectively) was achieved in both groups (n=14, n=13) [4].
Other dermatological indications possible
“Plasma can also help with rare diseases,” the speaker said. Thus, in patients with epidermolysis bullosa, there are indications from smaller studies of positive effects using cold plasma as an add-on therapy. The question of whether plasma can be integrated into a wound dressing was the starting point of a study in patients after split skin removal [5]. Compared to standard wound dressings, wound dressings with cold plasma resulted, among other things, in better blood circulation and less edema occurred (p<0.001) [5]. Furthermore, there is evidence of positive effects of cold plasma treatment in rosacea patients (reduction of erythema). Another potential application of cold plasma is laser assisted drug delivery, as cold atmospheric plasma makes the skin barrier more permeable for the delivery of active ingredients. And a major area of research currently is the use of cold plasma for cancer treatment. The basic idea is that the plasma destroys the cancer cells (e.g. melanocytes) in a targeted manner without affecting the healthy cells. Plasma treatment can be thought of as a kind of radiation therapy, but without the negative side effects, Prof. Emmert said.
Congress: Nuremberg Wound Congress
Literature:
- Emmert S: Modern wound treatment with cold plasma: disinfection, anti-inflammation and regeneration, Nuremberg Wound Congress, 01.12.2022.
- Stratmann B, et al: Effect of Cold Atmospheric Plasma Therapy vs Standard Therapy Placebo on Wound Healing in Patients With Diabetic Foot Ulcers: A Randomized Clinical Trial. JAMA Network Open 2020; 3(7): e2010411.
- Strohal R, et al: Chronic wounds treated with cold atmospheric plasmajet versus best practice wound dressings: a multicenter, randomized, non-inferiority trial. Scientific Reports; 2022; DOI: 10.1038/s41598-022-07333-x.
- Moelleken M, et al: Pilot study on the influence of cold atmospheric plasma on bacterial contamination and healing tendency of chronic wounds. J Dtsch Dermatol Ges 2020; 18(10): 1094-1102.
- van Welzen A, et al: The Response and Tolerability of a Novel Cold Atmospheric Plasma Wound Dressing for the Healing of Split Skin Graft Donor Sites: A Controlled Pilot Study. Skin Pharmacol Physiol 2021; 34(6): 328-336.
- “Cold Plasma Therapy for Chronic Wounds and Skin Diseases,” https://haut.nrw/2022/01/08/kaltplasmatherapie-bei-chronischen-wunden-un… , (last accessed 03.12.2022)
- Boeckmann L, et al: Cold Atmospheric Pressure Plasma in Wound Healing and Cancer Treatment. Appl Sci 2020; 10: 6898. https://doi. org/10.3390/app10196898
- S2k Guideline. Rational therapeutic use of cold physical plasma. AWMF Register No.: 007-107, as of February 23, 2022.
DERMATOLOGIE PRAXIS 2022; 32(6): 30
