Cold atmospheric plasma device eases severity of atopic dermatitis

Use of the cold atmospheric plasma (CAP) device, which generates free radicals through the ionization of air at room temperature, results in significantly improved mild and moderate atopic dermatitis (AD) with no serious safety concerns, a study has shown.

“CAP has the potential to effectively improve the severity of mild and moderate AD by recovering the diversity of skin microbiome, as well as promoting wound healing for damaged skin barrier,” the researchers said. “Patients’ subjective pruritic symptoms will also be alleviated by the treatment [with] CAP without safety issues.”

This prospective pilot study was conducted to examine the effectiveness and safety of CAP in AD patients. The researchers applied either CAP or sham control treatment in 22 randomly assigned patients with mild-to-moderate AD presenting with symmetric skin lesions.

Treatment sessions were carried out at weeks 0, 1, and 2, and clinical severity indices were evaluated at weeks 0, 1, 2, and 4 after treatment. In addition, the researchers analysed the microbial characteristics of the lesions before and after treatments.

CAP effectively reduced the clinical severity of AD, as shown by significant decreases in the modified AD antecubital severity (ADAS) and eczema and severity index (EASI) score among treated individuals. The scoring of atopic dermatitis (SCORAD) score and pruritic visual analogue scales (VAS) also significantly improved. [Sci Rep 2021;11:14461]

The mean modified ADAS score in the CAP group decreased to 21.56±16.07 at week 1 and 17.23±18.54 at week 2 from 33.73±21.21 at baseline. At week 4, this further decreased to 13.12±15.92.

“CAP-treated atopic skin lesions showed a significant improvement in modified ADAS score at week 4 (p<0.001) compared to sham treated lesion, which showed no statistically significant improvement (p=0.114),” the researchers said.

Furthermore, the mean EASI score gradually decreased to 3.70±2.23 at week 1 and 3.05±2.22 at week 2 from 4.24±2.82 at baseline. By end of study, the score further declined to 2.76±2.18 (p=0.002). In microbiome analysis, a substantial reduction also occurred in the proportion of Staphylococcus aureus in the treated group.

An earlier study reported significantly improved symptoms of pruritic skin with CAP treatment for an average of 4.7 times a day for 2 min. Moreover, CAP had been shown to promote skin regeneration and wound healing by increasing the interleukin (IL)-6 and transforming growth factor-beta (TGF-b) in the skin. [J Eur Acad Dermatol Venereol 2013;27:324-331; PLoS ONE 2013;8:e79325; Sci Rep 2016;6:19144]

“In this … study, patients with AD showed significant improvement in pruritic VAS (p=0.032) and atopic severity scores, including modified ADAS (p<0.001), EASI (p=0.002), and SCORAD score (p=0.001). These results support that CAP would be helpful to relieve symptoms of AD by reducing chronic itching and promoting the recovery of secondary wounds caused by scratching,” the researchers said.

“Further clinical investigations with real human atopic skin are required to prove the effectiveness of CAP as an adjuvant treatment,” they added.