This introductory review on plasma health care is intended to provide the interested reader with a summary of the current status of this emerging field, its scope, and its broad interdisciplinary approach, ranging from plasma physics, chemistry and technology, to microbiology, biochemistry, biophysics, medicine and hygiene. Apart from the basic plasma processes and the restrictions and requirements set by international health standards, the review focuses on plasma interaction with prokaryotic cells (bacteria), eukaryotic cells (mammalian cells), cell membranes, DNA etc. In so doing, some of the unfamiliar terminology—an unavoidable by-product of interdisciplinary research—is covered and explained. Plasma health care may provide a fast and efficient new path for effective hospital (and other public buildings) hygiene— helping to prevent and contain diseases that are continuously gaining ground as resistance of pathogens to antibiotics grows. The delivery of medically active 'substances' at the molecular or ionic level is another exciting topic of research through effects on cell walls (permeabilization), cell excitation (paracrine action) and the introduction of reactive species into cell cytoplasm. Electric fields, charging of surfaces, current flows etc can also affect tissue in a controlled way. The field is young and hopes are high. It is fitting to cover the beginnings in New Journal of Physics, since it is the physics (and non- equilibrium chemistry) of room temperature atmospheric pressure plasmas that have made this development of plasma health care possible.

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Plasma medicine: an introductory review

Plasmas for medicine

Effect of negative pressure wound therapy on wound healing.

The recent tremendous progress in understanding physical plasma phenomenon, together with the development of new plasma sources has put growing focus on the application of plasmas in health care. Active plasma components, such as molecules, atoms, ions, electrons and photons, reactive species, ultraviolet radiation, optical and infrared emission and heat have the ability of activating, controlling and catalysing reactions and complex biochemical procedures. Thermal and non-thermal (i.e. cold) plasmas - both already widely established in medicine - are used for various therapeutic applications. Particularly in dermatology, plasma applications hold big potential, for example, in wound healing, such as efficient disinfection or sterilization, therapy of various skin infections or tissue regeneration. This review gives an overview on potential plasma applications in medicine - including the recent research on skin diseases - and summarizes possible interactions between plasmas and living tissue.

Plasma applications in medicine with a special focus on dermatology

Acne is a prevalent condition in society and often results in secondary damage in the form of scarring. Of course, prevention is the optimal method to avoid having to correct the physically or emotionally troublesome scars. However, even with the best efforts, scars will certainly arise. This article attempts to give a broad overview of multiple management options, whether medically, surgically, or procedurally based. The hope is that a general knowledge of the current available alternatives will be of value to the physician when confronted with the difficult task of developing a treatment plan for acne-scarred individuals, even in challenging cases.

Acne scarring : A review and current treatment modalities

Topical negative pressure is an effective technique to promote wound healing and the integration of skin graft and synthetic dermal equivalents. We describe an in vitro model to investigate the effect of negative pressure on angiogenesis, a pivotal step. Dermal fibroblasts or human microvascular endothelial cells were cultured on Integra and subjected to intermittent or continuous negative pressure. At fixed intervals of over 120 hours, the Integra was fixed and assessed for cell migration (microscopy), cell viability (MTS assay), and cell proliferation (Ki67 immunostaining).Under control conditions, endothelial cells formed a monolayer and failed to ingress, whereas fibroblasts migrated throughout the Integra within 24 hours. Negative pressure switches endothelial cell to a migratory and proliferative phenotype. Ingress is greatest with intermittent rather than continuous negative pressure. It has no effect on dermal fibroblast function. This study identifies an important, potential pro-angiogenic mechanism by which topical negative pressure promotes wound healing.

Topical negative pressure stimulates endothelial migration and proliferation: a suggested mechanism for improved integration of Integra.

Background:A novel device for skin rejuvenation has been developed and tested. The device converts a stream of nitrogen into a plasma of ionized gas, which ablates surface tissue in a controlled manner.Methods:Eleven patients were followed up for 6 months. The results were assessed objectively using

Facial acne and fine lines: transforming patient outcomes with plasma skin regeneration

In vitro optimisation of topical negative pressure regimens for angiogenesis into synthetic dermal replacements.

Background Acute and chronic wounds are costly and invariably expose significant structures. Surgical reconstruction causes donor-site morbidity, scarring, and the need for intensive care. Reconstruction using an artificial dermis avoids donor sites, but available collagen-based solutions are susceptible to poor take. Using an in vitro angiogenic assay, the authors investigated dermal matrices for potential inclusion in a second-generation proangiogenic synthetic dermal replacement. Methods Human placental endothelial cells were cocultured on Cytodex beads (Pharmacia Biotech) and plated in eight different extracellular matrix gels (collagen, fibrin, four glycosaminoglycans, vitronectin, and fibronectin), with or without stimulation from two soluble angiogenic factors. Three different cell lines were used, with 30 beads per condition. Cellular invasion into gels was calculated using Sigma Scan computer software, and statistical comparisons were made. Results The authors found that fibrin provided greatest stimulus for endothelial invasion, with invasion in fibrin inhibited by collagen in a concentration-dependent fashion. Invasion by alternative extracellular matrix components and soluble angiogenic factors was far less than that in fibrin. Conclusions The authors identified that extracellular matrices can provide greater angiogenic potential than soluble angiogenic factors. Fibrin provided a better proangiogenic scaffold than collagen. This could well be used to encourage blood vessel ingress and eventual take of a second-generation proangiogenic synthetic dermal replacement.

Matthew J. Potter

Papers

Topical negative pressure stimulates endothelial migration and proliferation: a suggested mechanism for improved integration of Integra.

Facial acne and fine lines: transforming patient outcomes with plasma skin regeneration

In vitro optimisation of topical negative pressure regimens for angiogenesis into synthetic dermal replacements.

An investigation to optimize angiogenesis within potential dermal replacements.

A skin burn from culinary mustard.