Cold plasma in podiatry

Cold plasma in podiatry

Antimicrobial effect meets skin-friendly therapy

Podiatry practices are characterised by microbial contamination, chronic changes and sensitive skin and nail structures. Particularly in cases of onychomycosis, inflamed nails (nail fold) or therapy-resistant skin changes, treatment options are needed that are effective without causing additional stress.

Cold plasma offers an approach that combines therapy and prevention. Thanks to its antimicrobial effect, it can be used specifically against pathogenic agents, while protecting and even stabilising the surrounding healthy skin areas.

How does cold plasma have an antimicrobial effect?

The reactive oxygen and nitrogen species in the plasma generate a short-term oxidative stimulus. This stimulus damages the cells of fungi, bacteria and viruses: cell membranes, proteins and genetic material are attacked, limiting the pathogens' ability to reproduce.

Human skin cells react fundamentally differently. They have antioxidant protection systems and use the stimulus as a signal to activate repair mechanisms, improve microcirculation and stabilise the skin barrier. This context-dependent reaction explains why cold plasma can have an antimicrobial effect without damaging the surrounding tissue.

Podological areas of application

In podiatric practice, cold plasma can be used for, among other things:

• Nail fungus (onychomycosis))
• ingrown and inflamed nails
• Rhagades and skin cracks
• Warts
• Microbially contaminated skin
• Preventative treatment for sensitive or vulnerable skin

The exact treatment parameters – duration, frequency and interval – can be adjusted individually (see table).

* Only to the extent permitted by regulations and with appropriate qualifications

Practical examples: Nail fungus treatment

The documented case studies show typical courses of cold plasma treatment for onychomycosis. An intensive therapy phase lasting approximately 6 weeks is followed by a growth phase in which the nail regrows free of fungus. Cold plasma can be used preventively during this phase.

In addition to reducing fungal infection, additional effects have been observed in individual cases, such as improved sensitivity to touch or improved skin condition in the surrounding nail area. The case studies thus illustrate the potential of cold plasma as an integral part of podiatric treatment concepts.

CASE STUDIES FROM PODIATRY

Agenda

Cold plasma: controlled physics for skin, nails and microorganisms

• Cold plasma in podiatry
• Cold plasma in foot care & cosmetics
• How cold plasma treatment with GEHWOL TECH works

Literature review

(A) Antifungal effects of cold plasma

[1] Gnat, S., Łagowski, D., Dyląg, M. et al. Cold atmospheric pressure plasma (CAPP) as a new alternative treatment method for onychomycosis caused by Trichophyton verrucosum: in vitro studies. Infection 49, 1233–1240 (2021). https://doi.org/10.1007/s15010-021-01691-w
[2] S. R. Lipner, G. Friedman, R. K. Scher, Pilot study to evaluate a plasma device for the treatment of onychomycosis, Clinical and Experimental Dermatology, Volume 42, Issue 3, 1 April 2017, Pages 295–298, https://doi.org/10.1111/ced.12973
[3] Xiong, Z., Roe, J., Grammer, T.C. and Graves, D.B. (2016), Plasma Treatment of Onychomycosis. Plasma Process. Polym., 13: 588-597. https://doi.org/10.1002/ppap.201600010

(B) Hormesis effects and regenerative effects of cold plasma

[4] Schmidt A, Dietrich S, Steuer A, Weltmann KD, von Woedtke T, Masur K, Wende K. Non-thermal plasma activates human keratinocytes by stimulation of antioxidant and phase II pathways. J Biol Chem. 2015 Mar 13;290(11):6731-50. https://doi.org/10.1074/jbc.M114.603555
[5] von Woedtke, T., Schmidt, A., Bekeschus, S., Wende, K., & Weltmann, K.-D. (2019). Plasma Medicine: A Field of Applied Redox Biology. In Vivo, 33(4), 1011–1026. https://doi.org/10.21873/invivo.11570
[6] Ahn, G. R., Park, H. J., Koh, Y. G., Shin, S. H., Kim, Y. J., Song, M. G., Lee, J. O., Hong, H. K., Lee, K. B., & Kim, B. J. (2022). Low-intensity cold atmospheric plasma reduces wrinkles on photoaged skin through hormetic induction of extracellular matrix protein expression in dermal fibroblasts. Lasers in Surgery and Medicine, 54(7), 978–993. https://doi.org/10.1002/lsm.23559
[7] Schmidt, A., Bekeschus, S., Wende, K., Vollmar, B., & von Woedtke, T. (2017). A cold plasma jet accelerates wound healing in a murine model of full-thickness skin wounds. Experimental Dermatology, 26(2), 156–162. https://doi.org/10.1111/exd.13156
[8] Jung, J. M., Yoon, H. K., Won, C. H., Seo, Y. K., & Park, Y. W. (2021). Cold Plasma Treatment Promotes Full-thickness Healing of Skin Wounds in Murine Models. Journal of Experimental & Clinical Medicine, 13(2), 456–467. https://doi.org/10.1177/15347346211002144
[9] von Woedtke, T., Schmidt, A., Bekeschus, S., Wende, K., & Weltmann, K.-D. (2019). Plasma Medicine: A Field of Applied Redox Biology. In Vivo, 33(4), 1011–1026. https://doi.org/10.21873/invivo.11570
[10] Tan, F., Wang, Y., Zhang, S., Shui, R., & Chen, J. (2022). Plasma Dermatology: Skin Therapy Using Cold Atmospheric Plasma. Frontiers in Oncology, 12, 918484. https://doi.org/10.3389/fonc.2022.918484
[11] Busco, G., Robert, E., Chettouh-Hammas, N., Pouvesle, J.-M., & Grillon, C. (2020). The emerging potential of cold atmospheric plasma in skin biology. Free Radical Biology and Medicine, 161, 290–304. https://doi.org/10.1016/j.freeradbiomed.2020.10.004
[12] Choi, J. H., Song, Y. S., Song, K., Lee, H. J., Hong, J. W., & Kim, G. C. (2016). Skin renewal activity of non-thermal plasma through the activation of β-catenin in keratinocytes. Scientific Reports, 6, 27376. https://doi.org/10.1038/srep27376
[13] Kisch, T., Schleusser, S., Limpert, R., Seuser, A., Mailänder, P., Kraemer, R., & Arnemann, J. (2016). Initiation of microcirculation by cold atmospheric plasma. Wound Repair and Regeneration, 24(6), 1023–1030. https://doi.org/10.1111/wrr.12479