The topical use of non-thermal dielectric barrier discharge (DBD): Nitric oxide related effects on human skin

• Non-thermal dielectric barrier discharge (DBD) was used to generate air plasma.
• The generated air plasma contains nitric oxide (NO), ozone and nitrogen dioxide.
• Air plasma treatment lowers skin pH and induces NO penetration through epidermis.
• Air plasma treatment of skin increased dermal NO stores without damaging the skin.
• Air plasma treatment enhances dermal microcirculation in vivo.

Dielectric barrier discharge (DBD) devices generate air plasma above the skin containing active and reactive species including nitric oxide (NO). Since NO plays an essential role in skin physiology, a topical application of NO by plasma may be useful in the treatment of skin infections, impaired microcirculation and wound healing.Thus, after safety assessments of plasma treatment using human skin specimen and substitutes, NO-penetration through the epidermis, the loading of skin tissue with NO-derivates in vitro and the effects on human skin in vivo were determined.After the plasma treatment (0–60 min) of skin specimen or reconstructed epidermis no damaging effects were found (TUNEL/MTT). By Franz diffusion cell experiments plasma-induced NO penetration through epidermis and dermal enrichment with NO related species (nitrite 6-fold, nitrate 7-fold, nitrosothiols 30-fold) were observed. Furthermore, skin surface was acidified (~pH 2.7) by plasma treatment (90 s). Plasma application on the forearms of volunteers increased microcirculation fourfold in 1–2 mm and twofold in 6–8 mm depth in the treated skin areas.Regarding the NO-loading effects, skin acidification and increase in dermal microcirculation, plasma devices represent promising tools against chronic/infected wounds. However, efficacy of plasma treatment needs to be quantified in further studies and clinical trials.