Soğuk Atmosferik Plazma (CAP): Cilt Hastalıkları için Non-İnvaziv ve Ağrısız Bir Tedavi

Abstract

Soğuk Atmosferik Plazma (CAP), tıp, gıda işleme, tarım ve endüstri gibi geniş bir yelpazede çok yönlü uygulamalarıyla dikkat çeken çığır açıcı bir teknoloji olarak ortaya çıkmıştır. Bu kapsamlı inceleme, CAP’nin akne, atopik dermatit, rozasea, vitiligo, sedef hastalığı ve otoimmün cilt bozuklukları gibi geniş bir cilt hastalığı yelpazesini tedavi etmedeki terapötik potansiyelini sistematik olarak değerlendirmektedir. CAP’nin etkinliği, reaktif türlerin üretimi, maliyet etkinliği, çevresel sürdürülebilirlik ve cihaz taşınabilirliği gibi benzersiz özelliklerine bağlanmaktadır; bu özellikler, nitrojen, argon veya helyum gibi gazlar kullanılarak dielektrik bariyer deşarjı, korona deşarjı ve yüzer elektrot yöntemleri gibi tekniklerle desteklenmektedir. 2013'ten 2025'e kadar olan hakemli çalışmaları kapsayan kapsamlı bir analiz aracılığıyla, bu araştırma, CAP'nin dermatolojik uygulamalarda son derece etkili ve uyarlanabilir bir araç olduğunu vurgulamaktadır. Bulgular, CAP’nin patojenleri nötralize etme, inflamatuar ve otoimmün yanıtları modüle etme kapasitesini öne çıkararak, onu klinik dermatolojide umut verici bir yöntem olarak konumlandırmaktadır. Bu titiz ve kapsamlı derleme, CAP tedavi protokollerinin optimize edilmesi, uygulama sistemlerinin geliştirilmesi ve genişleyen biyomedikal ile disiplinlerarası alanlarda terapötik potansiyelinin tam anlamıyla araştırılması için gelecekteki çalışmalara duyulan kritik ihtiyacı vurgulamaktadır.

Keywords

• Soğuk Atmosferik Plazma (CAP)
• cilt hastalığı
• akne
• atopik dermatit
• sedef hastalığı
• rozasea (gül hastalığı)
• vitiligo

Cold Atmospheric Plasma (CAP): A Non-Invasive and Painless Treatment for Skin Diseases

Abstract

Cold Atmospheric Plasma (CAP) has emerged as a groundbreaking technology, attracting substantial interest for its versatile applications across medicine, food processing, agriculture, and industry. This comprehensive review systematically evaluates CAP’s therapeutic potential in treating a wide range of skin diseases, including acne, atopic dermatitis, rosacea, vitiligo, psoriasis, and autoimmune skin disorders. The efficacy of CAP is attributed to its unique characteristics, including the generation of reactive species, cost-effectiveness, environmental sustainability, and device portability, facilitated by techniques such as dielectric barrier discharge, corona discharge, and floating electrode methods, utilizing gases like nitrogen, argon, or helium. Through an exhaustive analysis of peer-reviewed studies spanning 2013 to 2025, this research underscores CAP’s role as a highly effective and adaptable tool in dermatological applications. The findings highlight CAP’s capacity to neutralize pathogens, modulate inflammatory and autoimmune responses, establishing it as a promising modality in clinical dermatology. This rigorous and comprehensive review emphasizes the critical need for future research to optimize CAP treatment protocols, enhance delivery systems, and fully explore its therapeutic potential across expanding biomedical and interdisciplinary fields.

Keywords

• Cold Atmospheric Plasma (CAP)
• skin disease
• acne
• atopic dermatitis
• psoriasis
• rosacea
• vitiligo

References

1. Menon GK, Kligman AM. Barrier functions of human skin: a holistic view. Skin Pharmacol Physiol. 2009;22(4):178-189. 10.1159/000231523.
2. Tan F, Wang Y, Zhang S, Shui R, Chen J. Plasma Dermatology: Skin therapy using cold atmospheric plasma. Front Oncol. 2022;12:918484. 10.3389/fonc.2022.918484.
3. Kim BC, Rana JN, Choi EH, Han I. Improvement of transdermal absorption rate by nonthermal biocompatible atmospheric pressure plasma. Drug Metab Pharmacokinet. 2024;54: 100536. https://doi.org/10.1016/j.dmpk.2023.100536.
4. Zhou J. Sun Z. Wang X. Wang S. Jiang W. Tang D. Xia T. Xiao F. Low-temperature cold plasma promotes wound healing by inhibiting skin inflammation and improving skin Microbiome. Front.Bioeng. Biotechnol. 2025;3:1511259. https://doi.org/10.3389/fbioe.2025.1511259.
5. Sharma N, Chaudhary SM, Khungar N, Aulakh SK, Idris H, Singh A, et al. Dietary Influences on Skin Health in Common Dermatological Disorders. Cureus. 2024; 16(2):10.7759/cureus.55282.
6. Gnat S, Łagowski D, Nowakiewicz A. Genetic predisposition and its heredity in the context of ıncreased prevalence of dermatophytoses. Mycopathol. 2021;186(2):163-176. 10.1007/s11046-021-00529-1.
7. Parrado C, Mercado-Saenz M, Perez-Davo A, Gilaberte Y, Gonzalez S, Juarranz A. Environmental stressors on skin aging. mechanistic insights. Front Pharmacol. 2019;10. 10.3389/fphar.2019.00759.
8. Kanda N, Hoashi T, Saeki H. 2019; The roles of sex hormones in the course of atopic dermatitis. Int J Mol Sci. 20(19): 4660. 10.3390/ijms20194660.

9. Xiao ZX, Miller JS, Zheng SG. 2021; An updated advance of autoantibodies in autoimmune diseases. Autoimmun Rev. 20(2): 102743. 10.1016/j.autrev.2020.102743.
10. Ma Y, Sun T, Ren K, Min T, Xie X, Wang H, et al. Applications of cold atmospheric plasma in immune-mediated inflammatory diseases via redox homeostasis: evidence and prospects. Heliyon. 2023;9(12): e22568. 10.1016/j.heliyon.2023.e22568.
11. Akarsu S, İlknur T, Erdemir Y, Gün M, Akyaz P, Bozkanat KM, et al. Onset characteristics and accompanying autoimmune diseases in autoimmune bullous dermatoses. J DEU Med. 2010;24(2):57-63.
12. Hoffmann JHO, Enk, AH. High-dose intravenous immunoglobulin in skin autoimmune disease. Front Immunol. 2019;10.10.3389/fimmu.2019.01090.
13. Zhai SY, Kong MG, Xia YM. Cold atmospheric plasma ameliorates skin diseases involving reactive oxygen/nitrogen species-mediated functions. Front Immunol. 2022;13:868386. 10.3389/fimmu.2022.868386.
14. Mruwat R, Cohen,Y, Yedgar S. Phospholipase A2 inhibition as potential therapy for inflammatory skin diseases. Immunotherapy. 2013;5(4):315-317. 10.2217/imt.13.18.
15. Adhikari BR, Khanal R. Introduction to the plasma state of matter. HimPhys. 2013;4:60-64. 10.3126/hj.v4i0.9430.
16. Braný D, Dvorská D, Halašová E Škovierová H. Cold atmospheric plasma: A powerful tool for modern medicine. Int J Mol Sci. 2020;21(8):2932.10.3390/ijms21082932.
17. Chaudhary K, Imam AM, Rizvi SZH, Ali J. Plasma kinetic theory. Kinetic Theory; InTech: Rijeka, Croatia. 2018;107-127.10.5772/intechopen.70843.
18. Chen Z, Chen G, Obenchain R, Zhang R, Bai F, Fang T, et al. Cold atmospheric plasma delivery for biomedical applications. Mater. Today. 2022;54:153–188. https://doi.org/10.1016/j.mattod.2022.03.001.
19. Stańczyk B, Wiśniewski M. The promising potential of cold atmospheric plasma therapies. Plasma. 2024;7(2):465-497. https://doi.org/10.3390/plasma7020025.
20. Sakudo A, Yagyu Y, Onodera T. Disinfection and sterilization using plasma technology: fundamentals and future perspectives for biological applications. Int J Mol Sci. 2019;20:5216. 10.3390/ijms20205216.
21. Chen YH, Hsieh JH, Wang IT, Jheng PR, Yeh YY, Lee JW, et al. Transferred cold atmospheric plasma treatment on melanoma skin cancer cells with/without catalase enzyme in vitro. Appl Sci. 2021;11(13):6181. https://doi.org/10.3390/app11136181.
22. Akimoto Y, Ikehara S, Yamaguchi T, Kim J, Kawakami H, Shimizu N, et al. Galectin expression in healing wounded skin treated with low-temperature plasma: Comparison with treatment by electronical coagulation. Arch Biochem Biophys. 2016;605:86-94. 10.1016/j.abb.2016.01.012.
23. Wang B, Liu D, Zhang Z, Li Q, Wang X, Kong MG. A new surface discharge source: plasma characteristics and delivery of reactive species. IEEE Trans. Plasma Sci. 2016;44(12):3295-3301.
24. Gan L, Jiang J, Duan JW, Wu XJZ, Zhang S, Duan XR, et al. Cold atmospheric plasma applications in dermatology: A systematic review. J Biophotonics. 2021;14(3):e202000415. 10.1002/jbio.202000415.
25. Boeckmann L, Bernhardt T, Schäfer M, Semmler ML, Kordt M, Waldner AC, et al. Aktuelle ındikationen der plasmatherapie in der dermatologie. Hautarzt. 2020;71:109-113.
26. Bai F, Ran Y, Zhai S, Xia Y. Cold atmospheric plasma: A promising and safe therapeutic strategy for atopic dermatitis. Int Arch Allergy Immunol. 2023;1-14. https://doi.org/10.1159/000531967.
27. Bernhardt T, Semmler ML, Schäfer M, Bekeschus S, Emmert S, Boeckmann L. Plasma medicine: Applications of cold atmospheric pressure plasma in dermatology. Oxid Med Cell Longev. 2019.10.1155/2019/3873928.
28. Scholtz V, Soušková H, Julák J, Kováčik D, Šimáková,J. Cold atmospheric plasma and its applications in medicine. Plasma Process. Polym. 2023;20(5):e2200212. https://doi.org/10.1002/ppap.202200212.
29. Laroussi M. Cold atmospheric plasma: Fundamentals and emerging applications in biomedicine. Front. Phys. 2024;12:1372148. https://doi.org/10.3389/fphy.2024.1372148.
30. Fridman G, Friedman G, Gutsol A, Shekhter AB, Vasilets VN, Fridman A. Applied plasma medicine. Biointerphases. 2008;3(2):FC02–FC12. https://doi.org/10.1116/1.2811876.
31. Lackmann JW, Bandow JE. Inactivation of microbes and macromolecules by atmospheric-pressure plasma jets. J.Phys. D: Appl. Phys. 2014;47(22):223001. https://doi.org/10.1088/0022-3727/47/22/223001.
32. López M, García-Alonso J, Herranz G. Plasma-activated media in biomedical applications: Reactive species stability and biological responses. Int. J. Mol. Sci. 2023;24(18):13742. https://doi.org/10.3390/ijms241813742.
33. Izadjoo M, Zack S, Kim H, Skiba J. Medical applications of cold atmospheric plasma: State of the science. J. Wound Care. 2018;27 (Sup9):4-10. 10.12968/jowc.2018.27.Sup9.S4.
34. Karthik C, Sarngadharan SC, Thomas V. Low-temperature plasma techniques in biomedical applications and therapeutics: an overview. Int. J. Mol. Sci. 2023;25(1), 524.
35. Yang Y, Liu Y, Shen Y. Plasmonic-enhanced graphene oxide-based aquatic robot for target cargo delivery. ACS Appl. Mater. Interfaces. 2020;13(1):1503-1510.
36. Dai X, Li H, Ning M. Plasma robot engineering: The next generation of precision disease management. Ann. Biomed. Eng. 2021;49(7):1593-1597.
37. Bolgeo T, Maconi A, Gardalini M, Gatti D, Di Matteo R, Lapidari M, et al. The role of cold atmospheric plasma in wound healing processes in critically ıll patients. J Pers Med. 2023;13(5):736. https://doi.org/10.3390/jpm13050736.
38. Mohseni P, Ghorbani A, Fariborzi N. Exploring the potential of cold plasma therapy in treating bacterial infections in veterinary medicine: Opportunities and challenges. Front Vet Sci. 2023;10. 10.3389/fvets.2023.1240596.
39. Hwang SG, Kim J, Jo SY, Kim YJ, Won CH. Cold atmospheric plasma prevents wrinkle formation via an anti-aging process. Plasma Med. 2020;10:91–102.
40. Moon IJ, Yun MR, Yoon HK, Lee KH, Choi SY, Lee WJ, et al. Treatment of atopic dermatitis using non-thermal atmospheric plasma in an animal model. Sci Rep. 2021;11(1):16091.
41. Tan X, Zhao S, Xu R, Cheng C. Cold atmospheric plasma promotes wound healing by modulating cytokines and growth factors in fibroblasts and keratinocytes. Int. J. Mol. Sci. 2022;23(21):12954. https://doi.org/10.3390/ijms232112954.
42. Flörke C, Kramer A, Daeschlein G. Antimicrobial efficacy of cold atmospheric plasma against skin pathogens and biofilms. Front. Microbiol. 2022;13:841230. https://doi.org/10.3389/fmicb.2022.841230.
43. Heinlin J, Bekeschus S, Landthaler M. Clinical applications of cold atmospheric plasma in chronic wounds and inflammatory skin diseases. J. Clin. Med. 2022;11(4):987. https://doi.org/10.3390/jcm11040987.
44. Bekeschus S, von Woedtke,T, Weltmann KD. Cold atmospheric plasma in dermatology-Recent advances and translational perspectives. Dermatol. Ther. 2024;37(1):e16245. https://doi.org/10.1111/dth.16245.
45. Mariachiara A, Anna V, Alessandra G, Edoardo GP, Stefania B, Mariateresa R, et al. Cold atmospheric plasma (CAP) as a promising therapeutic option for mild to moderate acne vulgaris: Clinical and non-invasive evaluation of two cases. Clin Plasma Med. 2020;19:100110. https://doi.org/10.1016/j.cpme.2020.100110.
46. Karrer S, Berneburg M, Zeman F, Koller M, Müller K. A prospective, randomised, controlled, split-face clinical trial to assess the safety and the efficacy of cold atmospheric plasma in the treatment of acne vulgaris. Appl Sci. 2021;11(23):11181. https://doi.org/10.3390/app112311181.
47. Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10.10.7573/dic.2021-8-6.
48. Yousefi M, Hadian K, Babossalam S, Diab R, Akhlaghi M, Aghighi M, et al. Split-face comparison of hydroquinone 4% plus nitrogen plasma vs. hydroquinone 4% alone in the treatment of melasma. Lasers Med Sci. 2023;38(1):113. 10.1007/s10103-023-03757-7.
49. Cho SB, Lee S, Yoo DS, Kim SE, Kim T, Zouboulis CC, et al. Cold atmospheric plasma ınhibits lipogenesis and proliferation of human sebocytes and decreases sebum production in human facial skin. Dermatol Ther. 2023. https://doi.org/10.1155/2023/2922191.
50. Traidl S, Roesner L, Zeitvogel J, Werfel T. Eczema herpeticum in atopic dermatitis. Allergy. 2021;76(10):3017-3027. 10.1111/all.14853.
51. Margolis JS, Abuabara K, Bilker W, Hoffstad O, Margolis DJ. Persistence of mild to moderate atopic dermatitis. JAMA Dermatol. 2014;150(6):593-600. 10.1001/jamadermatol.2013.10271.
52. Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy. 2018;73(6):1284-1293. 10.1111/all.13401.
53. Flohr C, Mann J. New insights into the epidemiology of childhood atopic dermatitis. Allergy. 2014;69(1):3-16. 10.1111/all.12270.
54. Alexander H, Paller AS, Traidl‐Hoffmann C, Beck LA, De Benedetto A, Dhar S, et al. The role of bacterial skin infections in atopic dermatitis: expert statement and review from the international eczema council skin infection group. Br J Dermatol. 2020;182(6):1331-1342. 10.1111/bjd.18643.
55. Geoghegan JA, Irvine AD, Foster TJ. Staphylococcus aureus and atopic dermatitis: a complex and evolving relationship. Trends Microbiol. 2018;26(6):484–97. 10.1016/j.tim.2017.11.008.
56. Serrano L, Patel KR, Silverberg JI. Association between atopic dermatitis and extracutaneous bacterial and mycobacterial infections: A systematic review and meta‐analysis. J Am Acad Dermatol. 2019;80:904–12. 10.1016/j.jaad.2018.11.028.
57. Peng WM, Jenneck C, Bussmann C, Bogdanow M, Hart J, Leung DY, et al. Risk factors of atopic dermatitis patients for eczema herpeticum. J Invest Dermatol. 2007;127(5):1261-1263. 10.1038/sj.jid.5700657.
58. Raharja A, Mahil SK, Barker JN. Psoriasis: A brief overview. Clin Med. 2021;21(3):170-173. 10.7861/clinmed.2021-0257.
59. Kim YJ, Lim DJ, Lee MY, Lee WJ, Chang SE, Won CH. Prospective, comparative clinical pilot study of cold atmospheric plasma device in the treatment of atopic dermatitis. Sci Rep. 2021;11(1):14461.
60. Gao J, Wang L, Xia C, Yang X, Cao Z, Zheng L, et al. Cold atmospheric plasma promotes different types of superficial skin erosion wounds healing. Int Wound J. 2019;16:1103–1111. 10.1111/iwj.13161.
61. Sun T, Zhang X, Hou C, Yu S, Zhang Y, Yu Z, Et al. Cold plasma irradiation attenuates atopic dermatitis via enhancing HIF-1α-induced MANF transcription expression. Front immunol. 2022;13:941219. 10.3389/fimmu.2022.941219.
62. Choi JH, Song YS, Lee HJ, Hong JW, Kim GC. Inhibition of inflammatory reactions in 2, 4-Dinitrochlorobenzene induced Nc/Nga atopic dermatitis mice by non-thermal plasma. Sci Rep. 2016;6(1): 27376. 10.1038/srep27376.
63. Barrea L, Savanelli MC, Di Somma C, Napolitano M, Megna M, Colao A, et al. Vitamin D and its role in psoriasis: An overview of the dermatologist and nutritionist. Rev Endocr Metab Disord. 2017;18(2):195-205. 10.1007/s11154-017-9411-6.
64. Kim N, Lee S, Lee S, Kang J, Choi YA, Park J, et al. Portable cold atmospheric plasma patch‐mediated skin anti‐ınflammatory therapy. Adv Sci. 2022;9(34):2202800. 10.1002/advs.202202800.
65. Zhou X, Chen Y, Cui L, Shi Y, Guo C. Advances in the pathogenesis of psoriasis: From keratinocyte perspective. Cell Death Dis. 2022;13(1): 81.
66. Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007;445 (7130):866-873. 10.1038/nature05663.
67. Ogawa E, Sato Y, Minagawa A, Okuyama R. Pathogenesis of psoriasis and development of treatment. J Dermatol. 2018;45(3):264-272. 10.1111/1346-8138.14139.
68. Baliwag J, Barnes DH, Johnston A. Cytokines in psoriasis. Cytokine. 2015;73(2):342-350. 10.1016/j.cyto.2014.12.014.
69. Chandra A, Ray A, Senapati S, Chatterjee R. Genetic and epigenetic basis of psoriasis pathogenesis. Mol Immunol. 2015;64(2):313-323. 10.1016/j.molimm.2014.12.014.
70. Gerdes S, Mrowietz U, Boehncke WH. Comorbidity in psoriasis. Hautarzt. 2016;67(6):438–444. 10.1007/s00105-016-3805-3.
71. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6):1475. 10.3390/ijms20061475.
72. Lin X, Huang T. Oxidative stress in psoriasis and potential therapeutic use of antioxidants. Free Radic Res. 2016;50(6):585-595. 10.3109/10715762.2016.1162301.
73. Elango T, Thirupathi A, Subramanian S, Ethiraj P, Dayalan H, Gnanaraj P. Methotrexate treatment provokes apoptosis of proliferating keratinocyte in psoriasis patients. Clin Exp Med. 2017;17: 371-381. 10.1007/s10238-016-0431-4.
74. Eding CB, Enerbäck C. Involved and uninvolved psoriatic keratinocytes display a resistance to apoptosis that may contribute to epidermal thickness. Acta Derm Venerol. 2017;97(7):788-796. 10.2340/00015555-2656.
75. Gan L, Duan J, Zhang S, Liu X, Poorun D, Liu X, et al. Cold atmospheric plasma ameliorates imiquimod-induced psoriasiform dermatitis in mice by mediating antiproliferative effects. Free Radic Res. 2019;53(3):269-280.
76. Bekeschus S, Masur K, Kolata J, Wende K, Schmidt A, Bundscherer L, et al. Human mononuclear cell survival and proliferation is modulated by cold atmospheric plasma jet. Plasma Process Polym. 2013;10(8):706-713. https://doi.org/10.1002/ppap.201300008.
77. Zhong SY, Dong YY, Liu DX, Xu DH, Xiao SX, Chen HL, et al. Surface air plasma‐induced cell death and cytokine release of human keratinocytes in the context of psoriasis. Br J Dermatol. 2016;174(3):542-552. 10.1111/bjd.14236.
78. Gareri C, Bennardo L, De Masi G. Use of a new cold plasma tool for psoriasis treatment: A case report. SAGE Open Med Case Rep. 2020;8:1-4. 10.1177/2050313X20922709.
79. Rainer BM, Kang S, Chien AL. Rosacea: Epidemiology, pathogenesis, and treatment. Derm Endocrinol. 2017;9(1):e1361574. 10.1080/19381980.2017.1361574.
80. Tan J, Schöfer H, Araviiskaia E, Audibert F, Kerrouche N, Berg M, et al. Prevalence of rosacea in the general population of Germany and Russia–The RISE study. J Eur Acad Dermatol Venereol. 2016;30(3):428-434. 10.1111/jdv.13556.
81. van Zuuren EJ, Arents BW, van der Linden MM, Vermeulen S, Fedorowicz Z, Tan J. Rosacea: new concepts in classification and treatment. Am J Clin Dermatol. 2021;22(4):457-465. 10.1007/s40257-021-00595-7.
82. Dursun R, Daye M, Durmaz K. Acne and rosacea: What's new for treatment?. Dermatol Ther. 2019;32(5):e13020. https://doi.org/10.1111/dth.13020.
83. Searle T, Ali FR, Carolides S, Firas Al-Niaimi F. Rosacea and diet: What is new in 2021?. J Clin Aesthet Dermatol. 2021;14(12):49–54.
84. Wollina U. Is rosacea a systemic disease?. Clin. Dermatol. 2019;37(6):629-635. 10.1016/j.clindermatol.2019.07.032.
85. Asai Y, Tan J, Baibergenova A, Barankin B, Cochrane CL, Humphrey S, et al. Canadian clinical practice guidelines for rosacea. J Cutan Med Surg. 2016;20(5):432-445. 10.1177/1203475416650427.
86. Anzengruber F, Czernielewski J, Conrad C, Feldmeyer L, Yawalkar N, Häusermann P, Et al. Swiss S1 guideline for the treatment of rosacea. J Eur Acad Dermatol Venereol. 2017;31(11):1775-1791. 10.1111/jdv.14349.
87. Zhang H, Tang K, Wang Y, Fang R, Sun Q. Rosacea treatment: review and update. Dermatol Ther. 2021;11:13-24. 10.1007/s13555-020-00461-0.
88. Schaller M, Kemény L, Havlickova B, Jackson JM, Ambroziak M, Lynde C, et al. A randomized phase 3b/4 study to evaluate concomitant use of topical ivermectin 1% cream and doxycycline 40-mg modified-release capsules, versus topical ivermectin 1% cream and placebo in the treatment of severe rosacea. J Am Acad Dermatol. 2020;82(2):336-343. 10.1016/j.jaad.2019.05.063.
89. Hofmeyer S, Weber F, Gerds S, Emmert S, Thiem A. A prospective randomized controlled pilot study to assess the response and tolerability of cold atmospheric plasma for rosacea. Skin Pharmacol Physiol. 2023;36(4):205-213. 10.1159/000533190.
90. Ahmed MM, Montaser SA, Elhadry AA, El-Aragi GM. Study of the possible cytogenetic and immunological effects of cold atmospheric pressure plasma jet on whole blood cultures of vitiligo patients. Plasma Med. 2022;12(4).
91. Seneschal J, Boniface K, D’Arino A, Picardo M. An update on Vitiligo pathogenesis. Pigment Cell Melanoma Res. 2021;34(2):236-243. 10.1111/pcmr.12949.
92. Dell'Anna ML, Picardo M. A review and a new hypothesis for non‐immunological pathogenetic mechanisms in vitiligo. Pigment Cell Res. 2006;19(5):406-411. 10.1111/j.1600-0749.2006.00333.x.
93. Boniface K, Seneschal J, Picardo M, Taïeb A. Vitiligo: focus on clinical aspects, immunopathogenesis, and therapy. Clin Rev Allergy Immunol. 2018;54:52-67. 10.1007/s12016-017-8622-7.
94. Sandoval-Cruz M, García-Carrasco M, Sánchez-Porras R, Mendoza-Pinto C, Jiménez-Hernández M, Munguía-Realpozo P, et al. A. Immunopathogenesis of vitiligo. Autoimmun Rev. 2011;10(12):762-765. 10.1016/j.autrev.2011.02.004.
95. Richmond JM, Frisoli ML, Harris JE. Innate immune mechanisms in vitiligo: danger from within. Curr Opin Immunol. 2013;25(6):676-682. 10.1016/j.coi.2013.10.010.
96. Bertolotti A, Boniface K, Vergier B, Mossalayi D, Taieb A, Ezzedine K, et al. Type I interferon signature in the initiation of the immune response in vitiligo. Pigment Cell Melanoma Res. 2014;27(3):398-407. 10.1111/pcmr.12219.
97. Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. J Dermatol. 2021;48(3):252-270. 10.1111/1346-8138.15743.
98. Rashighi M, Harris JE. Vitiligo pathogenesis and emerging treatments. Dermatol Clin. 2017;35(2):257-265. 10.1016/j.det.2016.11.014.
99. Zhai S, Xu M, Li Q, Guo K, Chen H, Kong MG, Xia Y. Successful treatment of vitiligo with cold atmospheric plasma‒activated hydrogel. J Invest Dermatol. 2021;141(11):2710-2719. 10.1016/j.jid.2021.04.019.