Therapeutic Use of Cold Atmospheric Plasma for the Treatment of Mild Acne Papulopustulosa—A Randomized, Controlled, Double-Blind Pilot Study

Acne is a common disease worldwide, predominantly occurring in teenagers. Commonly prescribed therapies often cause adverse effects and in case of antibiotics bare the risk of developing resistances. Cold atmospheric plasma (CAP) is a well-tolerable, physical treatment method, which is well established in the treatment of chronic wounds since it provides bactericidal and wound healing properties. Our aim was to evaluate the efficacy and safety of CAP as a potential add-on therapy for mild acne papulopustulosa in a randomized controlled, double-blind pilot study. Forty participants were randomized into two arms of 20 each. Both groups self-applied 0.1% of adapalene cream daily and received weekly skin-cleansing by a physician combined with either CAP verum-device treatments or placebo-device applications instead. The endpoint of the treatment segment was at 6, and follow-up was at 10 weeks. The co-primary endpoints total inflammatory lesion count (TILC) and acne-specific Investigator Global Assessment (IGA) score as well as secondary endpoints sebumetry, total porphyrin count (TPC) reflecting Cutibacterium acnes colonization, and occurrence of adverse events (AEs) were measured from baseline until follow-up, while the Acne-specific Quality of Life (AQOL) questionnaire was assessed at baseline and endpoint. TILC decreased greater in the verum versus control group from baseline (45.8 vs. 49.4) toward endpoint (22.1 vs. 38.6; p = 0.07) to follow-up (16.5 vs. 28.7; p = 0.48), matched by the IGA score with similarly greater improvement in the verum versus control group from baseline (2.3 vs. 2.6) to endpoint (1.3 vs. 2.3; p <  0.001) until follow-up (1.0 vs. 1.9; p = 0.006). Sebumetry, TPC, and AQOL scores decreased more during treatment and in the verum group. AE occurred less frequently in the verum group without serious AE reported overall (all p < 0.05). Conclusively, CAP proved to be an efficient and well-tolerable add-on therapy for the treatment of mild acne papulopustulosa.

Trial Registration: German Registry of Clinical Trials: DRKS00032416