Plasma technology found effective for repeated nonablative treatments

New Orleans - A new plasma-based system (Plasma Skin Resurfacing/PSR, Gyrus Medical) appears effective for repeated treatments using nonablative energy parameters.

"The goal of the study was to perform repeated treatments using nonablative parameters - parameters that will result in some redness and minimal peeling of the skin, but without significant wounding or downtime," says Jean-François Tremblay, M.D., C.M., F.R.C.P.C. He is associate professor, department of dermatology, University of Montréal, Canada, and a privately practicing cosmetic surgeon.

Recent research

More recently, the same researchers gave eight patients a series of four full-face PSR treatments, each about three weeks apart, over a period of three months. Using only topical anesthesia (5 percent lidocaine cream, ELA-Max, Ferndale Laboratories), researchers employed energy settings of 1.5 to 2 J (3 Hz) using a nonoverlapping sweeping motion. After each treatment, they assessed changes in dyspigmentation, wrinkles, skin roughness and skin tightness through direct clinical evaluation, standardized pictures and patient questionnaires.

"We found significant improvement in skin pigmentation after just one treatment. And that improvement grew more significant after successive treatments," Dr. Tremblay tells Dermatology Times.

At the study's end, "all patients also reported improved skin elasticity and skin texture - their skin was smoother. Some patients had sun-induced actinic keratoses (AKs). Those were also significantly improved," he says. Statistically, skin smoothness improved 30 percent to 60 percent; skin tightness, 20 percent to 30 percent; fine wrinkles, 10 percent to 50 percent.

Furthermore, skin biopsies performed before and after the treatment series revealed that the treatments had thickened the epidermis while decreasing solar elastosis and achieving more compact, uniform collagen deposition in the upper dermis.

Side effects were limited to milderythema and fine desquamation, which patients experienced for an average of two to four days after each treatment.

"All patients tolerated the treatment quite well," Dr. Tremblay says. "None of them required sedation or analgesia. The procedure was described by patients as hot but nonpainful." Accordingly, all patients reported high satisfaction with the procedure.

"Patients unanimously said that they got more improvement with the nonablative PSR technology than they had experienced with intense pulsed light (IPL) treatments in the past. Some patients had had microdermabrasion performed before, and they reported that the new technology was better than microdermabrasion. There was also a patient who suffered from acne scars and had experienced chemical peels, as well as CO₂ laser treatment, beforehand. She reported that she observed more improvement with PSR than with those other modalities," he says.

Plasma technology

The system's plasma beam is produced by the excitation of a nitrogen gas by radiofrequency energy. The photothermal effects of plasma on skin are still not fully understood.

"The interesting and unique aspect of plasma is that it induces an immediate photothermal injury in the dermis while leaving the epidermis relatively intact at first. We clinically observe some mild-to-moderate erythema and edema of the skin that develops within 20 to 30 minutes after treatment and peaks at about 24 hours. When using 'ablative' parameters, the epidermis eventually sloughs off at about 48 hours leaving a very superficial dermal wound that re-epithelializes in only a few days. Therefore, it seems that the epidermis acts as a biological dressing during the first 48 hours, speeding up the healing process," Dr. Tremblay says.