What is Cold Atmospheric Plasma therapy?

Cold Atmospheric Plasma (CAP) therapy is a relatively recent addition to the array of treatments available for wound healing and skin conditions. CAP refers to a physical plasma primarily composed of ionized gas generated at normal atmospheric pressure and ambient temperature. It encompasses multiple synergistically-acting components such as charged particles, electric currents, and ultraviolet radiation​ (1)​. This innovative therapy has emerged as an emerging method in dermatology, offering an alternative to traditional methods like oral or topical drugs, which can come with with systemic side effects and disease recurrence (​2)​.

History of Cold Atmospheric Plasma

Irving Langmuir was an American chemist and physicist who significantly contributed to the field of surface chemistry, earning him the Nobel Prize in Chemistry in 1932. He is also known for his work in plasma science and introduced the term “plasma” in 1928 to describe an ionized gas, laying a foundation for the development of plasma physics. Through his research, Langmuir helped in elucidating the behavior of electrons in ionized gases, which is fundamental to the understanding and applications of plasma, including its use in various medical and industrial applications.

The antimicrobial effect of Cold Atmospheric Plasma, which paved the way for its application in medicine, was discovered in the 1990s. However, it wasn’t until 2007 that the initial clinical trial utilizing a plasma device for facial rejuvenation procedures was conducted. This trial marked the beginning of CAP’s use in regenerative medicine, targeting the acceleration of acute and chronic wound healing by alleviating bacterial infection (​3)​.

The science behind CAP – How it improves skin conditions and wound healing

CAP therapy operates on a physicochemical approach based on ionized gases. This technology has already been employed in dermatology to promote wound healing, and it’s steadily gaining traction in the cosmetic field as well (​4)​. Its mechanism of action includes the elimination of bacterial infection, which is often a significant hurdle in the wound healing process. CAP’s capacity to reduce bacterial load in a wound initiates the healing process, a feature that has been showcased in various clinical settings including a case report where active wound dressings with cold plasma significantly improved chronic wounds​ (5)​.

Moreover, the interaction of CAP with living tissues generates reactive species which have cytotoxic and bactericidal effects, promoting cell proliferation and exhibiting anti-inflammatory effects. These properties make CAP a promising treatment for diseases involving chronic inflammation and bacterial infections.

The effectiveness and safety of CAP in treating skin diseases and promoting wound healing have opened new horizons in dermatology, marking a step forward towards establishing novel, non-invasive therapeutic approaches for managing skin conditions and improving patients’ quality of life.

Dermatological benefits of Cold Atmospheric Plasma therapy

• Treatment of skin diseases
  CAP can potentially provide effective therapy for numerous skin diseases, paving the way for innovative dermatological treatments​(6)​.
• Bacterial eradication
  CAP has demonstrated substantial antibacterial properties, reducing bacterial load and thus aiding in the management of skin infections and inflammations.
• Enhanced absorption
  By creating minuscule openings between cells, CAP facilitates enhanced absorption, augmenting product efficacy and transdermal delivery.
• Accelerated healing
  CAP has shown to promote wound healing by reducing bacterial contamination, making it a viable option for managing acute and chronic wounds​(7)​.
• Skin regeneration
  CAP activates angiogenesis-related molecules in skin keratinocytes, fibroblasts, and endothelial cells, leading to increased production of collagen and elastin, which are crucial for skin regeneration.
• Microbial inactivation
  CAP acts as an antimicrobial agent, aiding in microbial inactivation, which is particularly beneficial in dermatological contexts where infectious microorganisms and disease processes complicate wound healing​ (8)​.
• Alopecia treatment
  It has been utilised to treat alopecia areata, demonstrating its potential in addressing hair loss conditions.
• Occlusion management
  CAP has been effective in treating vascular occlusion post dermal filler complications.
• Blood coagulation
  CAP accelerates blood coagulation, which can be beneficial in certain dermatological procedures or conditions​ (9)​.
• Technical versatility
  The technical versatility of CAP, including direct irradiation and indirect aqueous treatment, expands the scope and efficacy of dermatological treatments, allowing for a more tailored approach to individual patient needs​(10).

The rise of interest for CAP therapy for Topical Steroid Withdrawal

The emergence of Cold Atmospheric Plasma (CAP) therapy in treating patients suffering from Topical Steroid Withdrawal (TSW) is a beacon of hope for both sufferers and their caregivers. While there is no medical cure for Topical Steroid Withdrawal, novel specialist clinics are utilising CAP therapy to treat the wound healing associated with the TSW skin condition.

Social media, online forums, and support groups have facilitated the popularity and growth of interest of CAP therapy to treat topical steroid withdrawal over the past two years. But how did it come about?

Peerawat Jay is a Thai practitioner who has been treating patients with topical steroid withdrawal in Bangkok for 16 years. His unique CAP machines have gone through various iterations and calibrations to specifically treat TSW skin have resulted in successful patient care and outcomes. The specific CAP machines and their custom tailored approach for each individual patient has resulted in patient care and treatment outcomes over the past 16 years.

Related Post: A Recent Visit to The CAP TSW Clinic in Bangkok

Jay’s Ultra Pulse Contact CAP treatment is tailored for people battling Topical Steroid Withdrawal (TSW). It operates on three core principles to rejuvenate TSW-affected skin:

• Cellular regeneration
  • It triggers growth factors in skin cells, enhancing their regeneration rate, especially when hindered by long-term medication use.
• Bacterial and fungal eradication
  • By interacting with pathogens on the skin, it eradicates harmful bacteria and fungus, aiding in skin recovery.
• Micro-exfoliation
  • It performs a gentle micro-exfoliation to manage hardened skin, making it suitable even for sensitive and damaged skin​,

This treatment method that incorporates CAP technology as the primary driving force, has expanded into the creation of Skin Solace, a UK based Skin Clinic. Skin Solace was founded in 2020 by Louise King and Jing Rui who were previous patients of Peerawat Jay and long term sufferers of topical steroid withdrawal. The entrepreneurial pair had been influential advocates for topical steroid withdrawal awareness for many years and have evolved from advocacy to treatment.

Online testimonials and videos from patients of these two skin clinics have gone viral across Instagram, Tiktok, and Facebook groups. 

Considerations for Eczema

It is important to note the initial underlying conditions that was previously being treated by topical steroids, such as atopic dermatitis (eczema), a chronic inflammatory skin condition. CAP’s potential as a treatment for AD has been explored, with positive implications for treating TSW as well. By addressing microbial infections, immune system dysfunction, and skin barrier deficits – central events in AD pathogenesis – CAP therapy could offer a broader spectrum of treatment options for individuals suffering from various skin conditions including TSW (11)(12).

Receiving CAP therapy can be beneficial for improving skin that has atrophied from long-term steroid use, focusing primarily on the skin cell regeneration, bacterial eradication, and micro-exfoliation. However, the underlying original skin conditions that were previously treated by topical steroids, such as eczema—which is often linked to genetic and environmental factors—may be untreated once CAP therapy ceases.

Related: Initial Skin Conditions Before Using Topical Steroids

Are there other CAP clinics for TSW around the world?

CAP machines have been around for many years and lower strength machines are commonly found in cosmetic and skin aesthetic clinics around the world. These CAP machines are different in calibration and technology to the specific machines used in the two clinics mentioned above. This does not devalue their efficacy, but it should be informed that the machines were not intended originally for patients with topical steroid withdrawal.

The emergence of the beneficial outcomes of Ultra Pulse CAP technology from Skin Solace and Bangkok clinic for treating Topical Steroid Withdrawal skin is opening up a new door for new technological advancements, research, customisations into treatment opportunities that utilize Cold Atmospheric Plasma for wound healing.

Recently, there has been an increasing adoption of skin aesthetic clinics around the world promoting treatments for TSW using their own CAP machines. These machines may be calibrated differently than Peerawat’s CAP machines, and the difference of established treatment protocols or trained personnel could potentially result in different outcomes. Nonetheless, there is optimism toward the future advancements in this technology and its potential to benefit more people in need.

Over the next few years, we expect to see various Cold Atmospheric Plasma machines and brands enter the skin treatment market, treating a wide range of medical and dermatological conditions.

The dawn of specialised CAP clinics for TSW

The advent of clinics specializing in CAP treatment for Topical steroid withdrawal reflects a growing recognition of the therapy’s potential. 

New clinics utilising CAP for TSW are marking a significant stride towards tailored care for TSW patients​ with more specialised clinics soon to emerge to facilitate this demand.

The interest and ongoing research in CAP therapy could potentially lead to more refined treatment protocols, better understanding of its mechanisms, and broader application in treating a variety of skin conditions. As more clinics adopt this therapy, the wider population could gain access to this innovative treatment, improving the quality of life for individuals afflicted with TSW and other related skin conditions.

Through the combination of evidence-based science and clinical practice, CAP therapy could become a cornerstone in the management and treatment of TSW, offering hope for countless sufferers and their families.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9576403/#:~:text=Cold%20atmospheric%20plasma%20,electric%20currents%2C%20ultraviolet%20radiation
2. https://www.frontiersin.org/articles/10.3389/fimmu.2022.868386/full#:~:text=The%20traditional%20therapies%20for%20skin,and%20effective%20functions%20in%20dermatology
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215620/
4. https://www.sciencedirect.com/science/article/pii/S0891584920312776#:~:text=Currently%2C%20a%20physicochemical%20approach%2C%20based,thus%20providing%20a%20new%20challenge
5. https://journals.lww.com/aswcjournal/Fulltext/2022/12000/Use_of_Cold_Plasma_in_Wound_Healing__A_Case_Report.12.aspx#:~:text=The%20concept%20of%20the%20fully,S%2C%20Helmke%20A%2C%20et%20al
6. https://onlinelibrary.wiley.com/doi/10.1002/jbio.202000415#:~:text=Cold%20atmospheric%20plasma%20,use%20of%20CAP%20in%20dermatology
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219374/#:~:text=Cold%20atmospheric%20plasma%20,contamination%20and%20promote%20wound%20healing
8. https://link.springer.com/chapter/10.1007/978-3-030-49966-2_12#:~:text=The%20understanding%20that%20cold%20atmospheric,1%2C%2024
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949367/#:~:text=1,accelerating%20blood%20coagulation%2C%20killing
10. https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.918484/full#:~:text=Cold%20atmospheric%20plasma,and%20practical 
11. https://www.medicalnewstoday.com/articles/using-coldwater-atmospheric-plasma-to-treat-atopic-dermatitis#:~:text=Researchers%20from%20the%20Institute%20of,a%20potential%20treatment%20for%20atopic
12. https://karger.com/iaa/article/doi/10.1159/000531967/862369/Cold-Atmospheric-Plasma-A-Promising-and-Safe

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Understanding Biomarker Testing and Immunity

Biomarkers are measurable biological indicators—such as proteins, cytokines, or gene expression patterns—that reflect immune activity or dysfunction. In immunology, cytokines including interleukins (ILs), chemokines, and interferons play central roles in orchestrating immune responses and are increasingly used as biomarkers for disease monitoring and diagnosis. Studies in both infectious and inflammatory contexts have shown that blood-based biomarker analysis, such as cytokine profiling, provides valuable insights into how the immune system responds to stressors or pathogens, and can help identify immune imbalances that underlie chronic inflammation or autoimmune disease.​

Improving immune function is not about stimulating the system indiscriminately—it involves restoring balance. Chronic inflammation, allergic sensitization, and immune insufficiency can all stem from dysregulated communication among immune cells. Biomarker testing enables clinicians to pinpoint which pathways are overactive or suppressed, allowing for targeted strategies to rebalance immune activity.

Immune Biomarkers in Eczema and Skin Health

Atopic dermatitis (AD), commonly known as eczema, exemplifies a condition driven by immune system imbalance. It involves an overactivation of the Th2 (type 2 helper T cell) pathway, leading to increased production of cytokines such as interleukin-4 (IL-4), IL-13, and IL-31, which drive inflammation, itching, and barrier dysfunction. Recent studies highlight IL-13 as a key biomarker that not only reflects disease severity but can also predict response to biologic treatments like dupilumab, an IL-4/IL-13 inhibitor.​

Emerging biomarker-based diagnostics are helping to identify early indicators of eczema. A landmark Danish study demonstrated that non-invasively collected skin samples containing elevated levels of IL-8, IL-18, and thymus and activation-regulated chemokine (TARC/CCL17) can predict the development and severity of atopic eczema within the first two years of life. These immune-related biomarkers reveal subclinical immune activation well before visible skin symptoms appear—an insight that could lead to early intervention and prevention.​

In adults, biomarker mapping of gene expression in inflamed skin provides further insight into disease endotypes, or molecular subtypes. A 2024 study established a molecular “immune map” to classify inflammatory skin diseases such as psoriasis and eczema based on specific immune gene modules, improving the diagnostic accuracy of ambiguous skin conditions. This molecular profiling supports precision dermatology, where therapies are matched to a patient’s dominant immune signature.​

How Biomarker Testing Could Support Immune Resilience

By providing a window into the immune system’s function, biomarker testing can reveal micronutrient deficiencies, chronic inflammation, oxidative stress, and immune regulation issues that underpin eczema severity. For example, C-reactive protein (CRP) and pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF-α) or IL-6 can signal systemic inflammation that may worsen skin barrier integrity.​

Addressing these imbalances through targeted nutrition, stress management, and microbiome-supporting interventions could help improve immune resilience. Biomarkers related to vitamin D, omega-3 fatty acid status, or gut-derived metabolites are also being explored for their links to skin immune regulation. Observing how these biomarkers shift over time offers a data-driven approach to evaluating the effectiveness of holistic or integrative therapies aimed at immune restoration.

Topical Steroid Withdrawal and Immune Dysregulation

Topical steroid withdrawal (TSW) represents a complex form of immune rebound and dysregulation that can occur when potent steroid creams used for eczema are suddenly discontinued. Research published by the NIH in the Journal of Investigative Dermatology highlights the biochemical roots of TSW, suggesting that chronic steroid use alters local and systemic immune responses, potentially affecting cortisol regulation and inflammatory pathways.​

The condition is characterized by intense redness, burning, swelling, and hypersensitivity of the skin—sometimes extending to areas not previously affected by eczema. Patients may also experience systemic symptoms such as fatigue, gland swelling, and disrupted thermoregulation. Although TSW is not officially classified as a distinct diagnosis, biomarkers could hold the key to distinguishing it from eczema flares and monitoring recovery.​

Early investigations have begun exploring immune markers associated with steroid-induced skin dysregulation. Patterns of altered cytokine expression and impaired skin barrier enzymes, such as reduced ceramide production and pH imbalance, have been linked to chronic steroid exposure. More recently, reports suggest that biomarker patterns in TSW overlap partially with those of severe eczema but may include distinct fingerprints related to immune suppression and adrenal axis disruption.​

Skin Diagnostic Advances and the Future of Care

Modern skin diagnostic tools increasingly incorporate biomarker analysis, combining genetic, proteomic, and transcriptomic profiling to reveal the underlying immune activity in the skin. Bioinformatics-based analyses have identified differentially expressed genes associated with immune cell infiltration in atopic dermatitis, providing opportunities for more personalized therapeutic choices.​

This precision extends beyond eczema: similar immune biomarker approaches are being used to monitor psoriasis, allergic dermatitis, and even response to immune-modulating therapies like biologics or systemic corticosteroids. As these technologies advance, clinicians will be able to distinguish between disease subtypes, track immune normalization, and reduce reliance on trial-and-error treatment.

In the context of eczema and TSW, diagnostics that can differentiate between active inflammation, barrier dysfunction, or steroid-induced immune suppression would be invaluable for tailoring care. Coupled with biomarker-guided immune support—through anti-inflammatory nutrition, microbiome modulation, or targeted biologic therapy—patients could achieve better, longer-lasting outcomes.

In Summary

Biomarker testing offers an innovative avenue for understanding immune system dysregulation at the molecular level. For those with eczema or topical steroid withdrawal, it opens the door to earlier detection, more precise diagnosis, and immune-targeted treatment strategies. Studies demonstrate that immune cytokines like IL-13, IL-8, IL-18, and TARC play central roles in eczema’s pathogenesis and could help predict disease onset or severity. Meanwhile, advanced skin mapping and non-invasive biomarker sampling represent significant steps toward truly personalized dermatologic care.

By revealing the body’s immune patterns, biomarker testing empowers clinicians and patients to not only treat symptoms but to address the root causes of immune dysfunction, creating opportunities for both skin healing and systemic immune resilience.

References

1. Gorelick J, Nguyen A, Schneider SK, Martel BC, Madsen DE, Armstrong AW. Biomarkers in Atopic Dermatitis: A Review of the Role of IL-13 and the Impact of Tralokinumab Treatment. American Journal of Clinical Dermatology. 2025;26(2):199–211. doi:10.1007/s40257-024-00913-9. [PMCID: PMC11850464]​

2. Sang J, Ye X. Potential biomarkers for predicting immune response and outcomes in lung cancer patients undergoing thermal ablation. Frontiers in Immunology. 2023;14:1268331. doi:10.3389/fimmu.2023.1268331.​

3. EADV (European Academy of Dermatology and Venereology). Non-invasive skin immune biomarker test helps predict development of eczema in babies: new study finds. 2022.

4. HealthCentral. Topical Steroid Withdrawal: Why It’s Not Just Eczema. 2025.

5. National Eczema Association. Topical Steroid Withdrawal (TSW): What We Know. 2025.

6. Nature Communications. Immune modules to guide diagnosis and personalized medicine in inflammatory skin diseases. Nature Communications. 2024;12(54559). doi:10.1038/s41467-024-54559-6.

7. PubMed Central. Key regulators and biomarkers of skin barrier function in atopic dermatitis. Scientific Reports. 2025;15(46250).

8. Frontiers in Allergy. Biomarkers to aid in diagnosis of allergic contact dermatitis. Frontiers in Allergy. 2025;6:1564588.

9. ScienceDirect. Laboratory biomarkers of an effective immune response. Journal of Allergy and Immunology Research. 2021;8(3):185–200.

10. Dermatology Times. Skin immune biomarker test helps predict eczema in infants. Dermatology Times. 2022.

11. Nance K, et al. Breaking the cycle: a comprehensive exploration of topical steroid withdrawal. Journal of Clinical Dermatology and Immunotherapy. 2025;30:11994697.

12. Bioinformatics‐Based Analysis. Reveals diagnostic biomarkers and immune infiltration features in atopic dermatitis. International Journal of Molecular Sciences. 2025;12051981.

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United Kingdom

• Topical steroid withdrawal reactions: a review of the evidence

Read more: https://www.gov.uk/government/publications/topical-steroid-withdrawal-reactions-a-review-of-the-evidence/topical-steroid-withdrawal-reactions-a-review-of-the-evidence

• MHRA Drug Safety Update – Topical Steroids

Read more: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1017844/Sept-2021-DSU-PDF.pdf

Australia

Additionally in Australia, the Australian Family Physician (AFP) website, now superseded by the AJGP: Australian Journal of General Practice has included information about topical steroid addiction and withdrawal. Although this is not a government website, the AJGP provides evidence-based, clearly articulated information to Australian general practitioners (GPs) to assist them in providing the highest quality patient care.

• Topical corticosteroid addiction and withdrawal – An overview for GPs

Read more: https://www.racgp.org.au/afp/2016/june/topical-corticosteroid-addiction-and-withdrawal-an

But awareness is only part of the equation. For comprehensive management and prevention of risks, it is crucial that this awareness translates into actionable strategies that are both preventive and remedial. Both countries have therefore emphasized the importance of patient education, understanding that an informed patient is more likely to adhere to guidelines, recognize early signs of misuse or withdrawal, and engage in a dialogue with their healthcare provider about their treatment.

However, it’s important to recognize that the work is far from over. While formal recognition of TSW as a medical condition is an important step, it does not solve the underlying issues associated with topical steroid misuse. It is essential for ongoing research to examine the long-term effects of these medications, especially in vulnerable populations such as children. This will require a coordinated effort between researchers, medical professionals, regulatory bodies, and patient advocacy groups.

The collective efforts in Australia and the United Kingdom signify an important shift towards acknowledging the complexities and potential dangers of topical steroid use. It represents a holistic approach to healthcare—and a shift of recognition of topical steroids withdrawal, always with the well-being of the patient in mind.

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