# Effectiveness and Safety Analysis of Plasma Beam in the Treatment of Facial Depressed Scars

Authors: Juan Li; Xia Zhang
Journal: Emergency Medicine International
 (2022)

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## Abstract

Objective. The study aimed to analyze the effectiveness and safety of microplasma beam in the treatment of facial depression scars. Methods. 106 patients with facial depression scars treated in the hospital between January 2017 and September 2021 were selected as the observation subjects. According to different treatment methods, the patients were divided into the control group (receiving ultrapulsed carbon dioxide lattice laser treatment, n = 51) and the observation group (undergoing plasma beam treatment, n = 55). The two groups were treated for 6 months, and the treatment effects were compared between the two groups. The Visual Analogue Scale (VAS) was used to compare the pain between the two groups, and the duration of pain and the time of scab shedding were recorded. The improvement of scars was compared between the two groups according to the Evaluation Clinique des Cicatrices d’ Acne (ECCA), and the adverse reactions during treatment were compared between the two groups. Results. A clinical effective rate of 94.55% in the observation group was higher than a clinical effective rate of 82.35% in the control group (P<0.05). The VAS score in the observation group was lower than that in the control group, and the pain duration and the scab shedding time were shorter than those in the control group (P<0.05). ECCA scores in the observation group after twice and 3 times of treatments were lower than those in the control group (P<0.05). The total incidence rate of adverse reactions of 10.91% in the observation group was lower, whereas it was 25.49% in the control group (P>0.05). Conclusion. Plasma beam has a significant efficacy in the treatment of facial depressed scars, and it has mild pain, quick recovery, and high safety. Clinical Trial Registration Number. The clinical trial registration number is T2017081.


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## Body

## 1. Introduction

Depressed scars mainly refer to scars caused by defects in the dermis and subcutaneous tissue of the skin, also known as atrophic scars. Postacne scars on the face are the most common type of depressed scars [1]. Facial acne scars are mainly caused by the overflow of the contents of the hair follicles into the dermis, resulting in different degrees of inflammation around the hair follicles, proliferation or defect and rupture of collagen fibers in the dermis, and formation of facial concave scars [2]. Depressed scars can be divided into different types according to their texture, size, depth, etc., but different types of scars will affect the patient’s facial appearance and social activities, and those with severe scars may suffer from poor self-esteem. Psychologically, it is not conducive to the physical and mental health of patients [3]. The treatment of depressed scars includes skin grinding, surgical excision, and filler injection, but there are also certain traumas, and the risk of pigmentation after treatment is high, so the acceptance of patients in clinical practice is not high [4]. Ultrapulse carbon dioxide (CO2) fractional laser is a treatment that stimulates collagen hyperplasia, remodeling through surface vaporization and heating of deep skin tissues. It has an ideal effect on facial beauty, but it is also prone to new scars due to individual differences, skin sensitivity, and other problems [5]. Microplasma beam therapy is a new type of dermatological treatment technology. It uses radio frequency technology to release energy to slightly peel off the epidermis at the scar and form micropores, which has a good effect on scar treatment [6]. In order to clarify the effective and safe treatment of depressed scars, this study compared the effects of ultrapulse CO2 and microplasma beam therapy, aiming to guide clinical treatment, and the report is as follows.


## 2. Materials and Methods

### 2.1. General Information

A total of 106 patients with facial depression scars who were admitted to our hospital from January 2017 to September 2021 were selected as the observation objects.106 patients were divided into the control group (receiving ultrapulsed carbon dioxide fractional laser treatment,n = 51) and the observation group (receiving plasma beam therapy, n = 55) according to different treatment methods. There were 51 cases in the control group, 27 males and 24 females; the age ranged from 18 to 33 years, with an average age of (26.75 ± 2.39) years; the course of disease was 1 to 4 years, with an average of (2.39 ± 0.75) years; Fitzpatrick skin classification: 28 cases of type III and 23 cases of type IV. There were 55 cases in the observation group, including 30 males and 25 females; the age ranged from 19 to 34 years, with an average age of (27.38 ± 2.80) years; the course of disease was 1–5 years, with an average of (2.67 ± 0.79) years; Fitzpatrick skin classification: 29 cases of type III and 26 cases of type IV. Inclusion criteria were as follows: ① conform to the diagnosis of facial depression [7]; ② Fitzpatrick skin classification III to IV [8]; ③ no inflammatory exudation, papules, etc., at the scar; ④ no other scar-related treatments in the past six months; ⑤ the course of disease is more than half a year, and the condition is stable. Exclusion criteria were as follows: ① severe scar constitution or combined with other facial skin diseases; ② recent sun exposure history or use of photosensitizing drugs; ③ mental disorders; ④ pregnant and lactating women. There was no significant difference in general data between the two groups (P>0.05).


### 2.2. Methods

Preparation before treatment: both groups were in the supine position. After selecting the patient’s facial treatment area, the skin was cleaned, and photos were taken at the same location under the lighting environment. The treatment area was coated with compound lidocaine ointment and wrapped with plastic wrap. The skin was anesthetized for 1 hour; then, the ointment was wiped off, and the treatment area was disinfected with alcohol.The control group was treated with an ultrapulse CO2 therapeutic apparatus (produced by Beijing Hertz Medical Technology Co., Ltd., HL-1C). We set the parameters of the therapeutic apparatus as wavelength 10600 nm, power 1∼30 w, spot diameter ≤ 0.1 mm, and single pulse energy 0.025∼250 mj. We adjusted the size and density of the scan pattern to perform random discrete scans 1 to 3 times at the treatment site.The observation group was treated with a plasma therapy device (produced by Feridun Medical Laser Company, Israel). Plasma 6 row image beam fixed-point treatment was selected, with a diameter of 7 mm, a beam spot spacing of 1 mm, and a power setting of 70∼90 w, 3∼5 times for each treatment.Precautions after treatment: after the treatment, the two groups were treated with ice packs for 30 minutes, and the control group was thickly coated with sodium hyaluronate on the affected area. The observation group used erythromycin eye ointment to prevent infection. The two groups were treated for 3 consecutive times, and the interval between each treatment was 8 weeks. The patients were instructed to avoid touching water after 7 days of treatment, so that the scabs would fall off naturally, and to avoid sun exposure and the use of cosmetics.


### 2.3. Observation Indicators

① Clinical efficacy [9]: After 3 times of treatment, the clinical effects of the two groups were compared according to the repaired area of facial scars. The recovered area was ≥90%, and the appearance was normal; the marked effect was 60% < repaired area ≤ 89%, and the skin of the affected area was close to normal; the effective rate indicated that the appearance of the affected area was basically close to normal, 30% < repaired area ≤ 60%; the invalid rate indicated that the appearance did not improve, and the repaired area was less than 30%. ② Treatment-related indicators: According to the Visual Analogue Score (VAS) [10], the pain conditions of the two groups were compared, and the VAS was recorded as 0–10 points according to “no pain”∼“unbearable pain,” and the higher the score, the more severe the pain; the VAS score, the duration of pain, and the time of scab falling off were recorded in the two groups during treatment. ③ Recovery of acne scars: Before treatment and after 3 treatments, respectively, the scars were evaluated according to the Echelle d’Evaluation Clinique des Cicatrices d’Acne score (ECCA) [11]. Weight 15 points: the U-shaped scar has a sharp edge and a diameter of 2–4 mm with a weight of 25 points. Intensity of scars: no scars were scored 0, the number of scars ≤5 was scored 1, the number of scars was more than 5 and less than 20 was scored 2, the number of scars >20 was scored 3, and the total ECCA score was weighted score × intensity score. ④ Adverse reactions: during the treatment period, the number of patients with severe burning pain, skin sensitivity, and pigmentation were recorded, and the incidence of adverse reactions between the two groups was compared.


### 2.4. Statistical Methods

SPSS 22.0 statistical software was used to analyze the data, and the measurement data between groups were compared by the independent samplest-test. The count data were expressed in %, the χ2 test was performed, and the Mann–Whitney U test was used for the rank data. P<0.05 was considered to be statistically significant.


## 2.1. General Information

A total of 106 patients with facial depression scars who were admitted to our hospital from January 2017 to September 2021 were selected as the observation objects.106 patients were divided into the control group (receiving ultrapulsed carbon dioxide fractional laser treatment,n = 51) and the observation group (receiving plasma beam therapy, n = 55) according to different treatment methods. There were 51 cases in the control group, 27 males and 24 females; the age ranged from 18 to 33 years, with an average age of (26.75 ± 2.39) years; the course of disease was 1 to 4 years, with an average of (2.39 ± 0.75) years; Fitzpatrick skin classification: 28 cases of type III and 23 cases of type IV. There were 55 cases in the observation group, including 30 males and 25 females; the age ranged from 19 to 34 years, with an average age of (27.38 ± 2.80) years; the course of disease was 1–5 years, with an average of (2.67 ± 0.79) years; Fitzpatrick skin classification: 29 cases of type III and 26 cases of type IV. Inclusion criteria were as follows: ① conform to the diagnosis of facial depression [7]; ② Fitzpatrick skin classification III to IV [8]; ③ no inflammatory exudation, papules, etc., at the scar; ④ no other scar-related treatments in the past six months; ⑤ the course of disease is more than half a year, and the condition is stable. Exclusion criteria were as follows: ① severe scar constitution or combined with other facial skin diseases; ② recent sun exposure history or use of photosensitizing drugs; ③ mental disorders; ④ pregnant and lactating women. There was no significant difference in general data between the two groups (P>0.05).


## 2.2. Methods

Preparation before treatment: both groups were in the supine position. After selecting the patient’s facial treatment area, the skin was cleaned, and photos were taken at the same location under the lighting environment. The treatment area was coated with compound lidocaine ointment and wrapped with plastic wrap. The skin was anesthetized for 1 hour; then, the ointment was wiped off, and the treatment area was disinfected with alcohol.The control group was treated with an ultrapulse CO2 therapeutic apparatus (produced by Beijing Hertz Medical Technology Co., Ltd., HL-1C). We set the parameters of the therapeutic apparatus as wavelength 10600 nm, power 1∼30 w, spot diameter ≤ 0.1 mm, and single pulse energy 0.025∼250 mj. We adjusted the size and density of the scan pattern to perform random discrete scans 1 to 3 times at the treatment site.The observation group was treated with a plasma therapy device (produced by Feridun Medical Laser Company, Israel). Plasma 6 row image beam fixed-point treatment was selected, with a diameter of 7 mm, a beam spot spacing of 1 mm, and a power setting of 70∼90 w, 3∼5 times for each treatment.Precautions after treatment: after the treatment, the two groups were treated with ice packs for 30 minutes, and the control group was thickly coated with sodium hyaluronate on the affected area. The observation group used erythromycin eye ointment to prevent infection. The two groups were treated for 3 consecutive times, and the interval between each treatment was 8 weeks. The patients were instructed to avoid touching water after 7 days of treatment, so that the scabs would fall off naturally, and to avoid sun exposure and the use of cosmetics.


## 2.3. Observation Indicators

① Clinical efficacy [9]: After 3 times of treatment, the clinical effects of the two groups were compared according to the repaired area of facial scars. The recovered area was ≥90%, and the appearance was normal; the marked effect was 60% < repaired area ≤ 89%, and the skin of the affected area was close to normal; the effective rate indicated that the appearance of the affected area was basically close to normal, 30% < repaired area ≤ 60%; the invalid rate indicated that the appearance did not improve, and the repaired area was less than 30%. ② Treatment-related indicators: According to the Visual Analogue Score (VAS) [10], the pain conditions of the two groups were compared, and the VAS was recorded as 0–10 points according to “no pain”∼“unbearable pain,” and the higher the score, the more severe the pain; the VAS score, the duration of pain, and the time of scab falling off were recorded in the two groups during treatment. ③ Recovery of acne scars: Before treatment and after 3 treatments, respectively, the scars were evaluated according to the Echelle d’Evaluation Clinique des Cicatrices d’Acne score (ECCA) [11]. Weight 15 points: the U-shaped scar has a sharp edge and a diameter of 2–4 mm with a weight of 25 points. Intensity of scars: no scars were scored 0, the number of scars ≤5 was scored 1, the number of scars was more than 5 and less than 20 was scored 2, the number of scars >20 was scored 3, and the total ECCA score was weighted score × intensity score. ④ Adverse reactions: during the treatment period, the number of patients with severe burning pain, skin sensitivity, and pigmentation were recorded, and the incidence of adverse reactions between the two groups was compared.


## 2.4. Statistical Methods

SPSS 22.0 statistical software was used to analyze the data, and the measurement data between groups were compared by the independent samplest-test. The count data were expressed in %, the χ2 test was performed, and the Mann–Whitney U test was used for the rank data. P<0.05 was considered to be statistically significant.


## 3. Results

### 3.1. Clinical Efficacy of the Two Groups

In the observation group, 26 cases (47.27%) were cured, 15 cases (27.27%) were markedly effective, and 11 cases (20.00%) were effective. The total clinical effective rate in the observation group was 94.55% (52/55), which was higher than 82.35% in the control group (P<0.05), as shown in Figure 1.Figure 1
Comparison of clinical efficacy between the control group and the observation group.Note. Compared with the control group, Z/χ2 = −2.572/3.919; ∗P<0.05.


### 3.2. Comparison of Treatment-Related Indicators between the Two Groups

The VAS score of the observation group was lower than that of the control group, and the duration of pain and the time of scab falling off were shorter than those of the control group, and the above differences were statistically significant (P<0.05), as shown in Figures 2–4.Figure 2
Comparison of VAS scores between the two groups.Figure 3
Comparison of the duration of pain between the two groups.Figure 4
Comparison of the scab shedding time between the two groups.Note. Compared with the control group, t = 17.378, 21.059, and 8.465; ∗P<0.05.


### 3.3. Comparison of ECCA Scores between the Two Groups before and after Treatment

There was no significant difference in ECCA scores between the two groups before and after treatment (P>0.05). After 2 and 3 treatments, the ECCA scores of the observation group were lower than those of the control group (P<0.05), as shown in Figure 5.Figure 5
Comparison of ECCA scores between the two groups before and after treatmentNote. Compared with the control group, t = 4.184 and 5.629; ∗P<0.05.


### 3.4. Comparison of the Incidence of Adverse Reactions between the Two Groups

In the observation group, 4 cases of severe burning pain occurred after treatment, and the pain was significantly relieved after ice compress; 4 cases of skin sensitivity were reported, and the symptoms disappeared after 8 weeks of treatment; the total incidence of adverse reactions in the observation group was 10.91%, which was lower than 25.49% in the control group. However, the difference was not statistically significant (P>0.05), as shown in Figure 6.Figure 6
Comparison of the incidence of adverse reactions between the two groups (χ2 = 2.498, P>0.05).


## 3.1. Clinical Efficacy of the Two Groups

In the observation group, 26 cases (47.27%) were cured, 15 cases (27.27%) were markedly effective, and 11 cases (20.00%) were effective. The total clinical effective rate in the observation group was 94.55% (52/55), which was higher than 82.35% in the control group (P<0.05), as shown in Figure 1.Figure 1
Comparison of clinical efficacy between the control group and the observation group.Note. Compared with the control group, Z/χ2 = −2.572/3.919; ∗P<0.05.


## 3.2. Comparison of Treatment-Related Indicators between the Two Groups

The VAS score of the observation group was lower than that of the control group, and the duration of pain and the time of scab falling off were shorter than those of the control group, and the above differences were statistically significant (P<0.05), as shown in Figures 2–4.Figure 2
Comparison of VAS scores between the two groups.Figure 3
Comparison of the duration of pain between the two groups.Figure 4
Comparison of the scab shedding time between the two groups.Note. Compared with the control group, t = 17.378, 21.059, and 8.465; ∗P<0.05.


## 3.3. Comparison of ECCA Scores between the Two Groups before and after Treatment

There was no significant difference in ECCA scores between the two groups before and after treatment (P>0.05). After 2 and 3 treatments, the ECCA scores of the observation group were lower than those of the control group (P<0.05), as shown in Figure 5.Figure 5
Comparison of ECCA scores between the two groups before and after treatmentNote. Compared with the control group, t = 4.184 and 5.629; ∗P<0.05.


## 3.4. Comparison of the Incidence of Adverse Reactions between the Two Groups

In the observation group, 4 cases of severe burning pain occurred after treatment, and the pain was significantly relieved after ice compress; 4 cases of skin sensitivity were reported, and the symptoms disappeared after 8 weeks of treatment; the total incidence of adverse reactions in the observation group was 10.91%, which was lower than 25.49% in the control group. However, the difference was not statistically significant (P>0.05), as shown in Figure 6.Figure 6
Comparison of the incidence of adverse reactions between the two groups (χ2 = 2.498, P>0.05).


## 4. Discussions

The formation of acne scars is closely related to the nature, location, and treatment of skin lesions. Depressed scars are the most common scars after acne healing. After the inflammatory nodules and cysts produced by acne rupture, sebum, keratin, etc., enter the dermis, resulting in a cascade reaction that induces dermal fibrosis and deposition and uneven skin surface morphology and scarring [12]. Depressed scars not only show uneven skin shape but also affect the texture and color of the skin. Research reports show that patients with acne scars have different degrees of limitations in choosing a career, a spouse, and work because of their lack of self-confidence. Therefore, taking active and effective treatment can greatly improve social communication and interpersonal relationships [13]. The key to the treatment of facial concave scars is to regenerate the collagen of the skin tissue, make up for the depression, and restore the normal shape of the skin [14]. Plasma can directly act on the collagen in the skin scar, and microplasma can break the chaotic collagen arrangement in the scar and produce nongasified mild exfoliation in the superficial layer of the skin, while radio frequency can generate heat, plasma, and radio frequency on the collagen in the deep tissue. Plasma is a technology that combines image beam radio frequency and microplasma, which does not interact with the target chromophore of the skin, can retain the separated epidermis, and has an obvious effect on the repair of scars.A study compared the effects of microplasma and fractional erbium laser in the treatment of depressed scars [15], and the results showed that the efficacy of microplasma beam was more obvious, and the ECCA score was reduced. Based on the previous research study, this study compared the effects of ultrapulsed CO2 fractional laser and plasma beam in the treatment of depressed scars. The reason for the lack of a statistically significant difference in ECCA scores between the two sets before and after treatment may be that plasma beam requires a certain amount of time to act. The data further showed that the clinical effective rate of the observation group was higher than that of the control group, and the ECCA scores were lower after 2 treatments in the control group, which shows that plasma beam has an obvious effect on the treatment of depressed scars, which is helpful for scar recovery. The reason is that after the plasma contacts the skin, a thin air gap is formed between the skin surface and the electrode, causing a relatively mild epidermal ablation and forming a microchannel directly to the dermis, which helps eliminate damaged cells and stimulate collagen in the dermis. The two energies work together, and they help improve the flatness and uniformity of the superficial scar and are conducive to the proliferation and rearrangement of the deep collagen layer of the skin tissue, thereby quickly and effectively rebuilding the dermis structure. On the other hand, the thermal effect produced by plasma can stimulate the deep tissue of the skin, induce fibrocyte-mediated thermal degeneration, and promote the regeneration of the dermis. Therefore, the clinical efficacy of the observation group was more significant, and the ECCA score of the patients decreased after 2 treatments.Some studies have pointed out that the effect of ultrapulsed CO2 fractional laser treatment of scars is worthy of recognition, but there are many adverse reactions after surgery, which is related to the greater damage to skin tissue after ablative fractional laser treatment [16]. The results of this study showed that the total incidence of adverse reactions in the observation group was lower than that in the control group, which is consistent with the above research point of view. The data also showed that the VAS score of the observation group was lower than that of the control group, and the duration of pain and the time of scab shedding were shorter than those of the control group, which indicated a higher safety profile for the treatment of depressed scars with plasma beam. The reason for the analysis is that the plasma beam generates heat on the skin through plasma action and does not need to interact with the skin chromophore, which can minimize the physical damage to the skin tissue. The heat generated by plasma is controllable thermal damage and will not cause oxidative damage to the epidermis. The thermal effect on the deep tissue of the skin can stimulate collagen remodeling and proliferation, which is conducive to the regrowth of the epidermis and better skin repair. However, in this study, the incidence of adverse reactions in the two groups was not statistically significant, which is different from the results of some studies [17], and considering the possible reason for this study, the patients were treated with ultrapulsed CO2 fractional laser treatment after transparent treatment. Sodium phosphate thick coating has a certain improvement effect on relieving pain and pigmentation of patients. In addition, it is also considered that the sample size of this study is small, and various factors will be further comprehensively analyzed in the future.In conclusion, plasma beam therapy has an obvious curative effect on the treatment of facial concave scars. During the treatment, the pain degree of patients is less, the recovery is quicker, and the safety is better.



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*Source: 1194355-2022-08-25.xml*