Successful treatment of recalcitrant pemphigus vulgaris with cold argon plasma

Pemphigus vulgaris is a severe autoimmune blistering disease that occasionally develops lesions refractory to conventional systemic immunosuppressive therapy. We report the first documented case of successful treatment of therapy-resistant pemphigus vulgaris using cold atmospheric plasma. A 34-year-old woman presented with extensive oral and genital erosions that dramatically improved after initiating therapy with pulse corticosteroids in combination with cyclophosphamide. In the following weeks, she developed treatment-resistant facial erosions that persisted for 6 months despite aggressive systemic therapy consisting of intravenous immunoglobulin, azathioprine, and plasmapheresis. After 3 weekly cold atmospheric plasma treatments at 33 to 37 °C with a 2 cm torch gap for 3 min per treatment zone, the patient had remarkable clinical improvement, with an estimated > 80% epithelialization of facial erosions within 4 weeks, progressing to complete epithelialization by week 6. Disease activity assessment using the Pemphigus Disease Activity Index confirmed rapid improvement from a baseline of 14 to 0 within 6 weeks. Indirect immunofluorescence was negative throughout treatment. Sustained disease remission was achieved for 24 months. This novel application of cold atmospheric plasma is a promising therapeutic approach for recalcitrant lesions of pemphigus vulgaris.