Skin brightening following combined topical Lactobacillus-derived Extracellular vesicles and Cold atmospheric plasma: A prospective clinical study

Uneven tone and dullness are common complaints in facial ageing. We conducted a prospective single-centre study evaluating a four-session protocol combining topical Lactobacillus-derived extracellular vesicles with cold atmospheric plasma (CAP) jet treatment for facial brightening. Thirty-three adults with mild-to-moderate photoageing received full-face treatments at 2-week intervals; 3 mL of the vesicle formulation was applied at each session followed immediately by CAP. Outcomes at week 12 were assessed using the Global Aesthetic Improvement Scale (GAIS) by two blinded dermatologists and by participant self-assessment. All participants completed treatment and follow-up (29 women, 4 men; mean age 41.8 ± 7.6 years). GAIS improvement (≥ 1) was observed in 93.9% and 90.9% of cases by the two dermatologists and in 97.0% by participants; ~70–75% were rated much/very much improved (GAIS 2–3). Adverse effects were transient (erythema, mild oedema) with no serious events. This protocol was associated with high rates of perceived facial brightening with minimal downtime.