Plasma pen and skin lesions — how it works and why it isn't "burning"

What plasma is and why it's the fourth state of matter

To understand how plasma pen works, we need to step outside the clinic for a moment and go back to physics. Matter exists in three states we all know from school: solid, liquid and gas. But there's a fourth — plasma — and it's more common in the universe than the other three combined. Stars, lightning, the aurora borealis, fire — all of this is plasma, or close to it. Plasma is a gas in which particles have been ionised: electrons have separated from atomic nuclei, creating a highly charged, reactive cloud.

In a plasma pen device, this ionised beam forms between the device tip and the skin — in the air, without any physical contact with the tissue. This matters: plasma pen doesn't touch the skin. It works from a few millimetres away, generating a micro electric arc. This arc transfers energy in a fraction of a second — enough to trigger sublimation at the chosen spot: the tissue passes directly from a solid to a gaseous state, bypassing the liquid stage.

Why does this matter in practice? Because it lets the operator work precisely and superficially — without disturbing tissue any deeper than necessary. With the right settings and an experienced operator, energy reaches only the skin layer where the lesion sits. It doesn't go deeper. This sets plasma pen apart from some laser or surgical methods, which by definition affect the whole cross-section they pass through.

Skin lesions — how they differ and why it matters

Before we look at what plasma pen does to a given lesion, it's worth knowing what these lesions actually are. A wart, a skin tag and xanthelasma are three completely different structures — different tissue, different location, different causes. And although plasma pen can be used on each of them, the mechanism differs slightly every time.

• Warts (verrucae) are viral lesions — caused by the human papillomavirus (HPV), which triggers uncontrolled epidermal growth in a specific spot. Warts have their own blood supply, can be deeply rooted and — importantly — can recur if the virus isn't eliminated. With warts, plasma pen works on this overgrown epidermal tissue, layer by layer. Sometimes several sessions are needed, because the lesion must be treated gradually.
• Skin tags (fibromata molluscum / acrochordon) are soft, pendulous growths — made of connective tissue and epidermis, often on a stalk. They appear in areas exposed to friction: the neck, armpits, under the bust, the groin. They're benign, not malignant, but can be mechanically irritating and unsightly. This is probably the ideal lesion for plasma pen: the stalk is thin, the tissue uniform, and sublimation here tends to be precise and effective.
• Xanthelasma (xanthelasma palpebrarum) is a completely different category — lipid deposits (fats), mostly cholesterol, accumulating just under the skin, usually at the inner corners of the eyelids. They have a characteristic yellowish colour and a flat, slightly raised structure. Plasma pen can help reduce them by working on the thin layer of tissue over the deposit — but xanthelasma tends to recur, especially when caused by a disrupted lipid metabolism.
• Milia are microcysts filled with keratin — white, firm bumps, usually on the cheeks or under the eyes. Plasma pen can gently treat them by opening the sac and allowing the contents to be removed. Needling or mechanical extraction often works well here too.
• Angiomas and cherry angiomas (ruby spots) are clusters of dilated blood vessels visible through the skin. Plasma pen is sometimes used for small vascular lesions, though for larger angiomas a vascular laser is more commonly used.

What happens to the skin during and after the treatment

Since plasma pen doesn't touch the skin, what does the treatment actually look like? The operator holds the device a few millimetres above the skin and delivers a sequence of very short pulses — each one a fraction of a second of contact between the micro electric arc and the surface. At that moment, the tissue at that point sublimates: it contracts and hardens into a small, dark brown dot — a dry, firm crust. This is an eschar — and it's a completely normal, expected result.

1. 01

   Treatment

   The operator marks the lesion with a series of micro-pulses. The skin contracts immediately at the point of contact with the plasma. Small, dark dots appear on the surface — this is an eschar, a dry scab.

2. 02

   First 24–72 hours

   The eschar hardens and rises slightly. Swelling and redness may appear around the lesion — this is a normal inflammatory process that triggers regeneration. The area is sensitive and shouldn't be touched.

3. 03

   5–10 days

   The scabs gradually fall off on their own. Fresh, pink skin appears underneath. Sun protection and gentle skincare matter here — don't speed up the process mechanically.

4. 04

   2–8 weeks

   The pinkness fades and skin tone evens out. In people with darker skin tones, post-inflammatory hyperpigmentation may be visible for a while — for many people it fades over time, though it takes patience.

5. 05

   Final result

   The full result is usually assessed after a few weeks. For recurring lesions (viral warts, xanthelasma), another session may be needed.

An important detail: the scab shouldn't be picked off mechanically. This is a common mistake — skin finds it hard to wait, and the scab is tempting. But the eschar protects the healing site. Removing it too early can lead to discolouration or — rarely — a slight scar. Patience during healing is genuinely part of the treatment.

When plasma pen makes sense — and when it doesn't

In the right hands and for the right indication, plasma pen is a tool that can be precise and effective. But it isn't a solution for everything — and it's worth knowing when something else makes more sense.

The precision made possible by no contact

There's a paradoxical advantage in the fact that plasma pen doesn't touch the skin. With contact methods — such as cryotherapy or surgical excision — the operator has to physically apply something to the skin. That always carries a risk of unexpected movement, a wider reach than planned, or a reaction to the contact itself. Plasma works in the air, and the pulse's reach is very small and controlled — which can be a real advantage for lesions in difficult spots (eyelids, corners of the eyes, the nasolabial fold).

Xanthelasma at the inner corner of the eye is a good example. The skin there is exceptionally thin, and the margin for error is very small. Plasma allows work almost point by point, layer by layer, without engaging deeper tissue. Classic surgery here involves cutting and stitching, and cryotherapy isn't precise enough. In this — geometrically justified — niche, plasma pen is one of the more sensible choices.

After the treatment — the aftercare that really makes a difference

Healing after plasma pen follows roughly the same pattern regardless of which lesion was treated. But a few rules genuinely matter clinically — and it's worth knowing them before the treatment, not after.

• Don't touch the scabs. The eschar is a natural dressing. Any mechanical interference — scratching, picking, rubbing — can lead to discolouration or a small scar.
• SPF50 for a minimum of 4–6 weeks. Even on cloudy days. UVA radiation penetrates clouds and activates melanocytes — this is what's behind most post-treatment discolouration.
• Gentle skincare — no acids. For the first two weeks, avoid retinoids, AHA/BHA acids and enzyme peels. The skin is in a repair phase and doesn't need stimulation right now — it needs support for the skin barrier.
• Hydration matters. A gentle cream with panthenol or ceramides supports regeneration and reduces the feeling of skin tightness.
• Sauna, swimming pool, intense training — pause for at least a week. High temperature and moisture slow healing and can increase the risk of infection.

How many sessions, when results appear, what to expect

Plasma pen doesn't give results that are "visible right away" — and it's worth saying this plainly, to avoid disappointment. For the first few days it looks worse, not better: scabs, possible swelling, pinkness. The final result appears after a few weeks. That's the trade-off for treating a lesion without cutting or stitching.

How many sessions are needed? It depends on the lesion. Skin tags on a stalk can often be treated in a single session. Warts — especially older, more deeply rooted ones — often need two, sometimes three sessions, spaced a few weeks apart. Xanthelasma tends to recur, because its cause (a disrupted lipid metabolism) doesn't lie in the skin — and here plasma pen can remove the lesion but won't eliminate what's causing it. For many people, it recurs after some time.

The results with skin tags are usually lasting — once a stalked skin tag is removed, it doesn't come back in the same spot for most people. Warts can recur, because HPV can be present in the skin beyond the visible lesion. Xanthelasma recurs more often than other lesions. This isn't a shortcoming of plasma pen — it's the biology of these lesions.