A Split Face Study to Compare the Efficacy of Platelet-Rich Plasma Combined with Microneedling Versus Microneedling Alone for Treatment of Acne Scars.

Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians

Objective: The aim of this study is to compare the efficacy of microneedling(MN) followed by platelet rich plasma(PRP) with microneedling alone in the treatment of atrophic acne scars. Patients and Methods: Experimental study without controlled study conducted for the period one year (May 2020- May 2021) at Tishreen University Hospital in Lattakia- Syria. The study included 35 patients with atrophic acne scars who received MN with PRP on the left side of the face (group I), and MN alone on the right side (group II). Results: Mean age was 29.7±7.8 years, the most frequent age group was 20- 30 year (62.9%), and female represented 62.9% of the patients. Acne scars ranged in severity from moderate (38.6%) to severe (55.7%), and boxcar was the most frequent type (41.4%). A statistically significantly reduction was occurred at the end of treatment in group I (6.37±3.5 vs 12.80±3.9) and group II (8.57±4.2 vs 11.88±4.5) according to Goodman and Barron, but the reduction was higher in groupI. The best therapeutic results (excellent and good) were obtained in groupI especially in boxcar type. Regarding of side effects, pain, edema, and erythema were occurred in all cases in the two group, and the mean duration of edema and erythema was significantly shorter in group I. Conclusion: Combination of MN and PRP was found to be safe and efficacious in the treatment of atrophic acne scars.

Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR=2.56, 95% CI 1.37-4.78 and OR=3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD=-0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.

Platelet-rich fibrin (PRF), a second-generation platelet concentrate, was developed for the purpose of overcoming the limitations of Platelet-rich plasma (PRP). PRF can produce a higher cumulative release of growth factors than PRP. Also, this release is slow and prolonged, making it ideal for tissue regeneration and growth stimulation. This study was conducted to evaluate the efficacy of fluid PRF either alone or combined with needling versus PRP in the treatment of atrophic acne scars. A comparative study including 30 patients with atrophic acne scars who were divided into two equal groups. Group I included 15 patients in which the left side of the face was treated with intradermal injection of PRP while the right side was treated with combined needling with PRP. Group II included15 patients in which the left side of the face was treated with intradermal injection of fluid PRF while the right side was treated with combined needling with fluid PRF. All patients received four sessions with 3 weeks interval. The acne scars significantly improved in both sides of face in both groups. According to quartile grading scale and patient satisfaction; the therapeutic response was significantly higher in PRF group than PRP either alone or combined with needling. The combination with needling increases efficacy of PRF and PRP. Fluid PRF is highly effective, safe and simple procedure that can be used instead of PRP in the treatment of acne scars.

Background The treatment of atrophic acne scars represents a therapeutic challenge. Recently, plasma gel has been introduced among treatment modalities. Objective To compare the efficacy of platelet-rich-plasma ‘fluid’ versus ‘gel’ form combined with fractional CO2 laser in the treatment of atrophic acne scars. Methods Twenty-seven patients with atrophic acne scars were included. Treatment with fractional CO2 laser plus plasma fluid/gel was randomly assigned to the right/left sides of the face. Clinical and Optical Coherence Tomography (OCT) assessments were scheduled at baseline, one month, and three months after the last session. Results There was a significant improvement in clinical assessment scores at third-month follow-up on the plasma gel- and plasma fluid-treated sides compared to those at the first-month follow-up (p < .001). Scar depth decreased significantly at third-month follow-up when compared to baseline on both plasma gel- and plasma fluid-treated sides (p < .001). The numerical pain score was significantly lower on the plasma fluid-treated side compared to the plasma gel-treated side (p = .004). Conclusion The use of platelet-rich plasma in combination with fractional CO2 laser, both in fluid and gel form, produced significant results in the treatment of atrophic acne scars. Patients reported an immediate more noticeable effect with plasma gel. However, the fluid injection was less painful.

Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma that may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition. Skin needling is a technique that uses a sterile dermaroller to puncture the skin and release growth factors. The combination of skin needling and PRP could enhance the efficacy of both modalities. Chemical reconstruction of skin scars technique consists of focal application of high concentration of trichloroacetic acid (TCA) on the acne scars to stimulate collagen production. To evaluate the efficacy and safety of intradermal injection of PRP, 100% focal TCA, and combined skin needling plus topical PRP in the treatment of atrophic acne scars. Forty-five patients with atrophic acne scars were randomly assigned to 3 equal groups; Group A received intradermal injection of PRP, Group B received chemical reconstruction of skin scars technique with TCA 100%, and Group C was treated by combined skin needling and PRP. Each patient underwent 3 sessions at 2-week interval. All the patients completed the study. The 3 groups showed statistically highly significant improvement in the degree of acne scars after treatment (p < .001). No major adverse effects were observed in the studied groups. This is the first study to use intradermal injection of PRP alone for the treatment of atrophic acne scars. The 3 modalities showed a promising efficacy and safety in the treatment of atrophic acne scars.

Acne scars are a major concerning problem to all acne patients affecting their quality of life. Platelet-rich plasma (PRP) and fractional CO2 laser are innovative treatment modalities for acne scars. Carboxytherapy can also be used to improve scar tissue through the increase in collagen deposition and reorganization, and the improvement in skin texture and tone. The aim of this work was to compare the efficacy, safety, and complications of the intradermal injection of PRP combined with carboxytherapy and PRP combined with fractional CO2 laser, in the treatment of atrophic acne scars. Forty patients with atrophic acne scars were divided into 2 groups. Group A included 20 patients and was subjected to three fractional CO2 laser sessions combined with PRP injection. Group B included 20 patients and was subjected to three sessions of carboxytherapy combined with PRP injection. Both fractional CO2 laser and carboxytherapy combined with PRP showed improvement in acne scars and patients' satisfaction but the improvement with fractional CO2 laser was significantly better than carboxytherapy but with more side effects. Improvement of acne scars was noted in both treatment modalities with obvious higher and statistically significant results in favor of fractional CO2 laser but with more side effects. Carboxytherapy is a promising tool in treatment of acne scars with less complication.

Ablative laser resurfacing is an effective treatment for atrophic acne scars. However, it often induces complications such as edema, prolonged erythema, scarring and hyperpigmentation. Therefore, a new concept of laser treatment called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation treatment of atrophic acne scars. This study was designed to prospectively evaluate the use of a technique similar to fractional photothermolysis using only the standard CO2 laser without the fractional laser device in the treatment of atrophic scars and demonstrates it as a safe, effective and economical treatment option. Clinical improvement was achieved in all 35 patients with minimal adverse effects.

There is presently little published data on the clinical effectiveness of nonablative lasers in the treatment of atrophic acne scars and the safety of their use in patients with darker skin types. This study aims to determine the clinical effectiveness and safety of the nonablative 1450 nm diode laser with cryogen cooling spray in the treatment of facial atrophic acne scars in Type IV-V Asian skin. This is a prospective non-comparative open study. 4 to 6 laser treatment sessions were performed on patients with atrophic acne scars. Final clinical assessment was performed 6 months after the last treatment. 57 patients were evaluated. Patient's self-assessment of scar improvement as compared with doctor's assessment was as follows: patients who completed 4 treatments (15.7% vs 6.6%), patients who completed 5 treatments (20% vs 7.9%) and patients those who completed 6 treatments (17.3% vs 5.0%). Main side effects were mild to moderate pain during the procedure, transient erythema, and hyperpigmentation which occurred in 39% of treated patients. The nonablative 1450 nm diode laser may be effective in achieving mild to moderate gradual clinical improvement in the treatment of facial atrophic acne scars. The procedure is associated with minimal downtime and is safe for use in darker skin types IV and V.

Multiple therapeutic approaches are usually required when treating atrophic acne scars. Subcision was reported to be of value in improving rolling scars. Autologous platelet-rich plasma (PRP) has recently been proposed as an adjuvant treatment option for atrophic acne scars with few reports evaluating its efficacy. Our objective was to compare the effect of intradermal injection of PRP vs combined PRP and subcision in the treatment of atrophic acne scars. Thirty patients with bilateral atrophic acne scars were enrolled. Each patient received three monthly sessions. Each side of the face was randomly treated either with intradermal PRP alone or with combined treatment with subcision followed by PRP injection. Patients were assessed at 3 and 6months following the last treatment session. Evaluation of serial photographs was performed by two blinded investigators. Platelet-rich plasma alone showed a better response, fewer side effects, and shorter downtime compared to combined subcision and PRP. Autologous PRP injection can be a therapeutic option in the treatment of atrophic acne scars, with fewer complications and better tolerability than combined subcision and autologous PRP.

Treatment of atrophic scars using a fractional laser resurfacing technique has demonstrated favorable outcomes. To evaluate the efficacy and safety of 2,790-nm-wavelength ablative fractional resurfacing on atrophic acne scars in Asian individuals. Twenty participants (8 female, 12 male, mean age 26) with skin phototype IV and atrophic acne scars were treated with two sessions of 2,790-nm ablative fractional resurfacing laser at a 6-week interval. Objective and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and 1 and 3 months after the final treatment. At the 3-month follow-up, 70% of the participants were rated as having at least 50% to 89% improvement of scars. Mild erythema was the most common adverse effect, observed in 30% of participants, but resolved completely in an average of 5 days. Yttrium scandium gallium garnet ablative fractional resurfacing (2,790-nm) appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians. The authors have indicated no significant interest with commercial supporters.

Background: Acne Vulgaris is a self-limiting, chronic skin lesion, which may heal with squally of different types of scars (ice pitted, boxcar, rolling, and keloid). Different options used to deal with scars such as laser dermabrasion, surgical excision, and chemical peeling. This study aims to assess the safety and effectiveness of using a combination of radiofrequency (RF) microneedling and platelet-rich plasma (PRP) in managing the atrophic acne scars among a sample of Iraqi patients.&#x0D; Method: An interventional study conducted from January 2017 to December 2018 at a private dermatological clinic in Kalar City, Al-Sulaymmania Province, Iraq. Patients with the atrophic scar and willing to participate are adequately assessed and treated by RF and PRP. A different number of sessions of therapy used, and patients followed for three months after the last meeting.&#x0D; Results: Thirty-one patients were involved in the study. The majority of them (27, 87.0%) were females with a mean age of 26.41±8 years. Twenty patients (64.5%) had opened mouth (boxcar and rolling) scars, and eleven (35.5%) had ice pitted scars. Ten patients (32.25%) showed an excellent response to RF and PRP therapy with two grades improvement, fifteen patients (48.38%) showed good response with one-grade improvement and six patients (19.6%) showed poor response without improvement in grades, (all of them of ice pitted scars). There was a direct relationship between the number of sessions and the response to therapy. Three patients developed folliculitis at sits of puncturing with the isolation of staphylococcus auras bacteria, which cleared by topical and systemic antibiotics.&#x0D; Conclusions: Although ice pitted scars showed an inadequate response to therapy, however, the reaction of the boxcar and rolling scars to RF and PRP was excellent, indicating that combination procedure is a safe, efficient and satisfactory option for the treatment of atrophic acne scars.

Objective: To compare the effectiveness of intradermal platelet-rich plasma with 30% Trichloroacetic acid in treating atrophic acne scars.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Tertiary Care Hospital of Multan Pakistan, from Aug 2019 to Sep 2020.&#x0D; Methodology: A total of 76 patients (38 in each group), were enrolled in the study. Platelet-rich plasma treatment was given to Group-A, and 30% Trichloroacetic acid treatment was given to Group-B patients. Platelet-rich plasma was injected in the dermis with an insulin syringe while 30%Trichloracetic acid was applied with a cotton tip applicator. The effectiveness of treatment was measured by Goodman and Baron quantitative acne scar scale.&#x0D; Results: A total of 76 patients with atrophic acne scars were included in the study. The mean age of patients in Plate rich plasma Group was 29.63±5.08 years and 29.92±5.85 years in the 30% Trichloroacetic acid Group. Platelet Rich Plasma was an effective treatment of atrophic acne scar (p= 0.030) with post-procedure improvement in the Goodman and Baron quantitative acne scar scale.&#x0D; Conclusion: Atrophic acne scar treatment with intradermal Plate-rich plasma is more effective than 30% Trichloroacetic acid.

To date, treatment of atrophic acne scars remains a therapeutic challenge for dermatologists, yet there is no standard option on the most effective treatment. Microneedling (MN) is a minimally invasive technology that involves repetitive skin puncture using sterile microneedles to disrupt dermal collagen that connects the scar tissue. Recent studies have demonstrated the potency of MN, such as dermaroller and fractionated microneedle radiofrequency, in the treatment of atrophic scars. The objective of this review is to evaluate systematically the current literature on MN for atrophic acne scars. A systematic search of literature was performed from PubMed, Medline, Cochrane Central, and Google Scholar databases for articles published during the last 20 years. Only randomised controlled trials (RCTs) with full‐text version of the manuscript available were included in our study. Nine RCTs were included in this review. All treatment modalities demonstrated consistent results that MN was efficacious in treating atrophic acne scars as a monotherapy or in combination with other treatments. Moreover, no serious adverse effects were reported in all studies after MN treatment. MN is a well‐tolerated and effective therapeutic modality in treating atrophic acne scars. Further research is required to validate the efficacy of MN with a larger sample size and lengthy follow‐up.

Acne scarring causes cosmetic discomfort, depression, low self-esteem and reduced quality of life. Microneedling is an established treatment for scars. A multimodality approach to scar treatment is usually necessary to achieve the best cosmetic results. The objective of this study was to evaluate the efficacy and safety of platelet rich plasma (PRP) combined with microneedling in comparison with microneedling with non-cross-linked hyaluronic acid for the treatment of atrophic acne scars. Forty-one patients of 20-40 years of age with atrophic acne scars were included. Microneedling was performed on both halves of the face. Topical application of PRP was given on right half of the face, while the left half of the face was treated with topical application of non-cross-linked hyaluronic acid. Four treatment sessions were given at an interval of 1 month consecutively. Goodman's Qualitative scale and the quartile grading scale are used for the final evaluation of results. There was a statistically significant improvement in acne scars after treatment among the studied group. Right and left halves showed 85.4% and 82.9% improvement, So the difference of the improvement between the two modalities is statistically insignificant P > 0.05 We conclude that microneedling has efficacy in the management of atrophic acne scars. It can be combined with either PRP or noncross-linked hyaluronic acid to enhance the final clinical outcomes in comparison with microneedling alone. The difference between the two modalities is insignificant.