Split Face Comparative Study of Microneedling with Platelet-rich Plasma versus Microneedling Alone in Treating Atrophic Postacne Scars

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.

Background:Multiple studies have proposed the effectiveness of Platelet rich plasma (PRP) in treatment of atrophic acne scars. But an unanswered question is - whether it is the presence of growth factors in PRP or the mechanical factors during the injection that are responsible for its effectiveness? Also, no study compares PRP as a monotherapy against inert solution like normal saline (NS), that too, in a split face pattern using a non-invasive objective evaluation method.Aims:Primary – To compare the efficacy of intralesional PRP and NS injections, in the treatment of atrophic acne scars. Secondary - To assess the side effect profile of the PRP injections.Study Design:Prospective Interventional Comparative Split Face studyMaterials and Methods:30 out of 33 patients completed the study and 20 of them were subjected to Ultrabiomicroscopic (UBM) analysis. Each patient received intralesional injections of NS and PRP in a split face pattern at two weekly intervals for five sittings. Treatment response was assessed using Goodman And Baron qualitative grading system, photographic evaluation by two blinded dermatologist and UBM analysis (scar depth & length).Results:All the three methods showed a statistically significant treatment response. However, there was no significant inter group difference and PRP and NS had similar efficacy in treating acne scars.Conclusion:We conclude that subscision like mechanical effect of injecting solution is more important than the nature of the solution in treatment of atrophic acne scars and UBM sonography can be proposed as an objective assessment tool for such studies.

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.

Background: Acne is a common skin condition that is prevalent in 90% of the adolescent population. Inflammatory lesions of acne may lead to scarring. Various treatment modalities such as subcision, punch excision, chemical peels, microdermabrasion, and fractional lasers have been tried for acne scars but with unsatisfactory results. Purpose: The aim of the present study is to compare the efficacy of microneedling with Jessner’s plus 35% trichloroacetic acid (TCA) peel versus the efficacy of microneedling with platelet-rich plasma (PRP) therapy for the management of atrophic acne scars. Methods: Sixty patients having atrophic scars due to acne were segregated into two groups each containing 30 patients. On Group A, patients microneedling was performed at weeks 0, 6, and 12 and Jessner’s plus 35% TCA peel was performed at weeks 3, 9, and 15. On Group B, patients microneedling and intradermal PRP were performed sequentially at weeks 0, 3, and 6. Patients were followed at the outset of the procedure and 24 weeks after the procedure using the Echelle d’Evaluation Clinique des Cicatrices d’acne (ECCA) score. Results: The difference in the mean ECCA score at the outset of the procedure and 24 weeks after the procedure was more in Group B as compared to Group A (47.8 ± 13.6 vs. 39.1 ± 11.4). Conclusion: The efficacy of the combination of microneedling with PRP was higher than the combination of microneedling with Jessner’s plus 35%TCA peel for the treatment of atrophic acne scars.

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.

Acne scarring usually causes cosmetic and psychological problems. Our aim of the study was to compare the efficacy of microneedling alone, intradermal injection of platelet rich plasma (PRP) alone and combined microneedling with PRP in the treatment of atrophic post-acne scars. Thirty adult patients with facial post-acne scars were randomly recruited and divided into two groups: A and B. Group A: included 15 patients; the left sides of their faces were treated with microneedling by dermapen followed by PRP while on the right side of the faces microneedling alone was performed. Group B: included 15 patients; the left sides of their faces were treated with microneedling by dermapen followed by PRP while the right sides of the faces were treated with intradermal injection of PRP. For both groups, the treatment session was repeated every 3 weeks until clearance of the atrophic acne scars or for four sessions maximally. Patients' evaluation was done pre-treatment and 3 weeks after the last session by photography, Goodman and Baron qualitative grading system and Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) scale. By using all of these evaluation methods, group A showed that there was better improvement on the left side but without statistical significant difference. However, group B showed that there was a significant reduction in the total number of post-acne scars on the left side compared to the right side by using photographic assessment and ECCA grading scale. Skin microneedling, PRP and combined microneedling with PRP are effective therapeutic modalities in atrophic post-acne scars treatment. However, combined microneedling with PRP gives better results and is better tolerated in all types of atrophic acne scars.

Microneedling is one of the cost-efficient and safe procedures for treatment of atrophic scars. Previous studies have shown variable results regarding the increased efficacy of platelet-rich plasma (PRP) when combined with microneedling. The aim of this split-face study was to compare the efficacy of PRP combined with microneedling versus microneedling alone in acne scars in type 3-6 skin in South Indian patients. The primary objective was to compare the mean reduction in acne scar using Goodman Baron quantitative scale on the side of the face treated with PRP and microneedling, with the side of the face treated with microneedling alone. A total of 64 patients were recruited, and three sessions of microneedling with PRP on the right side and microneedling on the left side were done with an interval of 4 weeks between the sittings. Results were evaluated after 1 month of the last sitting using Goodman and Baron's score and physician and patient satisfaction score. There was significant improvement in atrophic acne scars on both sides of the face before and after treatment. While comparing efficacy between sides, the side treated additionally with PRP had significantly more improvement than the side treated with microneedling alone. The trial was non-randomized, and complete blinding was not done. The study had a shorter follow -up interval. We did not analyze results based on the site of scar. PRP combined with microneedling is more effective than microneedling alone for the treatment of atrophic acne scars. Larger studies with longer follow-up are needed to confirm this result.

Scarring and facial disfigurement caused by severe acne can cause significant physical and psychosocial distress, particularly in adolescents. In treating acne scars, dermatologists face a therapeutic challenge. Ablative lasers Erbium YAG lasers or carbon dioxide lasers are effective, but they are associated with erythema, post-inflammatory hyperpigmentation, a longer recovery time, and scarring. With the introduction of fractional carbon dioxide lasers, acne scar treatment has become much more effective. PRP contains growth factors, which helps to speed up the natural healing process. As a result, combining fractional CO2 laser with platelet rich plasma has resulted in significant improvement of acne scars with good cosmetic results and skin rejuvenation. Through this study, we intend to assess the efficacy of fractional carbon dioxide laser with platelet rich plasma versus fractional carbon dioxide laser alone in the improvement of facial acne scars.To compare the efficacy of fractional carbon dioxide laser with and without platelet rich plasma (PRP) in treatment of facial acne scars.A total of 30 patients (18-40 years) with facial atrophic scars who attended the out-patient department at the Department of Dermatology, Venereology, and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara were randomly assigned to groups A (fractional CO2 with PRP group) and B (fractional CO2 group). Patients in both groups received four sequential treatments, with a four-week interval between each session. A side-by-side comparison of preoperative and post-operative photographs was used to assess the clinical improvement of atrophic scars one month after the last session, using Goodman and Baron's qualitative and quantitative grading system. Furthermore, patients were asked to provide feedback on scar improvement using the patient satisfaction Visual Analogue Score (VAS).Based on Goodman and Baron’s qualitative assessment one month after the last session (4 sessions), 13.33 percent (2) of patients in group A showed reduction by three grades compared to 6.66 percent (1) patient in group B, and 60 percent (9) of patients in both groups showed scar reduction by two grades. Based on Goodman and Baron’s quantitative assessment one month after the last session (4 sessions), 20 percent showed very good reduction in group A compared to 13.3 percent in group B, and 40 percent showed good reduction in group A compared to 33.3 percent in group B. [p=0.732, not statistically significant]. Patients treated with fractional carbon dioxide laser with PRP in group A had a slightly better mean percentage reduction of post acne scars at one month after the last session (4 sessions) compared to patients treated with fractional carbon dioxide laser in group B [75.83 vs 69.34 percent; p=0.72 which was statistically not significant]. At one month after the last treatment session (4 sessions), 66.67 percent (10) of patients in Group A were very satisfied with the treatment, compared to 46.67 percent (7) of patients in Group B. After four treatment sessions, the mean Patient Satisfaction VAS Score in Group A was 2.0, compared to 1.7 in Group B [p=0.000082, which was found to be statistically significant]. The result of this study shows that combination of fractional CO2 laser with intradermal PRP is slightly more efficacious than fractional carbon dioxide laser monotherapy in management of facial acne scars. Patients receiving fractional carbon dioxide laser with PRP were more satisfied with the treatment outcome.

Atrophic post acne scars have a profound psychosocial impact on patients of all ages. The dermatologists usually face the dilemma of choosing the most effective or choosing the safest modality of treatment. The fractional CO2 laser (FCL) resurfacing is the gold standard for treating atrophic scars but is associated with prolonged recovery and many side effects. To address these limitations, newer combined therapies have emerged. The current work aimed to evaluate the safety and efficacy of FCL combined with topical application of plasma gel in the treatment of atrophic acne scars.Twenty patients with facial atrophic post acne scars were enrolled in this study. All of them completed the study. All patients underwent 4 treatment sessions at 4 – weeks intervals. The evaluation was applied by the investigator at the baseline, and one month after final session. Then, the percentage of improvement was calculated. Patients were with Fitzpatrick skin types II-V. They were 8 males and 12 females. According to the qualitative global scarring grading system (GSGS), patients with grade 4 acne scars comprised 50% of the study population, followed by 10% with grade 2 and 40% with grade 3. GSGS scores were decreased from 3.10 ± 0.99 to 2.00 ± 0.47 after 1 month from the last treatment session with P- value <0.001. Reported side effects were mild and transient.The combination of plasma gel and FCL resurfacing was noticeably outstanding in their efficacy and safety.

To compare the efficacy of autologous platelet-rich plasma (PRP), ablative fractional carbon dioxide (FCO2 ) laser, and their combination in the treatment of atrophic acne scars, both clinically and immuno-histopathologically. Sixty patients were randomly divided into three equal groups. Group 1 received intradermal PRP injection sessions. Group 2 received FCO2 laser sessions. Group 3 received FCO2 laser followed by intradermal PRP injection sessions. Each group received three sessions at monthly intervals. The final assessment took place 3 months after the last session. Skin biopsies were obtained before and 1 month after treatment sessions with pathological evaluation. Combined PRP and FCO2 laser-treated patients had a better clinical response, fewer side effects, and shorter downtime than FCO2 laser alone. PRP-treated patients had some improvement but significantly lower than the other two groups. The current study concluded that a combination of PRP and FCO2 laser is an effective and safe modality in the treatment of atrophic acne scars with better results than PRP or FCO2 laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Postacne scarring is an unfortunate and frequent complication of acne, with varied morphological forms and associated significant psychological distress to patients. To evaluate the efficacy and safety of plasma gel injection alone and in combination with microneedling in treatment of atrophic postacne scars. Sixty patients with atrophic postacne scars were enrolled in this single blinded randomized controlled study. The patients were divided into three groups with 20 patients being treated with intradermal injection of plasma gel, 20 patients treated with dermaroller, and 20 patients subjected to combined plasma gel and dermaroller. Patients received four sessions at monthly intervals and were evaluated by clinical, histopathological, and immunohistochemical analysis. There was statistically significant improvement in postacne scars after treatment in all studied groups with variable degrees; the combined technique showed the best clinical improvement in postacne scars. There was an increase in newly formed collagen and elastic fibers with more organized and condensed bundles after the end of treatment. Plasma gel showed a remarkable improvement for most patients after one session, providing a quick and easy solution for acne scars. The combination of dermaroller and plasma gel potentiated its effect with more improvement in scars.

The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH). To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars. Forty-six patients with atrophic facial acne scars were randomized to microneedling and laser groups, receiving 3 sessions performed monthly. Two blinded dermatologists applied the validated "Quantitative Global Grading System for Postacne Scarring" scale, before, 2 months, and 6 months after the treatment. Side effects were recorded at each follow-up visit and patient's satisfaction was evaluated. Both groups showed a significant improvement, and there was no statistically significant difference between results of both therapies (p = .264). The erythema after each session was longer in the laser group and 13.6% subjects experienced PIH. No PIH was observed in the microneedling group. This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars. Microneedling is well tolerated, with fewer side effects and lower down time.

Background: There have been no well-controlled studies evaluating the efficacy of combining 1540 nm nonablative fractional laser with percutaneous collagen induction (PCI) and trichloroacetic acid (TCA) 20% in the treatment of atrophic acne scars. Objective: We hypothesized that combined alternating sessions of both modalities would show better results than each individual modality. Methods and materials: Thirty-nine patients with post acne atrophic scars were included in this study. Patients were randomly equally divided into three groups; group 1 was subjected to six sessions of PCI combined with TCA 20% in the same session, group 2 was subjected to six sessions of 1540 nm fractional laser and group 3 was subjected to combined alternating sessions of the previously mentioned two modalities. Results: Scar severity scores improved by a mean of 59.79% (95% CI 47.38–72.21) (p < 0.001) in group 1, a mean of 61.83% (95% CI 54.09–69.56) (p < 0.001) in group 2 and a mean of 78.27% (95% CI 74.39–82.15) (p < 0.001) in group 3. The difference in the degree of improvement was statistically significant when comparing the three groups using ANOVA test (p = 0.004). Conclusion: The current work recommends combining 1540 nm nonablative fractional laser in alternation with PCI and TCA 20% in the treatment of atrophic acne scars.