We are often asked, “Can you help with acne scars?” For many the answer is yes. We have seen many patients over the years with various levels and degrees of acne scaring who have benefitted from our PRP treatments. What are our PRP treatments and how do they work?
First, I want to provide some basic information.
- Platelet Rich Plasma (PRP) is a blood product that comes from you. We draw your blood and then spin it in a high speed centrifuge to separate the plasma from the red blood cells. What is left are a “platelet rich plasma” that contains concentrated growth factors and healing cells.
- “Micro-needling,’ gently pricking your skin stimulates the creation of new skin cells and regeneration of damaged cells. Your own PRP is then massaged into the skin. The goal is to stimulate the production of collagen and elastin, and the creation of new skin cells.
- Subcision, also called as subcutaneous incisionless surgery, is a minor surgical procedure for treating depressed scars using a hypodermic needle inserted through a puncture in the skin to to break the fibrotic strands, (which pulls the skin downward creating the scars). The strands also connect the scar to the underlying or subcutaneous tissue.
In our office we have seen PRP provide good results for wrinkles, sun-damaged skin and acne scars. Some patients get very good results. Not everybody gets positive results. But there is research. Let’s look at some of the research that seeks to validate PRP as a safe and effective acne scar treatment.
The science – PRP treatments, safe, effective, economical for deep acne scars
An April 2020 review published in the Journal of cosmetic dermatology (1) examined a 311 participants (153 whole-face participants and 158 split-face participants) across eight included studies. In measured analysis of 241 participants across six included studies showed a statistically significant reduction in scar severity scores in favor of microneedling or subcision with PRP. Combination therapy with intradermal or topical PRP was significantly more effective than monotherapy alone and combination therapy with an adjunct other than PRP. The researchers concluded: “This systematic review and meta-analysis demonstrated that microneedling or subcision with PRP produced statistically significant improvement in validated outcomes over microneedling or subcision alone.”
A February 2020 study also published in the Journal of cosmetic dermatology (2) produced similar findings. Here the researchers wrote: “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. (The researchers) 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 6 months following the last treatment session.
RESULTS: “Platelet-rich plasma alone showed a better response, fewer side effects, and shorter downtime compared to combined subcision and PRP.”
CONCLUSION: “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.”
“Increases in collagen density and dermal elastic fibers.”
In the medical publication Skin Therapy Letter, (3) Dr. Jason Emer writes: “Several reports demonstrate improvements in traumatic scars and acne scars with PRP treatment. Increases in collagen density and dermal elastic fibers are notable benefits when using PRP in aesthetic dermatology. When PRP is used in combination with other therapies, such as laser treatments, microneedling, and hyaluronic acid fillers, further improvements in skin appearance are achieved.”
In a study from Egypt,(4) doctors speculated that PRP may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition. Simply, this is the replenishment of new collagen in the scar. To accelerate this PRP induced process, the Egyptian doctors also performed skin needling (or microneedling) a technique that uses a sterile dermaroller (or Dermapen® see below) to puncture the skin and release growth factors. The doctors speculated that the combination of skin needling and PRP could enhance the efficacy of both modalities.
The doctors took Forty-five patients with atrophic acne scars and randomly assigned to 3 equal groups;
- Group A received intradermal injection of PRP alone,
- Group B received chemical reconstruction of skin scars,
- and Group C was treated by combined skin needling and PRP. Each patient underwent 3 sessions at 2-week interval.
The 3 groups showed statistically highly significant improvement in the degree of acne scars after treatment No major adverse effects were observed in the studied groups.
Since one group of patients derived benefit from the PRP injections alone, the doctors were able to conclude that PRP is a beneficial treatment for acne scars.
PRP and Microneedling
This research was continued by another team of researchers who published their review in The Journal of dermatological treatment in May 2018. (5)
Here the objective was to evaluate the effectiveness and safety of microneedling alone versus microneedling combined with platelet rich plasma in the treatment of post acne scars..
- The study included 35 patients with mild to severe post acne atrophic scar.
- All the patients received four sequential treatments of skin microneedling alone on the right side of the face and skin microneedling followed by topical application of platelet rich plasma (PRP) on the left side of the face with an interval of 3 weeks.
- Two blinded dermatologists evaluated the clinical response. Patients are queried about their satisfaction with the treatment outcomes.
RESULTS:
- There was a significant improvement in the degree of scar severity before and after treatment on both the sides. Regarding patient’s satisfaction grades, there was a significant improvement after both treatment modalities with insignificant differences between both treatment modalities.
- Both microneedling and microneedling in combined with PRP showed satisfactory results.
Dermapen® is an affordable treatment that can tighten and lifts skin through a fractional micro-needling device. Unlike laser fractional treatments; Dermapen® is safe for most everybody, including darker skin types when used with a careful post-procedure regimen that includes sunblock.
Dermapen® treatments are used for the following issues:
- Minimize fine lines and wrinkles
- Decrease pore size
- Diminish appearance of acne scars, surgical scars and stretch marks
Dermapen® offers better, safer results than rolling micro-needling systems. There is also less pain, bruising, and recovery time. Dermapen® uses collagen induction therapy, (CIT) which stimulates your own body to increase production of collagen. This “controlled injury” stimulates the production of new cells, which heals scars, minimizes wrinkles and diminishes stretch marks. Ideal regimens are 4-6 treatments over a space of 2-6 months. Each treatment is done approximately 4-5 weeks apart.
More research
In September 2019, investigators published their review of PRP’s effectiveness in treating acne scarring in the medical journal Aesthetic plastic surgery. (6) Here is what they wrote: “A number of studies have investigated the role of platelet-rich plasma (PRP) as an assisted therapy for atrophic acne scars. However, the results are diverse, and no up-to-date meta-analysis was found that exclusively examined atrophic acne scar treatment.”
To better understand how PRP could work, they looked at seven published research articles. In these seven studies PRP was utilized as an additive therapy. The major therapies included fractional carbon laser therapy and microneedling. The investigators concluded: “This review shows that PRP is a useful assisted therapy for atrophic acne scars, which can achieve better improvement.”
Further, a good summary can be drawn from combined research from the University of Michigan and John Hopkins University. This comes from the Journal of the American Academy of Dermatology June 2019.(7)
The field of dermatology has seen numerous therapeutic innovations in the past decade, with platelet-rich plasma recently garnering significant interest in acne scarring. . . This review reveals that activated, leukocyte- and platelet-rich plasma in combination with fractional ablative laser treatment administered in 2 or 3 sequential sessions 1 month apart improves the appearance of acne scars. The evidence for the use of platelet-rich plasma with microneedling is less supportive. Because of the heterogeneity of the studies and widely variable outcome measures, comparison between platelet-rich plasma treatments and subsequent statistical analysis could not be performed. Although these studies use various subjective and objective evaluation methods, the addition of platelet-rich plasma provides improvements in acne scarring, higher patient satisfaction, and decreased postprocedure downtime.”
In this December 2022 (9) paper doctors compared outcomes of micro-needling alone, intradermal injection of platelet rich plasma (PRP) alone and combined micro0-needling 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 micro-needling by Dermapen® followed by PRP while on the right side of the faces micro-needling alone was performed. Group A showed that there was better improvement on the left side of combined micro-needling and PRP but without statistical significant difference.
- Group B: included 15 patients; the left sides of their faces were treated with micro-needling 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.
Conclusion: Combined microneedling with PRP gives better results and is better tolerated in all types of atrophic acne scars.
A September 2023 paper (8) reappraised previous research on Platelet-rich plasma (PRP), alone or in combination with other treatments, compared to regimens PRP-free for the treatment of acne scars. The researchers looked at 15 systematic reviews that contained data from 124 overlapping reports, based on 34 individual primary studies. Most of the studies evaluated combination of PRP with micro-needling or with laser therapy compared to micro-needling or laser therapy without PRP.
Clinical improvement (reported as degree of improvement or improvement score) and patient’s satisfaction rate were significantly higher in PRP recipients compared to controls. However the researchers found that the studied papers were of low or very low certainty of evidence and did not clearly give evidence to support the PRP use in combination with micro-needling or laser therapy for the treatment of acne scars. The researchers called for more papers on the combination treatments to assess if they would offer the PRP patient more success.
References
1 Long T, Gupta A, Ma S, Hsu S. Platelet-rich plasma in noninvasive procedures for atrophic acne scars: A systematic review and meta-analysis. J Cosmet Dermatol. 2020;19(4):836–844. doi:10.1111/jocd.13331
2 Hassan, A.S., El‐Hawary, M.S., Abdel Raheem, H.M., Abdallah, S.H. and El‐Komy, M.M., 2020. Treatment of atrophic acne scars using autologous platelet‐rich plasma vs combined subcision and autologous platelet‐rich plasma: A split‐face comparative study. Journal of Cosmetic Dermatology, 19(2), pp.456-461.
3 Emer J. Platelet-Rich Plasma (PRP): Current Applications in Dermatology. Skin therapy letter. 2019 Sep;24(5):1-6.
4 Nofal E, Helmy A, Nofal A, Alakad R, Nasr M. Platelet-rich plasma versus CROSS technique with 100% trichloroacetic acid versus combined skin needling and platelet rich plasma in the treatment of atrophic acne scars: a comparative study. Dermatologic Surgery. 2014 Aug 1;40(8):864-73.
5 Ibrahim MK, Ibrahim SM, Salem AM. Skin microneedling plus platelet-rich plasma versus skin microneedling alone in the treatment of atrophic post acne scars: a split face comparative study. J Dermatolog Treat 2018; 29: 281–286.
6 Hsieh TS, Chiu WK, Yang TF, Wang HJ, Chen C. A Meta-analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars. Aesthetic plastic surgery. 2019 Jan 1:1-9.
7 Hesseler MJ, Shyam N. Platelet-rich plasma and its utility in the treatment of acne scars-A systematic review. Journal of the American Academy of Dermatology. 2019 Feb 8.
8 Cruciani M, Masiello F, Pati I, Pupella S, De Angelis V. Platelet rich plasma use for treatment of acne scars: an overview of systematic reviews: PRP for acne scars. Blood Transfusion. 2023 Sep 6.
9 Ismail SA, Khella NA, Abou‐Taleb DA. Which is more effective in atrophic acne scars treatment microneedling alone or platelet rich plasma alone or combined both therapeutic modalities?. Dermatologic Therapy. 2022 Dec;35(12):e15925.
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