Evaluating the Effectiveness of Platelet-Rich Plasma as an Adjunct to Fractional Carbon Dioxide Laser Therapy in Improving Facial Acne Scar Appearance: A Randomized Controlled Trial
DOI:
https://doi.org/10.66344/jpad.v36i1.3326Keywords:
Fractional Co2 laser, Ablative laser, Platelet rich plasma, Post acne atrophic scarsAbstract
Background Fractional carbon dioxide (CO₂) laser resurfacing is commonly used to treat atrophic acne scars, but treatment responses vary and adverse effects such as erythema and post-inflammatory hyperpigmentation are frequent. Platelet-rich plasma (PRP) has been proposed as an adjunct to enhance dermal remodeling and improve tolerability.
Objective To evaluate whether platelet-rich plasma (PRP) enhances the efficacy of fractional CO₂ laser resurfacing in reducing moderate-to-severe acne scars and minimises laser-induced complications such as erythema, oedema, and pain, thereby improving patient satisfaction.
Methods Seventy adults with moderate-to-severe atrophic acne scars were assigned to receive three sessions of fractional CO₂ laser with topical autologous PRP (35 participants) or laser alone (35 participants) at 4-week intervals. The primary outcome was change in scar severity at 12 weeks using the Goodman and Baron scale. Pain and satisfaction were assessed using the visual analogue scale (VAS).
Results Thirty-two participants in group A and 28 in group B completed the study. Scar severity improved significantly in both groups. In group A, scores decreased from 12.4±3.8 to 8.2±3.5; in group B, from 11.8±4.1 to 8.6±4.5. Although improvement was greater with PRP (4.2 vs. 3.2 points), it was not statistically significant (p = 0.129). Patient satisfaction was higher with PRP. Adverse-event rates were similar, but erythema, oedema, and pain were significantly less severe in the PRP group.
Conclusion The combination of fractional CO₂ laser with PRP showed greater, though not statistically significant, improvement in acne scars and a better safety profile, with greater satisfaction, than laser alone.
References
Liu L, Xue Y, Chen Y, Chen T, Zhong J, Shao X, et al. Prevalence and risk factors of acne scars in patients with acne vulgaris. Skin Res Technol. 2023 Jun;29(6):e13386. doi: 10.1111/srt.13386.
Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol. 2017 Sep;10(9):12-23.
Fabbrocini G, Annunziata MC, D'Arco V, De Vita V, Lodi G, Mauriello MC, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080.
Rullan PP, Olson R, Lee KC. A Combination Approach to Treating Acne Scars in All Skin Types: Carbolic Chemical Reconstruction of Skin Scars, Blunt Bi-level Cannula Subcision, and Microneedling-A Case Series. J Clin Aesthet Dermatol. 2020 May;13(5):19-23.
Omi T, Numano K. The Role of the CO2 Laser and Fractional CO2 Laser in Dermatology. Laser Ther. 2014 Mar 27;23(1):49-60.
doi: 10.5978/islsm.14-RE-01.
Shah SD, Mehta BD, Borkar MA, Aswani RC. Study of safety and efficacy of autologous platelet rich plasma combined with fractional CO2 laser in the treatment of post acne scars: a comparative simultaneous split-face study. Int J Res Med Sci. 2017 Mar. 28;5(4):1344-51.
McGoldrick RB, Theodorakopoulou E, Azzopardi EA, Murison M. Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars. Scars Burn Heal. 2017 Mar 14;3:2059513116689805. doi: 10.1177/2059513116689805.
Pavlovic, V., Ciric, M., Jovanovic, V. & Stojanovic, P. Platelet Rich Plasma: A short overview of certain bioactive components. Open Med. 206;11;242-7.
Galal O, Tawfik AA, Abdalla N, Soliman M. Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: Image analysis system evaluation. J Cosmet Dermatol. 2019 Dec;18(6):1665-71. doi: 10.1111/jocd.12909.
Chen J, Wan Y, Lin Y, Jiang H. Fractional Carbon Dioxide Laser or Erbium:Yttrium-Aluminum-Garnet Laser Assisted by Topical Application/Intradermal Injection of Platelet-Rich Plasma for Postacne Scars. Plast Reconstr Surg. 2021 Dec 1;148(6):915e-927e.
doi: 10.1097/PRS.0000000000008513.
Min S, Yoon JY, Park SY, Moon J, Kwon HH, Suh DH. Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation. Lasers Surg Med. 2018 Apr;50(4):302-10.
doi: 10.1002/lsm.22776.
Goodman GJ, Baron JA. Postacne scarring--a quantitative global scarring grading system. J Cosmet Dermatol. 2006 Mar;5(1):48-52.
doi: 10.1111/j.1473-2165.2006.00222.x.
Arsiwala NZ, Inamadar AC, Adya KA. A Comparative Study to Assess the Efficacy of Fractional Carbon Dioxide Laser and Combination of Fractional Carbon Dioxide Laser with Topical Autologous Platelet-rich Plasma in Post-acne Atrophic Scars. J Cutan Aesthet Surg. 2020 Jan-Mar;13(1):11-7.
Chang HC, Sung CW, Lin MH, Hu S, Hsiao YC, Cheng YC. Efficacy of autologous platelet-rich plasma combined with ablative fractional carbon dioxide laser for acne scars: a systematic review and meta-analysis. Aesthet Surg J. 2019;39(7):NP279–NP287.
Wu N, Sun H, Sun Q, Cong L, Liu C, Zheng Y, et al. A meta-analysis of fractional CO₂ laser combined with PRP in the treatment of acne scars. Lasers Med Sci. 2021;36(1):1–12.
Rahman S, Naveed T, Afridi IU, Suhail MA, Khan DD, Khan M, et al. Comparison of efficacy of micro-needling plus platelet-rich plasma and fractional CO₂ laser plus platelet-rich plasma in the treatment of post-acne scars. J Pak Assoc Dermatol. 2024;34(4 Suppl):S83–S88.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Yasaan Saaqib, Nabeela Shahzadi, Mahym Mansoor, Asma Tariq, Zahid Tahir, Maryam Wahla, Saira Riaz
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
