Combination therapy using subcision, needling, and platelet‐rich plasma in the management of grade 4 atrophic acne scars: A pilot study

Abstract

Summary Background Multimodality therapies including minimally invasive modalities are increasingly used in atrophic scarring. Objective To evaluate the role of platelet‐rich plasma (PRP) as adjunctive therapy to a combined subcision and needling treatment in severe (grade 4) atrophic acne scarring. Methods A total of 30 patients with grade 4 acne scars were randomly divided into two groups, 15 patients each: Group A underwent three sequential treatments of subcision and needling while Group B, three sequential treatments of subcision, needling, and topical application of PRP that were performed at 3‐week intervals. Scar grading was assessed 3 months following the final session. Participant's assessment of treatment response was registered. Results Scar improvement ≥50% was reported significantly more often by Group B than Group A patients (P = 0.025). Regarding physician‐based assessment of scar grading post‐therapy (number of patients with two grades improvement vs one grade or no improvement), there was a trend toward more improvement in Group B (P = 0.195). Physician's evaluation of acne scar improvement correlated with the patient's assessment of improvement: 60% of Group A and 66.6% of Group B patients appreciated an improvement of 25%‐49% and 50%‐74%, respectively. Mean duration of postprocedure erythema/edema was shorter among Group B than Group A patients (16.1 vs 32.9 hours, respectively). Overall, substantial improvement was noticed in rolling and boxcar scars with only a mild change in icepick scars. Conclusion Platelet‐rich plasma appears to add to the improvement of grade 4 atrophic acne scars when combined with needling and subcision. These findings require further evaluation by future studies.

Effect of Subcision and Microneedling in the Treatment of Atrophic Acne Scars in Ten Patients: A Case Series

“…20 Subcision has been found to be effective alone as well as in combination with fractional carbon dioxide laser, micro needling, platelet rich plasma and fractionated micro needling radio frequency in various studies. [19][20][21][22][23][24][25] On estimation of improvement with Goodman and Baron's Global qualitative acne scarring system , we found good results in patients with Grades 3 and 4 acne scars. Out of 7 patients with grade 4 scars, 29% showed improvement by 2 grades and 71% showed improvement by 1 grade.…”

Evidence-based surgical management of post-acne scarring in skin of color

“…Rolling acne scars responded best followed by boxcars (33.88%). [ 90 ] Bhargava et al [ 91 ] combined PRP with subcision and needling in a randomized study of 30 patients. Significantly more patients in the PRP group had >50% improvement in scars and the downtime was also less.…”

“…Significantly more patients in the PRP group had >50% improvement in scars and the downtime was also less. [ 91 ]…”

In vitro characterization and clinical use of platelet‐rich plasma‐derived Endoret‐Gel as an autologous treatment for atrophic scars

“…Thus, platelet concentrates represent increasingly popular adjuncts to a variety of medical interventions when dealing with scar management.Platelet-rich plasma has shown to improve the quality of atrophic scars treated with ablative fractional CO2 lasers and decrease the duration of laser-related side effects including edema and erythema 19. Regarding surgical scars, several studies suggest that PRP may improve wound healing and early tissue quality when combined with subcision techniques 20. Furthermore, incorporation of PRP in fat-grafting procedures can contribute to better cutaneous repair as well as a significant improvement in texture, color, and contour in traumatic scar resurfacing.…”