Microneedling with PRP for Acne Scars: A New Tool in Dermatologist Arsenal - A Scoping Review

ABSTRACT

Acne scars can greatly impact patient quality of life. While treatment options have included mi- croneedling, the recent addition of platelet-rich plasma (PRP) to this regimen has led to an increased popularity of combination treatment. Here, we aimed to review the efficacy of microneedling and PRP therapies and review the literature on combination treatment for acne scars.

INTRODUCTION

Post-acne scars are a permanent patient-distressing sequela of acne that does not fade with time. It even becomes worse with skin aging. Acne scars usually result from the inflammatory acne lesions and their severity correlates with acne severity, duration, and the delay of management. Therefore, the treatment of acne scars is crucial to restoring esthetics, emotional well-being, and social confidence.[1] In this review, we aimed to explore the efficacy of recently popularized microneedling and platelet-rich plasma (PRP) therapies for the treatment of acne scars.

MATERIAL AND METHOD

Randomized and non-randomized controlled studies were identified by search of the following terms “platelet-rich plasma” OR “PRP” OR “platelet-rich plasma” OR “platelet concentrate” OR “platelet concentrates”; “needle” OR “microneedle” OR “microneedling”; and “scar” OR “scars” in Medline, Embase, and Cochrane’s Library databases.

RESULT

We reviewed 14 studies, including four randomized controlled trials (RCTs) and 10 non-randomized controlled studies in our review [Table 1].

Table 1.

Characteristics of Included Studies

Authors	No. of pts	Scar	Mean Age (years)	Details of MN	PRP preparation	Intervention	Control	Sessions	Follow-up duration (weeks)	Outcome assessment
Fabbrocini et al.[2]	12	Acne scars	32.2	Using rolling barrel 1 mm wide equipped with 96 needles in 4 rows	70-80 ml autologous whole blood centrifuged at 1,200g for 15 min, then further centrifuged at 1,800g for 10 min, to get a 4.5x PRP	MN + PRP	MN only	2	32	Rate of GQS improvement and changes of GQS
Chawla[3]	27	Grade 2-4 acne scars	27.5	Using rolling drum of 192 needles	10 ml autologous whole blood centrifuged at 1500 rpm for 10 min, then further centrifuged at 3700 rpm for 10 min, to get a 4.5x PRP	MN + PRP	MN + Vitamin C	3	4	Rate of GQS improvement and patient satisfying
Asif et al.[4]	50	Grade 2-4 acne scars	25.7	Using a standard roller device with 192 needles, each of 1.5 mm in size	17 ml autologous whole blood centrifuged at 294g for 5 min, then further centrifuged at 691g for 17 min, to get a 5.2x PRP	MN + PRP	MN + distilled water	3	12	Rate of GQS improvement and patient satisfying
Ibrahim et al.[5]	36	Acne scars	26.3	Using dermapen 3 with nine microneedles of 0.25 mm to 2.5 mm length	20 ml autologous whole blood centrifuged at 1,419g for 7 min, then further centrifuged at 2,522g for 5 min, to get a 10x PRP	MN + PRP	MN only	6	12	Rate of GQS improvement
Porwal et al.[6]	55	Grade 2-4 acne scars	26	Using a dermaroller with 192 needles of 1.5 mm length	20 ml autologous whole blood centrifuged at 1,200 rpm for 15 min, then further centrifuged at 2,000 rpm for 10 min, to get a PRP	MN + PRP	MN only	3	4	Changes of GQS improvement
El Domyati et al.[7]	24	Acne scars	27.3	Using a dermaroller with 600 needles of 1.5 mm length	10 ml autologous whole blood centrifuged at 252g for 10 min, then further centrifuged at 1,792g for 5 min, to get a PRP	MN + PRP	MN only	2	12	Rate of GQS improvement
Ibrahim et al.[8]	35	Acne scars	24.7	Using a dermaroller with 192 needles of 1.5 mm length	10 ml autologous whole blood centrifuged at 2,500 rpm for 10 min, then further centrifuged at 3,500 rpm for 10 min, to get a PRP	MN + PRP	MN only	4	12	Changes of GQS and rate of patient satisfying
Bhargava et al.[9]	30	Grade 4 acne scars	27.7	Using a dermaroller with 192 needles of 1.5 mm length	10 ml autologous whole blood centrifuged at 1,500 rpm for 10 min, then further centrifuged at 3,700 rpm for 10 min, to get a 4.5x PRP	MN + PRP	MN only	3	12	Rate of GQS improvement and patient satisfying
Elfar and Hasby[10]	40	Grade 2-4 acne scars	27.2	Using a dermaroller with 540 needles of 2.0 mm length	10 ml autologous whole blood centrifuged at 72g for 15 min, then further centrifuged at 1,006 g for 5 min, to get a PRP	MN + PRP	MN only	4	12	Rate of GQS improvement
Sharma et al.[11]	40	Grade 2-4 acne scars	25.3	Using a dermaroller with 192 needles of 1.5 mm length	10 ml autologous whole blood centrifuged at 1,500 rpm for 10 min, then further centrifuged at 3,700 rpm for 10 min, to get a 4.5x PRP	MN + PRP	MN + NS	4	24	Rate of GQS improvement and patient satisfying
Amer et al.[12]	41	Grade 2-4 acne scars	28	Using a dermaroller	10 ml autologous whole blood centrifuged at 1,600 rpm for 10 min, then further centrifuged at 4,000 rpm for 15 min, to get a PRP	MN + PRP	MN + HA	4	4	Rate of GQS improvement and patient satisfying
Pawar and Singh[13]	16	Acne scars	24.7	Using a dermaroller with 192 needles of 1.5 mm length	10 ml autologous whole blood centrifuged at 1,500 rpm for 10 min, then further centrifuged at 3,700 rpm for 10 min, to get a 4.5x PRP	MN + PRP	MN + insulin	4	12	Changes of GQS and incidence of severe side effect
Gupta et al.[14]	36	Acne scars	23.7	Using a dermaroller with 192 needles of 2.0 mm length	8.5 ml autologous whole blood centrifuged at 1,400 rpm for 10 min, then further centrifuged at 3,500 rpm for 10 min, to get a PRP	MN + PRP	MN only	4	24	Changes of GQS
Albhahat W et al.[15]	30	Grade 2-4 acne scars	26.7	Dermapen, with a 36-needle head using a 1.5 mm needle length at speed 3–4	10 ml of autologous whole blood was collected into PRP tubes and centrifuged at 1500 rpm for 10 min. Then, the PRP was further centrifuged at 3700 rpm for 10 min to get a 4.5x PRP	MN + PRP	MN + Botox	1	1	Rate of GQS improvement and patient satisfying
Nandini et al.[16]	32	Grade 2-4 acne scars	27	Using a dermaroller with 192 needles of 2.0 mm length	8 ml autologous whole blood centrifuged at 3,600 rpm for 15 min to get a PRP	MN + PRP	MN only	6	14	Rate of GQS improvement and patient satisfying

DISCUSSION

The possible synergistic effect of PRP based on microneedling treatment for atrophic acne scars may be explained by multiple mechanisms. The primary mechanisms for the microneedling treatment are the formation of skin microwounds to induce collagen production and dermal remodeling.[2] Previous studies[3,4] have confirmed that PRP contains multiple active cytokines and growth factors that are primarily released from the a-granules of platelets and actively involved in the process of dermal remodeling, such as the dermal-transforming growth factor, the platelet-derived growth factor, the vascular endothelial growth factor, and the fibroblast growth factor. A recent study has shown that, compared to the use of microneedling alone, combined treatment with microneedling and PRP was associated with a marked excellent improvement of the skin lesions, a more significant deposition of collagen and elastic fibers, and an increased proliferative activity in the epidermis in people with striae distensa, which may also reflect the synergetic benefits of action of microneedling and PRP on scar formation and collagen/dermal remodeling.[5]

CONCLUSION

Combining both modalities is superior in various ways, including cosmetic outcomes, post-procedural downtime, and patient satisfaction. It is worth noting that there is no standardized protocol for obtaining PRP and no standardized concentration that is used.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.