Efficacy and safety of microneedling with and without platelet-rich plasma versus fractional CO2 laser for treatment of acne scars: a randomized clinical trial

Background: acne scarring can significantly affect patients’ quality of life, particularly when it involves the face. this study aimed to compare the efficacy of microneedling with and without platelet-rich plasma (prp) versus fractional co2 laser therapy in treating acne scarring. methods: this randomized clinical study was performed on 90 patients with acne scarring. all the patients were divided into three groups (n = 30 per each): group a received microneedling, group b received microneedling plus prp, and group c was treated by fractional co2 laser. each patient underwent three treatment sessions across three-week intervals. the severity and depth of acne scars were graded using goodman and baron’s scale and visio face systems, respectively. results: out of 90 patients, 30 in group a, 22 in group b, and 26 in group c completed the trial. analysis was done based on the per-protocol method on a total of 78 patients. regarding the severity of acne scarring, significantly better results were obtained for groups a and b than for group c (p ≤ 0.001) while no meaningful difference was seen between groups a and b. also, there was a significant difference between group b and other groups in terms of patients’ satisfaction (p = 0.04). the visio face systems showed that the depth of acne scars in group b had better improvement than in other groups (p = 0.02). conclusion: microneedling plus prp led to the most patient satisfaction and highest improvement in acne scar depth. however,considering the fewer side effects and acceptable cost-benefit profile of microneedling alone compared with fractional co2 laser or microneedling plus prp, isolated microneedling could be considered the first choice for treating acne scars.