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A Meta-analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars

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  • Non-Surgical Aesthetic
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Abstract

Background

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.

Objectives

To perform a meta-analysis to assess improvements in the side effects of PRP and the effect of assisted therapy for atrophic acne scars.

Methods

This study followed PRISMA guidelines. A comprehensive search of the literature was carried out in September 2018 using the electronic databases of PubMed, EMBASE, MEDLINE, and the Cochrane Library.

Results

Seven articles were included in this review. All of the studies published utilized PRP as additive therapy. The major therapies included fractional carbon laser therapy and microneedling. Five studies (249 participants) reported four degrees of improvement on an improvement scale (degrees 3 and 4 were considered improvement in this analysis). Four studies (200 participants) reported mean improvement scores. A significantly higher degree of improvement was shown in the PRP group compared to the control group (OR = 8.19; 95% CI 4.32–15.52; p < 0.00001), as well as better mean improvement score (WMD = 23.73; 95% CI 18.60–28.87; p < 0.00001).

Substantial heterogeneity was seen in the degree of improvement (I2 = 54% p = 0.07) and the mean improvement score (I2 = 75%; p = 0.008). There were overall fewer monitored side effects, including erythema and edema (in days), in the PRP groups; however, no significance was found.

Conclusions

This review shows that PRP is a useful assisted therapy for atrophic acne scars, which can achieve better improvement.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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References

  1. Capitanio B, Sinagra JL, Bordignon V, Cordiali Fei P, Picardo M, Zouboulis CC (2010) Underestimated clinical features of postadolescent acne. J Am Acad Dermatol 63(5):782–788

    Article  Google Scholar 

  2. Carlavan I, Bertino B, Rivier M, Martel P, Bourdes V, Motte M, Déret S, Reiniche P, Menigot C, Khammari A, Dreno B, Fogel P, Voegel JJ (2018) Atrophic scar formation in patients with acne involves long-acting immune responses with plasma cells and alteration of sebaceous glands. Br J Dermatol 179(4):906–917

    Article  CAS  Google Scholar 

  3. Setayesh K, Villarreal A, Gottschalk A, Tokish JM, Choate WS (2018) Treatment of muscle injuries with platelet-rich plasma: a review of the literature. Curr Rev Musculoskelet Med 11(4):635–642

    Article  Google Scholar 

  4. Lin MT, Chiang CF, Wu CH, Huang YT, Tu YK, Wang TG (2019) Comparative effectiveness of injection therapies in rotator cuff tendinopathy: a systematic review, pairwise and network meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 100(2):336–349

    Article  Google Scholar 

  5. Ling Y, Wang S (2018) Effects of platelet-rich plasma in the treatment of plantar fasciitis: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 97(37):e12110

    Article  Google Scholar 

  6. Ye Y, Zhou X, Mao S, Zhang J, Lin B (2018) Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: a meta-analysis of randomized controlled trials. Int J Surg 53:279–287

    Article  Google Scholar 

  7. Giordano S, Romeo M, di Summa P, Salval A, Lankinen P (2018) A meta-analysis on evidence of platelet-rich plasma for androgenetic alopecia. Int J Trichol 10(1):1–10

    Article  Google Scholar 

  8. Jared Christophel J, Elm C, Endrizzi BT, Hilger PA, Zelickson B (2012) A randomized controlled trial of fractional laser therapy and dermabrasion for scar resurfacing. Dermatol Surg 38(4):595–602

    Article  CAS  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341

    Article  Google Scholar 

  10. Goodman GJ, Baron JA (2006) Postacne scarring: a qualitative global scarring grading system. Dermatol Surg 32:1458–1466

    CAS  PubMed  Google Scholar 

  11. Goodman GJ, Baron JA (2006) Postacne scarring: a quantitative global scarring grading system. J Cosmet Dermatol 5:48–52

    Article  Google Scholar 

  12. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  Google Scholar 

  13. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  Google Scholar 

  14. Lee JW, Kim BJ, Kim MN, Mun SK (2011) The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split­face trial. Dermatol Surg 37:931–938

    Article  CAS  Google Scholar 

  15. Gawdat HI, Hegazy RA, Fawzy MM, Fathy M (2014) Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars. Dermatol Surg 40:152–161

    Article  CAS  Google Scholar 

  16. Asif M, Kanodia S, Singh K (2016) Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol 15(4):434–443

    Article  Google Scholar 

  17. Faghihi G, Keyvan S, Asilian A, Nouraei S, Behfar S, Nilforoushzadeh MA (2016) Efficacy of autologous platelet­rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: a split­face randomized clinical trial. Indian J Dermatol Venereol Leprol 82:162–168

    Article  Google Scholar 

  18. Ibrahim ZA, El-Ashmawy AA, Shora OA (2017) Therapeutic effect of microneedling and autologous platelet-rich plasma in the treatment of atrophic scars: a randomized study. J Cosmet Dermatol 16:388–399

    Article  Google Scholar 

  19. Deshmukh NS, Belgaumkar VA (2019) Platelet-rich plasma augments subcision in atrophic acnescars: a split-face comparative study. Dermatol Surg 45(1):90–98

    Article  CAS  Google Scholar 

  20. El-Domyati M, Abdel-Wahab H, Hossam A (2017) Microneedling combined with platelet-rich plasma or trichloroacetic acid peeling for management of acne scarring: a split-face clinical and histologic comparison. J Cosmet Dermatol 17:73–83

    Article  Google Scholar 

  21. Fife DJ, Fitzpatrick RE, Zachary CB (2009) Complications of fractional CO2 laser resurfacing: four cases. Lasers Surg Med 41:179–184

    Article  Google Scholar 

  22. Cervelli V, Nicoli F, Spallone D, Verardi S, Sorge R, Nicoli M, Balzani A (2012) Treatment of traumatic scars using fat grafts mixed with platelet­rich plasma, and resurfacing of skin with the 1540 nm nonablative laser. Clin Exp Dermatol 37:55–61

    Article  CAS  Google Scholar 

  23. Nita AC, Orzan OA, Filipescu M, Jianu D (2013) Fat graft, laser CO2 and platelet­rich­plasma synergy in scars treatment. J Med Life 6:430–433

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Nofal E, Helmy A, Nofal A, Alakad R, Nasr M (2014) Platelet­rich 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. Dermatol Surg 40:864–873

    CAS  PubMed  Google Scholar 

  25. Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA (2012) Platelet­rich plasma: a milieu of bioactive factors. Arthroscopy 28:429–439

    Article  Google Scholar 

  26. Lacci KM, Dardik A (2010) Platelet­rich plasma: support for its use in wound healing. Yale J Biol Med 83:1–9

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Cho JW, Kim SA, Lee KS (2012) Platelet­rich plasma induces increased expression of G1 cell cycle regulators, type I collagen, and matrix metalloproteinase­1 in human skin fibroblasts. Int J Mol Med 29:32–36

    Article  CAS  Google Scholar 

  28. Kim SA, Ryu HW, Lee KS, Cho JW (2013) Application of platelet­rich plasma accelerates the wound healing process in acute and chronic ulcers through rapid migration and upregulation of cyclin A and CDK4 in HaCaT cells. Mol Med Rep 7:476–480

    Article  CAS  Google Scholar 

  29. Rivera AE (2008) Acne scarring: a review and current treatment modalities. J Am Acad Dermatol 59:659–676

    Article  Google Scholar 

  30. Majid I, Imran S (2014) Fractional CO2 laser resurfacing as monotherapy in the treatment of atrophic facial acne scars. J Cutan Aesthet Surg 7:87–92

    Article  Google Scholar 

  31. Hantash BM, Bedi VP, Chan KF, Zachary CB (2007) Ex vivo histological characterization of a novel ablative fractional resurfacing device. Lasers Surg Med 39:87–95

    Article  Google Scholar 

  32. Costa IMC, Costa MC (2014) Microneedling for varicella scars in a dark-skinned teenager. Dermatol Surg 40:333–357

    Article  CAS  Google Scholar 

  33. Chawla S (2014) Split face comparative study of microneedling with PRP versus microneedling with vitamin C in treating atrophic post acne scars. J Cutan Aesthet Surg 7:209–212

    Article  Google Scholar 

  34. Manuskiatti W, Triwongwaranat D, Varothai S, Eimpunth S, Wanitphakdeedecha R (2010) Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. J Am Acad Dermatol 63:274–283

    Article  Google Scholar 

  35. Zhu JT, Xuan M, Zhang YN, Liu HW, Cai JH, Wu YH, Xiang XF, Shan GQ, Cheng B (2013) The efficacy of autologous platelet-rich plasma combined with erbium fractional laser therapy for facial acne scars or acne. Mol Med Rep 8:233–237

    Article  CAS  Google Scholar 

  36. Fabbrocini G, De Vita V, Pastore F, Panariello L, Fardella N, Sepulveres R, D'Agostino E, Cameli N, Tosti A (2011) Combined use of skin needling and platelet-rich plasma in acne scarring treatment. Cosmet Dermatol 24(4):177–183

    Google Scholar 

  37. Anitua E, Sánchez M, Nurden AT, Zalduendo MM, de la Fuente M, Azofra J, Andía I (2007) Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology 46:1769–1772

    Article  CAS  Google Scholar 

  38. Eppley BL, Pietrzak WS, Blanton M (2006) Platelet-rich plasma: a review of biology and applications in plastic surgery. Plast Reconstr Surg 118:147–159

    Article  Google Scholar 

  39. Sampson S, Gerhardt M, Mandelbaum B (2008) Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 1:165–174

    Article  Google Scholar 

Download references

Funding

This work was supported by Taipei Medical University—Wan Fang Hospital under the Grant No. 108TMU-WFH-23.

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Author notes

  1. Tyng-Shiuan Hsieh and Wen-Kuan Chiu contributed equally to this work.

Authors and Affiliations

  1. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC

    Tyng-Shiuan Hsieh

  2. Division of Plastic Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan, ROC

    Wen-Kuan Chiu, Hsian-Jenn Wang & Chiehfeng Chen

  3. Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan, ROC

    Wen-Kuan Chiu & Ten-Fang Yang

  4. Graduate Institute of Medical Informatics and Cardiology, Taipei Medical University and Hospital, Taipei, Taiwan, ROC

    Ten-Fang Yang

  5. Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC

    Chiehfeng Chen

  6. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan, ROC

    Chiehfeng Chen

  7. Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Wenshan District, Taipei City, 11696, Taiwan, ROC

    Chiehfeng Chen

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Correspondence to Chiehfeng Chen.

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Hsieh, TS., Chiu, WK., Yang, TF. et al. A Meta-analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars. Aesth Plast Surg 43, 1615–1623 (2019). https://doi.org/10.1007/s00266-019-01471-w

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  • DOI: https://doi.org/10.1007/s00266-019-01471-w

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