Comparison of Efficacy of Combined Fractional CO2 Laser with Autologous Platelet-Rich Plasma vs. Fractional CO2 Laser Alone in Treating Atrophic Acne Scars

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Acne scars, a common cosmetic concern, can lead to psychological distress. This study compares the effectiveness of combining CO2 laser with PRP versus using CO2 laser alone for treating atrophic acne scars. Various scar types, treatment options, limitations of CO2 laser, and benefits of autologous PRP are discussed in detail. The objective is to evaluate the efficacy of these treatments in improving the appearance of atrophic acne scars.

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Comparison of Efficacy of Combined Fractional CO2 Laser with Autologous Platelet Rich Plasma versus Fractional CO2Laser alone in the Treatment of Atrophic Acne Scars Dr. Sumaira Mushtaq Post-graduate Resident Dermatology Department FJMU/ Sir Ganga Ram Hospital, Lahore

Introduction Acne --- common inflammatory disorder of pilosebaceous unit 80% adolescents Acne scars --- inflammatory mediators, enzymatic degradation collagen fibers & subcutaneous fat Acne scars --- a cosmetic problem Psychological morbidity --- low self-esteem, poor quality of life

Introduction (Contd.) Classified into 3 types: Atrophic Hypertrophic Keloid Atrophic scars --- most common

Introduction (Contd.) Based on shape and depth, three types of atrophic scars: o o o Ice pick Boxcar Rolling

Types of atrophic scars Boxcar Rolling Ice pick

Introduction (Contd.) Multiple treatment options: Chemical peeling Dermabrasion Subcision Punch excision & elevation Tissue augmentation with fillers Ablative & non-ablative lasers

Introduction (Contd.) Fractional CO2---- Established & popular modality Initiates healing, collagen synthesis & remodelling Limitations: Longer downtime Post-inflammatory hypo-hyperpigmentation New scarring Secondary infection

Introduction (Contd.) Autologous PRP --- platelet rich plasma portion of autologous blood Platelet derived growth factors --- tissue remodelling, upregulation collagen & protein synthesis Anti-inflammatory --- reduces side effects of laser

Objective To compare the efficacy of combined fractional CO2 laser and autologous platelet rich plasma (PRP) with Fractional CO2 laser alone in the treatment of atrophic acne scars

Material and Methods Dermatology Department, FJMU/ SGRH, LHR March, 2018 to August, 2018 Sample size 26 (13 each group) 10 males and 16 females Aged 18 to 50 years Patients with moderate to severe acne scars according to Goodman and Baron qualitative scar grade scale

Exclusion criteria Active acne Chemical peeling, microdermabrasion, dermabrasion in last 1 month Oral and topical retinoid therapy Herpes simplex, Hepatitis B, C & HIV infection Blood dyskrasias Keloidal tendency

Material and Methods (Contd.) Patients randomly divided into 2 groups: Group A --- fractional CO2 laser alone Group B --- combined fractional CO2 laser and autologous PRP Topical anesthetic cream 60 minutes before treatment Cleansing with 70% isopropyl alcohol Fractional CO2 laser both cheeks

Materials and Methods (Contd.) PRP --- 15 ml autologous blood drawn Transferred into vial containing 0.5 ml sodium citrate Centrifuged at 1500 RMP ----- 10 mins Buffy coat aspirated, platelet rich plasma, RBC transferred to other vial Centrifugation at 3000 RMP ------ 5 mins Middle platelet rich layer aspirated

Material and Methods (contd) Group B --- O.05 ml PRP injected into scars with 2 cm interval Moisturizer --- after treatment Topical antibiotics ---5 days Sun protection Avoid heat exposure, friction and soap 6 sessions at 1 month interval Photographs --- before and after each session

EFFICACY Clinical response categorized: 2 step upgradation from baseline --- 1 month after last session

Side Effects Dyschromia Acneiform eruption Secondary infection Persistent erythema New scarring

Results Characteristics Fractional CO2 alone Combined fractional CO2 & PRP No. of patients 13 13 Male Female 5 (38.5%) 8 (61.5 %) 5 (38.5%) 8 (61.5%)

Results Grading of acne scars at baseline Total No. 2 step upgradation 1 step upgradation No response Fractional CO2 alone Moderate Severe 9 (69.2%) 4 (30.8%) 4 (44.4%) 3 (75%) 2 (22.2%) 1 (25%) 3 (33.3%) Fractional CO2 Laser combined with PRP Moderate Severe 4 (30.8%) 9 (69.2%) 4 (100%) 7 (77.8%) 0 0 0 2 (22.8%) Complications Hyperpigmentation Hypopigmentation Persistent erythema Secondary infection Acneiform eruption 1 (7.7%)

Fractional CO2 alone BEFORE AFTER

Fractional CO2 with PRP BEFORE AFTER

Discussion Challenge to treat New techniques fractional CO2 laser & PRP popular This study shows: Efficacy 53% (7) --- Fractional CO2 laser alone Efficacy 85% (11) --- Fractional CO2 laser + PRP

Discussion (Contd.) PRP combined with Fractional CO2 laser --- significant improvement in scar grading Decreased laser downtime

Discussion (contd....) Sidhartha D. Shah et al. comparative split face study 30 patients with moderate to severe atrophic acne scars 2 sessions 4 weeks apart Right side ------- Fractional CO2 laser + PRP Left side -------- Fractional CO2 laser + normal saline

Discussion (Contd.) Response assessment: 4 months after last session Excellent Response --- 33 % with PRP, 13% with control Side effects (edema, persistent erythema , acneiform eruption) --- both sides

Discussion (Contd.) Faghihi G et al. --- split face comparative study 16 patients with moderate to severe acne scars 2 sessions at 4 weeks apart 1 side of face --- Fractional CO2 laser with intradermal normal saline Other side of face --- Fractional CO2 laser with intradermal PRP

Discussion (Contd.) Outcome assessment: 4 months after last session Good improvement : 14 (87.5%) ----- Fractional CO2 laser + PRP 11 (68.8%) ----- Fractional CO2 laser + normal saline Longer duration of edema & erythema with PRP