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.