Split Face Comparative Study of Dermaroller versus Dermaroller with Platelet Rich Plasma in the Treatment of Atrophic Acne Scars

Abstract

Treatment options like laser resurfacing or dermabrasion that offer significant improvement in facial scars are invariably associated with considerable morbidity and long downtime and interfere with the daily activities of the patient in the post-treatment period. On the other hand, treatments like micro-dermabrasion and non-ablative resurfacing with lasers that are associated with minimal or no downtime do not show the same level of efficacy as the traditional, ablative resurfacing techniques. Jacob et al.in 2001proposed a widely accepted classification system, where acne scars were divided into: icepick scars, rolling scars and boxcar scars. Usually they cannot be effectively corrected by a single treatment modality because of their widely varied depth, width and structure. Puncturing the skin with microneedling will bypass the stratum corneum and create transient channels. These channels give way to PRP that intensify thenatural wound healing cascade because of the highconcentration of patients own growth factors. It actssynergistically with growth factors induced by skinneedling in order to enhance the wound healingresponse. This combination is safe for all skin phototypes, cheaper cost and also their is minimal downtime. There is no risk of photosensitivity or any post-inflammatory dyschromia. The presented study aimed at comparing the effectiveness of combined use of dermaroller with topical PRP and dermaroller alone in the treatment of atrophic post acne scars.Patients had 3 treatment sessions, 4-weeks interval. Dermaroller was rolled onto the skin with mild pressure at the same intensityover the scarred areaon both halves and in the left side of the face needling with mild pressure was performed then 2 cm of PRP was applied on the treated area and needling was then immediately performed. The overall success of our study was defined according to clinical improvement of post acne scars subjectively by patients’ satisfaction score which showed that (66.6%) of them rated their improvement as excellent to the side treated with dermaroller and PRP. However, 20% of them rated their improvement as excellentto the side treated with dermaroller alone. Objective assessment was also done by Goodman and Baron’s quantitative global acne scarring grading system, which showed that the side treated with dermaroller and PRP resulted in highly significant improvement at follow up period. Icepick scars showed the least improvement when compared to boxcar and rolling type which showed the highest improvement. All patients showed improvement in severity of acne scars in this side after each sessionwith maximal percent at the follow up period. Treatment with dermaroller alone resulted in significant improvement with least effect on icepick scars when compared to boxcar and rolling type which showed the highest improvement. Histopathological evaluation by the image analyzer was also done and showed significant improvement inthe left side treated with dermaroller and PRP, there is significant increase in the epidermal thickness, highly significant increase in the collagen fiber content and highly in the elastin content.However the side treated with dermaroller alone showed highly significant increase in the epidermal thickness, highly significant increase in the collagen fiber content and significant increase in the elastin content.