Microneedling in Conjunction With PRP for Treatment of Acne Scarring
Microneedling, initially described in 1995, is an aesthetic technique that has re-emerged as a popular alternative in the treatment of acne scarring.1 This technique is gaining more interest, as it is less costly, has minimal downtime, and fewer side effects than other traditional modalities. Acne scarring historically has been a difficult entity to treat for both the physician and the patient, as typically multiple expensive sessions are required with less than optimal outcomes.
The microneedling technique has been utilized for the treatment of striae, surgical scarring, photoaging, and is now considered a standard treatment for mild (grade I/II) acne scarring.2 A variety of microneedling devices exist with needle sizes ranging from 0.1 mm to 2.5 mm. Outcomes of microneedling vary based on the device, the depth of needle penetration, frequency of needle penetration, and the number of passes.2
The needles traumatically create pores in the dermis, which stimulates the release of growth factors and cytokines. The growth factors and cytokines in turn stimulate collagen, elastin, and neovascularization.3 Studies and case reports have shown that microneedling physically breaks down acne scars and initiates collagen synthesis, specifically collagens I, III, and VII.4 Needling sessions are typically spaced 4 to 6 weeks apart. Microneedling has minimal side effects and can be used safely in patients with skin types I-VI in addition to patients with a history of melasma.3 Microneedling should be avoided in patients with a history of keloid or hypertrophic scarring, inflammatory dermatoses, history of herpes simplex virus in perioral area, or any type of growth in the target area. Absolute contraindications for microneedling include scleroderma, collagen vascular disease, clotting disorders, active infection, and immunosuppression.3
Platelet-rich plasma (PRP) is a highly concentrated autologous serum that is rich in growth factors and cytokines such as platelet-derived growth factor, transforming growth factor, insulin-like growth factor, and vascular endothelial growth factor. These growth factors regulate and induce cell migration, attachment, proliferation, and differentiation as well as promote extracellular matrix accumulation. PRP and the induction of growth factors has been used specifically in the treatment of bony defects, wound healing, gastrointestinal surgery, and more recently in aesthetic dermatology.5
Acne scarring can be categorized by a severity grading scale. Grade I acne scarring is defined as abnormally colored scarring, macular disease. Grade II scarring is mild atrophy or hypertrophy that may only be perceived when <50 cm from the patient. Grade III scarring is moderate atrophic or hypertrophic scars that are not easily camouflaged and can be seen at distances >50 cm. Grade IV is severely abnormally contoured disease that is obvious at social distances, is not easily camouflaged, and cannot be flattened with manual stretching.2
This is a case of microneedling used in conjunction with topical PRP for the treatment of grade II acne scarring.
Read the case on page 2