|

Received: 23 November 2018    Accepted: 16 April 2019

DOI: 10.1111/jocd.12988

C O S M E T I C C O M M E N TA RY

Microneedling and PRP for acne scars: A new tool in our

arsenal

Elizabeth Schoenberg BA | Mackenzie O’Connor BS | Jordan V Wang MD, MBE, MBA  |

Sherry Yang MD | Nazanin Saedi MD

Department of Dermatology and Cutaneous

Biology, Thomas Jefferson University,
Philadelphia, Pennsylvania
Correspondence
Jordan V. Wang, MD, MBE, MBA,
Department of Dermatology and Cutaneous
Biology, Thomas Jefferson University, 833
Chestnut Street, Suite 740, Philadelphia, PA
19107.
Email: jordan.wang@jefferson.edu
Abstract
A common complication of acne vulgaris is clinically significant scarring, which can
greatly impact patient quality of life. While treatment options have included mi‐
croneedling, the recent addition of platelet‐rich plasma (PRP) to this regimen has led
to an increased popularity of combination treatment. Here, we offer backgrounds on
microneedling and PRP therapies and review the literature on combination treatment
for acne scars.

KEYWORDS
acne, aesthetics, dermatology, microneedling, platelet‐rich plasma

1 |  I NTRO D U C TI O N 3 | PR P TH E R A PY

Acne vulgaris frequently causes permanent scarring of the face,
which can have immense physical, psychological, and social impact
significantly affecting quality of life. 1,2
Therefore, the treatment of
acne scars is crucial to restoring aesthetics, emotional well‐being,
and social confidence. Here, we offer background on microneedling
and platelet‐rich plasma (PRP) therapies, which have recently be‐
come popular for the treatment of acne scars, and review the prom‐
inent studies on combination treatment.
2 |  M I C RO N E E D LI N G TH E R A PY
While PRP has been utilized in the treatment of orthopedic, mus‐
culoskeletal, and maxillofacial conditions for many years, it has
only recently gained popularity in dermatology.8 PRP consists of
the patient's own plasma that is enriched with a concentration of
platelets that exceeds normal levels. It also contains various growth
factors, including platelet‐derived growth factor (PDGF), transform‐
ing growth factor (TFG), vascular endothelial growth factor (VEGF),
and insulin‐like growth factor (IGF). These growth factors stimulate
tissue remodeling and are associated with enhanced healing through
the attraction of macrophages, upregulation of collagen synthesis,
and promotion of tissue regeneration.9

Microneedling has been used to treat various dermatologic conditions,

including scars, rhytides, and dyschromia.3 The treatment causes small
channels of epidermal and dermal injury through the use of needles that
puncture the skin.4 The damaged collagen is removed, and new growth
and remodeling subsequently occur.5 The release of platelet‐derived
growth factors, fibroblasts, and elastic fiber formation contribute to
neovascularization and neocollagenesis. 3,6
Ultimately, this improves
the appearance of scars, especially atrophic scars. Since microneedling
minimally alters the epidermis, there are limited adverse effects and
downtime compared to more invasive treatment modalities. 7 offer a unique treatment approach.
4 | CO M B I N ATI O N TR E ATM E NT FO R
AC N E S C A R S
Microneedling has been known to be an effective treatment option
for acne scars; however, the addition of PRP has only recently been
investigated. The upregulation of growth factors associated with
PRP is believed to augment the effects of microneedling to promote
aesthetically superior tissue remodeling. Their synergistic effects

J Cosmet Dermatol. 2019;00:1–3. © 2019 Wiley Periodicals, Inc. |  1

wileyonlinelibrary.com/journal/jocd  
 |
2       SCHOENBERG et al.
4.1 | Review
A recent randomized trial for the treatment of scars included 90 pa‐
tients separated into three treatment groups.10 One group received
microneedling, another group received intradermal PRP, and the
final group received alternating microneedling and intradermal PRP
treatments. The PRP was injected only within the scars. Although all
groups demonstrated improvement in scar appearance by physician
assessment, combination treatment was associated with the highest
mean improvement score followed by microneedling and then PRP.
Patient satisfaction was also significantly greater for the combina‐
tion group. Histologically, it produced a thickened epidermis with
more developed rete ridges compared to the single treatment mo‐
dalities. The addition of intradermal PRP to microneedling enhanced
the cosmetic appearance of atrophic scars.
A split‐face study of 50 patients evaluated microneedling with
and without PRP for acne scars. Microneedling was performed on
the entire face, while each half was treated with either PRP or dis‐
tilled water.11 Intradermal PRP was injected within acne scars, and
then, topical PRP was spread over the entire same half of the face.
While both sides showed clinical improvement, the PRP‐treated side
suggested a better response using Goodman's qualitative and quan‐
titative scoring systems and also independent physician assessment.
Patient satisfaction was similarly greater. At study completion, al‐
most all patients stated that the addition of PRP led to improved
reduction in the visibility of acne scars and also skin roughness.
Combination treatment was efficacious for the treatment of acne
scars.
Another split‐face trial of 35 patients compared microneedling
with and without PRP, but only used topical PRP application, which
is more commonly used in practice than intradermal injections.9 For
each side, there was significant improvement of acne scars following
treatment using Goodman's qualitative scoring, and patients were
equally satisfied. Although the PRP‐treated side showed greater im‐
provement, the difference was not found to be statistically signifi‐
cant. However, the addition of PRP did offer improved healing with
reduced erythema and edema, which demonstrates its additional
benefits.
A randomized split‐face trial evaluated microneedling alone or
in combination with either topical PRP or trichloroacetic acid (TCA)
15% peels.7 Both combination treatments demonstrated signifi‐
cantly improved cosmetic outcomes for acne scars than micronee‐
dling alone according to assessments by blinded dermatologists
and independent observers. However, there was no significant dif‐
ference between combination treatments, since topical PRP only
offered minimal improvement over TCA. Histologically, both com‐
bination treatments produced a comparably thicker epidermis than
microneedling alone. While all groups showed more organized and
dense collagen bundles following treatment, this was more pro‐
nounced for the topical PRP treatment arm.
A split‐face study of 30 patients compared microneedling in
combination with either topical PRP or vitamin C.12 Treatment
with PRP was associated with improved reduction of acne scars as
determined by physician assessment using Goodman's qualitative
scoring. Patients were also more satisfied with the PRP‐treated side.
Interestingly, the addition of vitamin C was demonstrated to be ef‐
fective at treating postinflammatory hyperpigmentation from acne.
Overall, the results demonstrated the superiority of adding PRP to
microneedling.
5 | CO N C LU S I O N
Although the available literature is currently limited, combination
treatment with microneedling and PRP therapies for the treat‐
ment of acne scars appears to be effective. Combining both mo‐
dalities has been shown to be superior in various ways, including
cosmetic outcomes, postprocedural downtime, and patient satis‐
faction. It is worthy to note that there is no standardized protocol
for obtaining PRP and no standardized concentration that is used.
Further studies are needed to determine the optimal methods
and procedures. Larger studies are still required in order to better
evaluate the addition of PRP to microneedling and also to com‐
pare its outcomes to other common modalities for the treatment
of acne scars.
C O N FL I C T O F I N T E R E S T S
The authors have no conflict of interest to declare.
ORCID
Jordan V Wang  https://orcid.org/0000-0001-7437-2745
REFERENCES
1. Wang JV, Saedi N. The utility of understanding atrophic acne
scar formation for prevention and treatment. Br J Dermatol.
2018;179(4):819.
2. Gieler U, Gieler T, Kupfer JP. Acne and quality of life – impact
and management. J Eur Acad Dermatol Venereol. 2015;29(Suppl
4):12‐14.
3. Alster TS, Graham PM. Microneedling: a review and practical guide.
Dermatol Surg. 2018;44(3):397‐404.
4. Harris AG, Naidoo C, Murrell DF. Skin needling as a treatment for
acne scarring: an up‐to‐date review of the literature. Int J Womens
Dermatol. 2015;1(2):77‐81.
5. Fabbrocini G, Fardella N, Monfrecola A, Proietti I, Innocenzi D.
Acne scarring treatment using skin needling. Clin Exp Dermatol.
2009;34(8):874‐879.
6. Hashim PW, Levy Z, Cohen JL, Goldenberg G. Microneedling
therapy with and without platelet‐rich plasma. Cutis. 2017;99(4):
239‐242.
7. El‐Domyati M, Abdel‐Wahab H, Hossam A. Microneedling com‐
bined with platelet‐rich plasma or trichloroacetic acid peeling for
management of acne scarring: a split‐face clinical and histologic
comparison. J Cosmet Dermatol. 2018;17(1):73‐83.
8. Zhang M, Park G, Zhou B, Luo D. Applications and efficacy of plate‐
let‐rich plasma in dermatology: a clinical review. J Cosmet Dermatol.
2018;17(5):660‐665.
SCHOENBERG et al. |
      3

9. Ibrahim MK, Ibrahim SM, Salem AM. Skin microneedling plus plate‐ 12. Chawla S. Split face comparative study of microneedling with PRP
let‐rich plasma versus skin microneedling alone in the treatment of versus microneedling with vitamin C in treating atrophic post acne
atrophic post acne scars: a split face comparative study. J Dermatol scars. J Cutan Aesthet Surg. 2014;7(4):209‐212.
Treat. 2018;29(3):281‐286.
10. Ibrahim ZA, El‐Ashmawy AA, Shora OA. Therapeutic effect of
microneedling and autologous platelet‐rich plasma in the treat‐
How to cite this article: Schoenberg E, O’Connor M, Wang
ment of atrophic scars: a randomized study. J Cosmet Dermatol.
JV, Yang S, Saedi N. Microneedling and PRP for acne scars: A
2017;16(3):388‐399.
11. Asif M, Kanodia S, Singh K. Combined autologous platelet‐rich new tool in our arsenal. J Cosmet Dermatol. 2019;00:1–3.
plasma with microneedling verses microneedling with distilled https​://doi.org/10.1111/jocd.12988​
water in the treatment of atrophic acne scars: a concurrent split‐
face study. J Cosmet Dermatol. 2016;15(4):434‐443.