Evaluating the Effectiveness of Platelet-Rich Plasma as an Adjunct to Fractional Carbon Dioxide Laser Therapy in Improving Facial Acne Scar Appearance: A Randomized Controlled Trial

Background Fractional carbon dioxide (CO₂) laser resurfacing is commonly used to treat atrophic acne scars, but treatment responses vary and adverse effects such as erythema and post-inflammatory hyperpigmentation are frequent. Platelet-rich plasma (PRP) has been proposed as an adjunct to enhance dermal remodeling and improve tolerability. Objective To evaluate whether platelet-rich plasma (PRP) enhances the efficacy of fractional CO₂ laser resurfacing in reducing moderate-to-severe acne scars and minimises laser-induced complications such as erythema, oedema, and pain, thereby improving patient satisfaction. Methods Seventy adults with moderate-to-severe atrophic acne scars were assigned to receive three sessions of fractional CO₂ laser with topical autologous PRP (35 participants) or laser alone (35 participants) at 4-week intervals. The primary outcome was change in scar severity at 12 weeks using the Goodman and Baron scale. Pain and satisfaction were assessed using the visual analogue scale (VAS). Results Thirty-two participants in group A and 28 in group B completed the study. Scar severity improved significantly in both groups. In group A, scores decreased from 12.4±3.8 to 8.2±3.5; in group B, from 11.8±4.1 to 8.6±4.5. Although improvement was greater with PRP (4.2 vs. 3.2 points), it was not statistically significant (p = 0.129). Patient satisfaction was higher with PRP. Adverse-event rates were similar, but erythema, oedema, and pain were significantly less severe in the PRP group. Conclusion The combination of fractional CO₂ laser with PRP showed greater, though not statistically significant, improvement in acne scars and a better safety profile, with greater satisfaction, than laser alone.