A comparative study of fractional carbon dioxide laser alone and in combination with autologous platelet-rich plasma in the treatment of post-acne scars

Background: Atrophic acne scars cause considerable psychosocial distress. Fractional carbon dioxide (FCO2) laser resurfacing is a standard treatment, whereas platelet-rich plasma (PRP), which is rich in autologous platelets, promotes wound healing and tissue regeneration. Aims and Objectives: This study aimed to evaluate the efficacy and safety of FCO2 laser alone versus its combination with PRP in the treatment of post-acne atrophic scars in a randomized controlled trial. Materials and Methods: A prospective, single-center trial was conducted at JJMMC, Davangere, from October 2020 to October 2022. One hundred patients were randomized into two equal groups: Group A received FCO2 laser alone, and Group B received FCO2 laser with intradermal PRP. Each participant underwent six sessions at 4-week intervals. Outcomes were assessed objectively using Goodman’s quantitative acne scar grading system and subjectively using a 5-point Visual Analog Scale. Results: Group B (FCO2+PRP) showed significantly greater improvement, with a 35.25% reduction in scar scores compared to 21.8% in Group A (P=0.001). The benefits were consistent across mild, moderate, and severe scars. Subjective satisfaction was also higher in Group B, and recovery time, as reflected by erythema, edema, and crusting, was shorter in the combination group. Although PRP injections increased procedural discomfort, post-inflammatory hyperpigmentation (PIH) was significantly less frequent in Group B (42% vs. 72%, P=0.002), despite a higher proportion of darker skin types. Conclusion: The combination of FCO2 laser and autologous PRP is more effective than laser treatment alone for treating atrophic acne scars. This modality enhances scar reduction, improves patient satisfaction, accelerates healing, and reduces PIH, making it a valuable therapeutic option for acne scar management.