Adjunctive Use of Platelet-Rich Plasma With Fractional CO2 Laser Versus Standalone Laser Therapy for the Treatment of Atrophic Acne Scarring

BACKGROUNDAtrophic acne scars are a common and persistent sequela of inflammatory acne. Fractional CO2 laser treatment promotes collagen production and scar remodeling but is often associated with adverse effects such as prolonged erythema, edema, and hyperpigmentation. Adjunctive use of platelet-rich plasma (PRP) has been proposed to enhance efficacy and reduce complications, yet existing evidence remains inconsistent.

METHODSThis meta-analysis of randomized controlled trials (RCTs) compared PRP combined with fractional CO2 laser versus laser alone for atrophic acne scars. Following PRISMA methodology, databases were searched up to July 31, 2025. Data were synthesized using RevMan 5.4 and R 4.5.2. Seven RCTs involving 165 patients were included.

RESULTSCombination therapy significantly outperformed laser monotherapy in excellent improvement rate (> 75%; OR = 3.21, 95% CI: 1.04–9.83, p = 0.04) and patient satisfaction (very satisfied; OR = 3.05, 95% CI: 1.27–7.29, p = 0.01). With respect to safety outcomes, no statistically significant differences were observed between the two groups in duration of erythema, duration of edema, incidence of hyperpigmentation, or frequency of persistent erythema (all p > 0.05), indicating that adding PRP did not increase postoperative adverse events.

CONCLUSIONCurrent evidence, though limited by small sample size, short follow-up (≤ 6 months in all included trials), and a study population restricted predominantly to Middle Eastern and East Asian skin types (Fitzpatrick III–V), suggests that combining PRP with fractional CO2 laser may improve short-term efficacy and patient satisfaction compared with laser alone, while maintaining a comparable safety profile. Larger, well-designed RCTs with extended follow-up (≥ 12 months) and broader skin types (I–II and VI) are warranted.

TRIAL REGISTRATIONInternational Prospective Register of Systematic Reviews (PROSPERO) identification number: CRD420261283574

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