Authors : Dr. Amarjeet Singh .

INTRODUCTION

ACNE SCARS: There are mainly four types of acne scars; (1) Box scars, (2) Ice pick scars, (3) Rolling scars & (4) Hypertrophic scars

PLATELET RICH PLASMA (PRP): Recent strategies in clinical treatment plans of acne scars encourage the production of autologous platelet-rich plasma (PRP) containing high concentrations of platelet growth factors like, Platelet derived growth factor (PDGF), Transforming growth factors (TGF), vascular endothelial growth factor (VEGF), Insulin like growth factor (IGF), Epidermal growth factor (EGF), & Interleukin (IL)- 1.The optimal PRP platelet concentration >10 lacs platelets/ μl1/2 having 300-700% enrichment.

MICRONEEDLING: The principle of using Dermaroller modality is to provide collagen induction therapy. This is done by causing a minute injury to the dermis with use of microneedles. This results in starting of the wound healing cascade and hence utilizing the body self-healing mechanisms.

RATIONALE OF STUDY

• We need to find treatment which should be safe, effective, nominal, and having minimal side effects & Autologous Platelet rich plasma combined with microneedling can be fruitful to us.
• As fractional laser and Erbium laser are costly and can’t be applicable for Indian population on high scale. There are lots of side effects associated with laser along with down time period.
• Chemical peels can’t be used as solo therapy for satisfactory results and limited to darker skin types. We can’t use phenol and TCA peels on 4-6th skin type.
• Microdermabrasion also provide some effects but down time of procedure and over all efficacy is not that much high.

SELECTION OF PATIENTS

INCLUSION CRITERIA	EXCLUSION CRITERIA
Patients above 15-25 years of age	Positive history of keloidal tendency
Patient with Moderate to sever acne classified on the basis of Goodman’s classification	Positive history of bleeding, platelet disorder or any major surgery in past 6 months.
No active acne lesions.	Positive history of any acute infection on face like herpes, folliculitis
Patients with atrophic scars only	Positive history HIV, HBsAg, or chronic illness.

ENROLLEMENT FOR STUDY

After selection of patient, enrollment is done in four steps i.e.

• Informed consent form
• Case record form,
• Base line investigation and
• Patient information sheet

PRE-PROCEDURE EVALUATION

Serial photography of both side of the face is done before each sitting, 1^st at 50 cm distance and then close view is taken.

Lesions are classified on the basis of GOODMAN’S classification.



PRP PREPARATION

17 ml blood is withdrawn from the patient in a 20 ml syringe prefilled with 3 ml of ACD anticoagulant.

The syringe is allowed to shake 5 times for proper mixing of anticoagulant.

Tubes are kept for centrifugation first at 1500 rpm for 5 min

Blood is separated in three zones (1) Red cell sediment (2) Buffy coat 3) Plasma

• Plasma and Buffy coat both are separated and red cell sediment are discarded second centrifugation is done at 2300 rpm for 17 min, forming two zones one is platelet poor plasma (PPP) & concentrated Platelet at the base.

Most of the PPP is discarded and small amount for plasma is mixed with concentrated Platelet forming 2ml of Platelet rich plasma (PRP)

Readings on autoanalyzer

PROCEDURE

Topical anesthesia is applied for 2 hr and meanwhile preparation of PRP took place.

1.5 mm dermaroller (192) is used for microneedling and sterilized with Povidone – iodine solution for 20 min before each sitting.

Patient is kept supine with head stable, microneedling is performed first 4 times in 4 different direction perpendicular and diagonally on both sides of the face.

PRP is mixed with 10 % calcium chloride in a ratio of 10:1, and injected intradermally over right halve of the face.

Three sittings were performed on one patient at an interval of 1 month (total 90days)

PRP            Intradermal injection of PRP on right halve of the face

POST PROCEDURE INSTRUCTION

Avoid face wash for 4 hrs following procedure

Avoid sun exposure and judicial use of sunscreen for photo protection.

Follow up

Review on 2^nd , 3^rd and 7^th day from procedure and we should look for;

• Erythema
• Odema
• Peeling of skin
• Postinflammatory hyperpigmentation (PIH)
• Other noticeable effects

RESEARCH QUESTIONS (?)

• PRP; is it really helpful for the management of acne scars and giving significant clinically appreciable results?
• How to standardize preparation of platelet rich plasma, Mode of administration and amount to be injected?
• Does it provide significant result as adjuvant to other modalities of treatment like microneedling, laser etc.?
• Are there any adverse effects associated with the procedure?
• Can autologous platelet rich plasma leads to break through in the management of acne scaring?