Comparing the role of subcision suction method with and without the injection of platelet-rich plasma in the treatment of depressed scars

  • Nouran Abd El-Aziz Abou Khedr Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
  • Tarek Mahmoud Hussein Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
  • Ayat Mohamed El-Sayed Abd El-Fatah Faculty of Medicine, Alexandria University, Egypt
Keywords: Platelet-rich plasma, scars, subcision, suction

Abstract

Among wound-healing modalities, platelet-rich plasma (PRP) has been used for wound healing, through the release of multiple growth factors. The platelets mediate wound healing by initiating the clotting pathway and the subsequent matrix remodelisation. The aim of the work was to study the role of injection of platelet-rich plasma in the treatment of scars. This study was conducted on thirty patients who were divided into two groups (A and B). Each group included fifteen patients. The two groups were randomly distributed by using individual sealed envelopes. Group A was subjected to subcision of their acne scars using Nokor needle, followed by suction. Group B patients were subjected to the same treatment but followed by an injection of platelet-rich plasma once per month over three months. In Group A, 6 patients (40%) showed moderate improvement, 5 patients (33.3%) showed slight improvement and 4 patients (26.7%) showed significant improvement. In Group B, 7 patients (46.7%) showed moderate improvement, 5 patients (33.3%) showed marked improvement and 3 patients (20%) showed significant improvement. There was a statistically significant difference on the independent observer’s after-treatment assessment between the groups (P=0.014). In conclusion, subcision suction leads to a persistent improvement of acne scars in a short time, and the coupling with injection of PRP is the most effective in the treatment of depressed facial scars.

Author Biography

Nouran Abd El-Aziz Abou Khedr, Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Egypt
dermatology

References

Orgill DP, Blanco C. The pathophysiologic basis for wound healing and cutaneous regeneration. In: Bio materials for treating skin loss. Cambridge: Elsevier, 2009. p 25. doi: 10.1201/9781420099904.ch4.

Rieger S, Zhao H, Martin P, Abe K, Lisse TS. The role of nuclear hormone receptors in cutaneous wound repair. Cell Biochem Funct 2015; 33: 1–13. doi: 10.1002/cbf.3086.

Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg 1998; 176(2A Suppl): 26S–38S.

Breathnach SM, McGrath JA. Wound healing. 7th ed. In: Burns T, Breathnach S, Cox N, Griffiths C (editors). Rook`s textbook of dermatology. Oxford: Blackwell Science Ltd, 2004. p. 11.1–11.25.

Bayat A, McGrouther DA, Ferguson MW. Skin scarring. Br Med J 2003; 326: 88–92. doi: 10.1136/bmj.326.7380.88.

Orentreich DS, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg 1995; 21: 543–549. doi: 10.1111/j.1524-4725.1995.tb00259.x.

Ghatan HEY. Morphologic eruptions. Dermatological differential diagnosis and pearls, 1st ed. New York: The Parthenon Publishing Group, 1994. pp 37–45.

Balighi K, Jamshidi S, Daneshpajooh M, Lajevardi V, Harandi SA, et al. Subcision for acne scarring with or without suctioning: A clinical trial. Iran J Dermatol 2011; 14: 95–99.

Driver VR, Hanft J, Fylling CP, Beriou JM, AutoloGel Diabetic Foot Ulcer Group. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage 2006; 52(6): 68–87.

Frykberg RG, Driver VR, Carman D, Lucero B, Borris Hale C, et al. Chronic wounds treated with a physiologically relevant concentration of platelet-rich plasma gel: A prospective case series. Ostomy Wound Manage 2010; 56: 36–44.

Trowbridge CC, Stammers AH, Woods E, Yen BR, Klayman M, et al. Use of platelet gel and its effects on infection in cardiac surgery. J Extra Corpor Technol 2005; 37: 381–386.

Englert SJ, Estep TH, Ellis-Stoll CC. Autologous platelet gel applications during cardiovascular surgery: Effect on wound healing. J Extra Corpor Technol 2005; 37: 148–152.

Eisenbud D, Huang NF, Luke S, Silberklang M. Skin substitutes and wound healing: Current status and challenges. Wounds 2004; 16(1): 2–17.

Goodman GJ, Barton JA. Postacne scarring: A qualitative global scarring grading system. Dermatol Surg 2006; 32: 1458–1466. doi: 10.1111/j.1524-4725.2006.32354.x.

Leheta T, El Tawdy A, Abdel Hay R, Farid S. Percutaneous collagen induction versus full concentration trichloroacetic acid in the treatment of atrophic acne scars. Dermatol Surg 2011; 37: 207–216. doi: 10.1111/j.1524-4725.2010.01854.x.

Ganio C, Tenewitz FE, Wilson RC, Moyles BG. The treatment of chronic nonhealing wounds using autologous platelet-derived growth factors. J Foot Ankle Surg 1993; 32(3): 263–268.

Alam M, Omura N, Kaminer MS. Subcision for acne scarring: Technique and outcomes in 40 patients. Dermatol Surg 2005; 31: 310–317. doi: 10.1097/00042728- 200503000-00011.

Balighi K, Robati RM, Moslehi H, Robati AM. Subcision in acne scar with and without subdermal implant: A clinical trial. J Eur Acad Dermatol Venereol 2008; 22: 707–711. doi: 10.1111/j.1468-3083.2008.02583.x.

Goodman GJ. Therapeutic undermining of scars (Subcision). Australas J Dermatol 2001; 42: 114–117. doi: 10. 1046/j.1440-0960.2001.00492.x.

Fulchiero GJ Jr, Parham-Vetter PC, Obagi S. Subcision and 1320-nm Nd:YAG nonablative laser resurfacing for the treatment of acne scars: A simultaneous split-face single patient trial. Dermatol Surg 2004; 30: 1356–1360. doi: 10.1111/j.1524-4725.2004.30411.x.

Kang W, Kim Y, Pyo W, Park SJ, Kim JH. Atrophic acne scar treatment using triple combination therapy: Dot peeling, subcision and fractional laser. Cosmet Laser Ther 2009; 11: 2–5. doi: 10.3109/14764170903134326.

Alsufyani MA, Alsufyani MA. Subcision: A further modification, an ever continuing process. Dermatol Res Pract 2012; 2012: 685347. doi:10.1155/2012/685347.

Ayeni O, Carey W, Muhn C. Acne scar treatment with subcision using a 20-G cataract blade. Dermatol Surg 2011; 37(6): 846–847. doi: 10.1111/j.1524-4725.2011.02010.x.

Jacob CI, Dover JS, Kaminer MS. Acne scarring: A classification system and review of treatment options. J Am Acad Dermatol 2001; 45: 109–117. doi: 10.1067/mjd. 2001.113451.

Redaelli A, Romano D, Marciano A. Face and neck revitalization with platelet-rich plasma (PRP): Clinical outcome in a series of 23 consecutively treated patients. J Drugs Dermatol 2010; 9: 466–472.

Lee J, Kim B, Kim M, Mun S. The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: A simultaneous split face trial. Dermatol Surg 2011; 37(7): 931–938. doi: 10.1111/j.1524-4725.2011.01999.x.

Fabbrocini G, De Vita V, Pastore F, Panariello L, Fardella N, Sepulveres R. et al. Combined use of skin needling and platelet-rich plasma in acne scarring treatment. J Cosmet Dermatol 2011; 24: 177–183.

Harandi SA, Balighi K, Lajevardi V, Akbari E. Subcisionsuction method: A new successful combination therapy in treatment of atrophic acne scars and other depressed scars. J Eur Acad Dermatol Venereol 2011; 25: 92–99. doi: 10.1111/j.1468-3083.2010.03711.x.

Nofal E, Helmy A, Nofal A, Alakad R, Nasr M. Platelet-rich plasma versus CROSS technique with 100% trichloroacetic acid versus combined skin needling and platelet rich plasma in the treatment of atrophic acne scars: A comparative study. Dermatol Surg 2014; 40(8): 864–783. doi: 10.1111/dsu.0000000000000091.

Chawla S. Split face comparative study of microneedling with PRP versus microneedling with vitamin C in treating atrophic post acne scars. J Cutan Aesthet Surg 2014; 7: 209–212. doi: 10.4103/0974-2077.150742.

Garg S, Baveja S. Combination therapy in the management of atrophic acne scars. J Cutan Aesthet Surg 2014; 7: 18–23. doi: 10.4103/0974-2077.129964.

Asif M, Kanodia S, Singh K. Combined autologous platelet-rich plasma with microneedling verses [sic] microneedling with distilled water in the treatment of atrophic acne scars: A concurrent split-face study. J Cosmet Dermatol 2016; 1–10. doi: 10.1111/jocd.12207.

Gawdat HI, Hegazy RA, Fawzy MM, Fathy M. Autologous platelet rich plasma: Topical versus intradermal platelet rich plasma after fractional ablative carbon dioxide laser treatment of atrophic acne scars. Dermatol Surg 2014; 40: 152–161. doi: 10.1111/dsu.12392.

Zhu JT, Xuan M, Zhang YN, Liu HW, Cai JH, Wu YH, et al. The efficacy of autologous platelet-rich plasma combined with erbium fractional laser therapy for facial acne scars or acne. Mol Med Rep 2013; 8: 233-7.

Published
2017-02-14
Section
Original Research Articles