Combination of Subcision, Microneedling, and Platelet-Rich Plasma Therapy in Patient with Grade Four Atrophic Acne Scars
Abstract
Atrophic acne scars affect up to 75% of patients with a history of acne and are often associated with significant psychosocial distress. These scars are classified into three main types: ice pick, rolling, and boxcar. A multimodal therapeutic approach is often required for effective management, particularly in severe cases. This report presents a case of a 40-year-old married woman with a 10-year history of inflammatory acne lesions that progressed into grade 4 atrophic scars. The acne was suspected to be triggered by injectable contraceptive use, which contains progestins with androgenic activity. The patient frequently picked at her acne, leading to deep scarring predominantly on both cheeks. Based on clinical evaluation, dermoscopy, and skin analyzer assessment, the patient underwent a series of treatments combining subcision, microneedling, and platelet-rich plasma (PRP) therapy. Following treatment, the Self-Assessment of Clinical Acne-Related Scars (SCARS) score improved from 22 to 14, while the Facial Acne Scar Quality of Life (FASQoL) score improved from 32 to 16. This case highlights the effectiveness of a combination approach in remodeling scar tissue and improving quality of life in patients with severe atrophic acne scars. A tailored, comprehensive treatment plan is essential for optimal outcomes.
References
Ahramiyanpour, N., Rastaghi, F., Parvar, S. Y., Sisakht, A. K., Hosseini, S. A., & Amani, M. (2023). Subcision in acne scarring: A review of clinical trials. Journal of Cosmetic Dermatology, 22(3), 744–751. https://doi.org/10.1111/jocd.15480
Ali, B., ElMahdy, N., & Elfar, N. N. (2019). Microneedling (Dermapen) and Jessner’s solution peeling in treatment of atrophic acne scars: A comparative randomized clinical study. Journal of Cosmetic and Laser Therapy, 21(6), 357–363. https://doi.org/10.1080/14764172.2019.1661490
Amer, A., Elhariry, S., & Al‐Balat, W. (2021). Combined autologous PLATELET‐RICH plasma with microneedling versus microneedling with non‐cross‐linked hyaluronic acid in the treatment of atrophic acne scars: Split‐face study. Dermatologic Therapy, 34(1). https://doi.org/10.1111/dth.14457
Baldwin, H. E., Bs, M. N., Ma, C. K., Mays, D. A., Grossman, R., & Newburger, J. (2013). 40 Years of Topical Tretinoin Use in Review. 12(6).
Bandyopadhyay, D. (2021). Topical antibacterials in dermatology. Indian Journal of Dermatology, 66(2), 117. https://doi.org/10.4103/ijd.IJD_99_18
Bhargava, S., Cunha, P. R., Lee, J., & Kroumpouzos, G. (2018). Acne Scarring Management: Systematic Review and Evaluation of the Evidence. American Journal of Clinical Dermatology, 19(4), 459–477. https://doi.org/10.1007/s40257-018-0358-5
Bhargava, S., Kroumpouzos, G., Varma, K., & Kumar, U. (2019). Combination therapy using subcision, needling, and platelet‐rich plasma in the management of grade 4 atrophic acne scars: A pilot study. Journal of Cosmetic Dermatology, 18(4), 1092–1097. https://doi.org/10.1111/jocd.12935
Bhate, K., & Williams, H. C. (2013). Epidemiology of acne vulgaris: Epidemiology of acne vulgaris. British Journal of Dermatology, 168(3), 474–485. https://doi.org/10.1111/bjd.12149
Bosanac, S. S., Trivedi, M., Clark, A. K., Sivamani, R. K., & Larsen, L. N. (2018). Progestins and acne vulgaris: A review. Dermatology Online Journal, 24(5). https://doi.org/10.5070/D3245040035
Dadkhahfar, S., Robati, R. M., Gheisari, M., & Moravvej, H. (2020). Subcision: Indications, adverse reactions, and pearls. Journal of Cosmetic Dermatology, 19(5), 1029–1038. https://doi.org/10.1111/jocd.13308
Davtyan, C. (2012). Four generations of progestins in oral contraceptives. 16.
Deshmukh, N. S., & Belgaumkar, V. A. (2019). Platelet-Rich Plasma Augments Subcision in Atrophic Acne Scars: A Split-Face Comparative Study. Dermatologic Surgery, 45(1), 90–98. https://doi.org/10.1097/DSS.0000000000001614
Goh, C., Cheng, C., Agak, G., Zaenglein, A. L., Graber, E. M., Thiboutot, D. M., & Kim, J. (n.d.). 14 Acneiform Disorders PART. Acne Vulgaris.
Ibrahim, Z. A., El-Ashmawy, A. A., & Shora, O. A. (2017). Therapeutic effect of microneedling and autologous platelet-rich plasma in the treatment of atrophic scars: A randomized study. Journal of Cosmetic Dermatology, 16(3), 388–399. https://doi.org/10.1111/jocd.12356
Juhasz, M. L., & Cohen, J. L. (2020). Microneedling for the Treatment of Scars: An Update for Clinicians. Clinical, Cosmetic and Investigational Dermatology, Volume 13, 997–1003. https://doi.org/10.2147/CCID.S267192
Kamel, M. M., Hegazy, R. A., Hegazy, A. A., Fotoh, O. M. A. E., & Amer, M. A. (2021). Combined subcision, autologous platelet-rich plasma, and CROSS technique in the treatment of atrophic acne scars: Prospective split face study. Clinics in Dermatology, 39(6), 1018–1024. https://doi.org/10.1016/j.clindermatol.2021.07.003
Khafagy, G. M., Shalaby, H. L., Saad, N. E., & Hasan, M. D. (2021). Effect of the Monthly Injectable Combined Contraceptives versus Oral Contraceptive Pills on Mood. Korean Journal of Family Medicine, 42(6), 471–476. https://doi.org/10.4082/kjfm.20.0106
Nilforoushzadeh, M. A., Lotfi, E., Heidari‐kharaji, M., Nickhah, N., Alavi, S., & Mahmoudbeyk, M. (2020). Comparing cannula‐based subcision with the common needle method: A clinical trial. Skin Research and Technology, 26(1), 39–44. https://doi.org/10.1111/srt.12761
Peng, G. L. (2019). Platelet-Rich Plasma for Skin Rejuvenation. Facial Plastic Surgery Clinics of North America, 27(3), 405–411. https://doi.org/10.1016/j.fsc.2019.04.006
Rahmayani, T., Putra, I. B., & Jusuf, N. K. (2019). Association of serum interleukin-10 (IL-10) with the severity of acne vulgaris. Bali Medical Journal, 8(3), 753–756. https://doi.org/10.15562/bmj.v8i3.1514
Rohanda, B. A., & Jusuf, N. K. (2022). Platelet-Rich Plasma: Applications in Cosmetic Dermatology. Open Access Macedonian Journal of Medical Sciences, 10(F), 609–613. https://doi.org/10.3889/oamjms.2022.9339
Schoenberg, E., O’Connor, M., Wang, J. V., Yang, S., & Saedi, N. (2020). Microneedling and PRP for acne scars: A new tool in our arsenal. Journal of Cosmetic Dermatology, 19(1), 112–114. https://doi.org/10.1111/jocd.12988
Sitohang, I. B. S., Sirait, S. A. P., & Suryanegara, J. (2021). Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials. International Wound Journal, 18(5), 577–585. https://doi.org/10.1111/iwj.13559
Skroza N, Tolino E, Mambrin A, Zuber S, Balduzzi V, Marchesiello A, & Bernardini N. (2018). Adult acne versus adolescent acne: A retrospective study of 1.167 patients. JCAD, 11(1), 21.
Vempati, A., Zhou, C., Tam, C., Khong, J., Rubanowitz, A., Tam, K., Hazany, S., Vasilev, R., & Hazany, S. (2023). Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments. Clinical, Cosmetic and Investigational Dermatology, Volume 16, 125–134. https://doi.org/10.2147/CCID.S397888
Ward, R. E., Sklar, L. R., & Eisen, D. B. (2019). Surgical and Noninvasive Modalities for Scar Revision. Dermatologic Clinics, 37(3), 375–386. https://doi.org/10.1016/j.det.2019.03.007
Wei, B., Pang, Y., Zhu, H., Qu, L., Xiao, T., Wei, H.-C., Chen, H.-D., & He, C.-D. (2010). The epidemiology of adolescent acne in North East China: Epidemiology of adolescent acne. Journal of the European Academy of Dermatology and Venereology, 24(8), 953–957. https://doi.org/10.1111/j.1468-3083.2010.03590.x
Woong-Suk CHAE; Jun-Young SEONG; Ha-Na JUNG; Sook-Hyun KONG; Ho-Seok SUH; Yu-Sung CHOI. (2015). The Consideration of Dermoscopic Findings during Atrophic Acne Scar Treatment: A Pilot Study / 대한피부과학회지. Korean Journal of Dermatology, 23–29.
Copyright (c) 2025 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
