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 Aug;40(8):864-73. doi: 10.1111/dsu.0000000000000091.


Background: Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma that may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition. Skin needling is a technique that uses a sterile dermaroller to puncture the skin and release growth factors. The combination of skin needling and PRP could enhance the efficacy of both modalities. Chemical reconstruction of skin scars technique consists of focal application of high concentration of trichloroacetic acid (TCA) on the acne scars to stimulate collagen production.

Objective: To evaluate the efficacy and safety of intradermal injection of PRP, 100% focal TCA, and combined skin needling plus topical PRP in the treatment of atrophic acne scars.

Patients and methods: Forty-five patients with atrophic acne scars were randomly assigned to 3 equal groups; Group A received intradermal injection of PRP, Group B received chemical reconstruction of skin scars technique with TCA 100%, and Group C was treated by combined skin needling and PRP. Each patient underwent 3 sessions at 2-week interval.

Results: All the patients completed the study. The 3 groups showed statistically highly significant improvement in the degree of acne scars after treatment (p < .001). No major adverse effects were observed in the studied groups.

Conclusion: This is the first study to use intradermal injection of PRP alone for the treatment of atrophic acne scars. The 3 modalities showed a promising efficacy and safety in the treatment of atrophic acne scars.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acne Vulgaris / complications
  • Adult
  • Atrophy / pathology
  • Atrophy / therapy
  • Cicatrix / etiology
  • Cicatrix / pathology*
  • Cicatrix / therapy*
  • Combined Modality Therapy
  • Face
  • Female
  • Humans
  • Keratolytic Agents / adverse effects
  • Keratolytic Agents / therapeutic use*
  • Male
  • Needles / adverse effects
  • Pain / etiology
  • Photography
  • Platelet-Rich Plasma*
  • Single-Blind Method
  • Skin / pathology
  • Trichloroacetic Acid / adverse effects
  • Trichloroacetic Acid / therapeutic use*
  • Young Adult


  • Keratolytic Agents
  • Trichloroacetic Acid