Platelet‐rich plasma in the treatment of scars, to suggest or not to suggest? A systematic review and meta‐analysis

Abstract

Despite the rising trend for applying platelet‐rich plasma (PRP) in the management of various types of scars, there is no convincing evidence supporting its use. This motivated us to review the randomized clinical trials that examine the effectiveness and safety of PRP, alone or in combination with other methods, for the management of atrophic or hypertrophic/keloidal scars. The Web of Science, Scopus, Google Scholar, and Cochrane Library databases were systematically searched until September 1st, 2020. Thirteen clinical trials were enrolled in the meta‐analysis, and 10 more were reviewed for their results. The random effect meta‐analysis method was used to assess the effect size of each outcome for each treatment type, and I2 was used to calculate the statistical heterogeneity between the studies. Patients treated with PRP experienced an overall response rate of 23%, comparable to the results seen with laser or micro‐needling (22% and 23%, respectively) When used alone, moderate improvement was the most frequently observed degree of response with PRP (36%) whereas, when added to laser or micro‐needling, most patients experienced marked (33%, 43%, respectively) or excellent (32% and 23%, respectively) results. Concerning the hypertrophic/keloid scars, the only study meeting the required criteria reported a better improvement and fewer adverse effects when PRP was added to the intralesional corticosteroids. Platelet‐rich plasma appears to be a safe and effective treatment for various types of atrophic scars. In addition, when added to ablative lasers or micro‐needling, it seems to considerably add to the efficacy of treatment and reduce the side effects.

Impact of autologous platelet concentrates on wound area reduction: A meta‐analysis of randomized controlled trials

“…10,26 A meta-analysis conducted by Ebrahimi et al assessed the efficacy of PRP, either alone or in combination with other modalities, for managing atrophic or hypertrophic/keloidal scars. 27 Similarly, Tasmania et al reported the effectiveness of PRP in reducing the wound area of diabetic foot ulcers compared with conventional treatment alone, 28 which aligns with our findings. However, other studies failed to identify significant differences or positive effects.…”

“…By delivering PRP or PRF to wounds, the abundance of growth factors can be utilized to expedite healing and promote larger healing areas in various types of skin wounds 10,26 . A meta‐analysis conducted by Ebrahimi et al assessed the efficacy of PRP, either alone or in combination with other modalities, for managing atrophic or hypertrophic/keloidal scars 27 . Similarly, Tasmania et al reported the effectiveness of PRP in reducing the wound area of diabetic foot ulcers compared with conventional treatment alone, 28 which aligns with our findings.…”

Ablative fractional carbon dioxide laser combined with autologous platelet‐rich plasma in the treatment of atrophic acne scars: A systematic review and meta‐analysis

“…This assumption has been supported by Ebrahimi et al which showed that marked and excellent response rate to be similar among both groups (65% vs. 66%). The study also showed that the combined use of PRP with microneedling or laser therapy generally shows better clinical improvement than any of these methods alone 41 . On the other hand, Ibrahim et al in a clinical trial showed a comparable clinical improvement and side effect profile with the combined use of PRP and microneedling versus microneedling alone in treating acne scars 42 …”

“…The study also showed that the combined use of PRP with microneedling or laser therapy generally shows better clinical improvement than any of these methods alone. 41 On the other hand, Ibrahim et al in a clinical trial showed a comparable clinical improvement and side effect profile with the combined use of PRP and microneedling versus microneedling alone in treating acne scars. 42 FCO 2 laser shows substantial clinical efficacy in the management of atrophic acne scars, the post-inflammatory hyperpigmentation (PIH) stands as a considerable obstacle, especially in dark skin types.…”

Prevention and Treatment of Chemotherapy-Induced Alopecia: What Is Available and What Is Coming?

“…Additionally, platelets can also release numerous anti-inflammatory cytokines such as interleukin-1 receptor antagonist (IL-1ra), soluble tumor necrosis factor (TNF) receptor (sTNF-R) I, interleukin (IL)-4, IL-10, IL-13, and interferon γ [ 73 ]. PRP has been used as an autologous injection for various medical conditions to promote healing and tissue regeneration/rejuvenation [ 73 , 74 , 75 , 76 , 77 , 78 ]. Additionally, PRP has also been used widely in alopecia treatment due to its ability to induce cell proliferation, supporting HF growth, and extending anagen [ 72 , 79 , 80 , 81 , 82 ].…”