This randomized controlled trial aims to evaluate whether adding platelet-rich plasma (PRP) to fractional CO₂ laser resurfacing improves the treatment of moderate-to-severe acne scars compared with laser alone. Seventy adults aged 18-40 years will be recruited from the Dermatology Department of Gujranwala Medical College Teaching Hospital. Participants will be randomly assigned to receive either fractional CO₂ laser combined with topical PRP or fractional CO₂ laser alone, with three treatment sessions delivered four weeks apart.

The primary outcome is the change in acne scar severity measured using the Goodman and Baron Quantitative Acne Scar Scale. Secondary outcomes include redness, edema, pain scores, and patient satisfaction assessed using Likert and numeric rating scales. The study is single-blinded, with patients unaware of treatment allocation. PRP will be prepared using a standardized double-spin centrifugation process. Data will be analyzed using appropriate statistical tests with a significance level of p < 0.05. The study aims to determine whether PRP enhances laser efficacy, reduces side effects, and improves patient-reported outcomes.

Acne scarring is a frequent and distressing outcome of acne vulgaris. Fractional carbon dioxide (CO₂) laser therapy is widely used for acne scar management because it creates controlled microthermal zones that stimulate collagen remodeling and improve skin texture. However, laser treatment alone may lead to side effects such as erythema, edema, discomfort, and variable degrees of clinical improvement.

Platelet-rich plasma (PRP) is an autologous biological product containing high concentrations of platelets, growth factors, and cytokines known to promote wound healing, enhance collagen production, and modulate inflammation. The combination of PRP with fractional CO₂ laser treatment is believed to enhance clinical results, improve healing time, and reduce post-procedural complications. This study is designed to evaluate whether adding PRP to fractional CO₂ laser improves outcomes for patients with moderate-to-severe acne scars.

This randomized controlled trial will recruit 70 patients aged 18-40 years with moderate-to-severe facial acne scars. Participants will be randomly allocated into two groups. Group A will receive fractional CO₂ laser therapy combined with PRP, and Group B will receive fractional CO₂ laser therapy alone. Both groups will undergo three treatment sessions spaced four weeks apart. The study uses single blinding, where patients are unaware of their treatment assignment. To maintain blinding, a placebo-filled syringe will be used in the control group and gently applied without injecting any substance.

PRP will be prepared using a standardized double-spin method. Ten milliliters of venous blood will be collected in anticoagulant tubes, centrifuged at low speed to separate plasma and buffy coat, followed by a second high-speed centrifugation to isolate platelet-rich plasma. Topical anesthesia with lignocaine-prilocaine cream will be applied before each laser session. Treatment areas will be prepared using antiseptic measures, and eye protection will be provided.

Outcome assessment will be performed at baseline and at each visit. The primary outcome is the change in acne scar severity measured using the Goodman and Baron Quantitative Acne Scar Scale. Secondary outcomes include assessments of erythema and edema by the evaluator, as well as patient-reported pain scores and satisfaction ratings. Standardized clinical photographs will support patient self-assessment under consistent lighting and camera settings.

Data will be analyzed using appropriate statistical methods. Continuous variables will be assessed for normality and compared using t-tests or nonparametric equivalents. Categorical and ordinal data will be analyzed using Chi-square or related tests. A significance level of p < 0.05 will be applied. Data will be coded, and the statistician will remain blinded to group allocation.

The purpose of this trial is to determine whether PRP enhances the efficacy, safety profile, and patient satisfaction of fractional CO₂ laser treatments. If successful, this combination approach may offer a more effective therapeutic option for managing moderate-to-severe acne scarring.

Inclusion Criteria:Adults aged 18 to 40 years

Male and female participants

Fitzpatrick skin types I to V

Presence of moderate-to-severe acne scars

Willing to undergo 3 treatment sessions and follow-up visits

Able to provide informed consent -

Exclusion Criteria:Use of topical anti-acne medications in the past 1 month

History of keloid formation or hypertrophic scarring

Active acne or active skin inflammation at treatment area

Diabetes mellitus

Photosensitive disorders (e.g., lupus, dermatomyositis)

Melasma

Active infections (e.g., Herpes simplex)

Recent laser resurfacing or similar procedures

Outdoor workers with high sun exposure

Vitiligo

Pregnancy or breastfeeding

Bleeding disorders or anticoagulant therapy

Unrealistic expectations or inability to comply with follow-up

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I sill do it after publication of my study

This study uses single masking. Participants are blinded to their group assignment by placebo-filled syringes covered with opaque tape applied to the skin without injection to mimic the appearance and procedure of PRP application in control group.

The treating physician and study staff are aware of the allocation, while the patients and the outcome statistician remain blinded to group identity.