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Fractional CO₂ laser combined with intradermal and topical platelet-rich plasma for hypertrophic scars: a randomized
Junjie Sun1, Jun Wang2, Shujun Song1
1Geriatric Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China.
Purpose:
This study compared the clinical efficacy and safety of fractional CO₂ laser combined with platelet-rich plasma (PRP) delivered by intradermal injection plus topical application versus fractional CO₂ laser alone for the treatment of hypertrophic scars.
Methods:
In this prospective, randomized, assessor-blinded trial, 120 patients were assigned to a combined group (laser + PRP, n = 60) or a control group (laser + saline, n = 60). Four sessions were delivered at 4-6-week intervals. The primary outcome was Vancouver Scar Scale (VSS) total score. The prespecified primary endpoint was the between-group difference in VSS total score at T4 (6 months after the final treatment session). Secondary outcomes included POSAS scores, ultrasound-measured scar thickness, patient satisfaction, and adverse events.
Results:
Both groups showed significant VSS improvement (both P < 0.001). The combined group had significantly lower VSS total scores than the control group from T1 onward (P = 0.036 at T1; P < 0.001 at T2 and T4; P = 0.007 at T3; estimated between-group difference at T4 -1.85 points, 95% CI -2.48 to -1.22, from the primary mixed-effects model) and lower POSAS scores from T1 onward (P = 0.022 at T1; P < 0.001 at T2, T3, and T4) than the control group. Ultrasound-measured scar thickness was lower in the combined group at 3 months (P = 0.045); at 6 months the difference was attenuated and of borderline statistical significance (P = 0.042-0.065 across missing-data approaches). Patient satisfaction was higher in the combined group (P < 0.001). Procedural pain was greater in the combined group (mean between-group difference 1.34 points on a 0-10 VAS; P < 0.001). Post-inflammatory hyperpigmentation was numerically lower in the combined group (18.33% vs. 33.33%; P = 0.094).
Conclusion:
Fractional CO₂ laser combined with intradermal and topical PRP provided greater improvement in clinical scar scores than laser alone, with an acceptable safety profile. The advantage in ultrasound-measured thickness at 6 months was of borderline statistical significance. These findings support PRP as a potential adjunct for hypertrophic scars.
