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Microneedling: Where do we stand now? A systematic review of the literature
Abstract and Figures
Background
Patients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or aging.
Objective
This review aims to evaluate the current evidence in the literature on microneedling.
Methods
A systematic literature review was performed by searching the electronic databases Pubmed and Google Scholar. The reviewed articles were analysed and compared on study design, treatment protocol, outcome parameters, efficacy measurement and results to evaluate the strength of the current evidence.
Results
Microneedling was investigated in experimental settings for its effects on atrophic acne scars, skin rejuvenation, hypertrophic scars, keloids, striae distentiae, androgenetic alopecia, melasma and acne vulgaris. Several clinical trials used randomisation and single-blindation to strengthen the validity of the study outcome. Microneedling showed significant results when used on its own and when combined with topical products or radiofrequency. When compared to other treatments, it showed similar results but was prefered due to minimal side-effects and shorter downtime.
Conclusion
This systematic review positions microneedling as a safe and effective therapeutic option for the treatment of scars and wrinkles. The current literature does show some methodological shortcomings and further research is required to truly establish microneedling as an evidence based therapeutic option for treating scars, wrinkles and other skin conditions.
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... Treatment of atrophic scars includes corrective procedures such as fillers, dermabrasion, laser resurfacing, and microneedling [14]. To date topical therapy and ablative modalities such as dermabrasion, peelings, and lasers were the main focus of atrophic scar therapy but in recent years newer, regenerative medicine methods, such as microneedling have gained popularity [15]. Ablative procedures base their effectiveness on partial removal of the epidermis to trigger the growth of new skin to replace scars [16]. ...
... On the other hand, percutaneous collagen induction reaches the papillary and reticular dermis in a purely mechanical way, minimizing the disruption of the epidermis and leading to scarless wound healing [19]. However, microneedling being a fairly new treatment modality still lacks strong clinical evidence to fully support its use in the treatment of atrophic post-acne scars [15]. This is the "call for action", which has been echoed in several papers [15,20]. ...
... However, microneedling being a fairly new treatment modality still lacks strong clinical evidence to fully support its use in the treatment of atrophic post-acne scars [15]. This is the "call for action", which has been echoed in several papers [15,20]. This existing knowledge gap led us to design and execute this double-blind randomized controlled trial (RCT) to examine the possible synergistic effect of the use of microneedling and a combination of trichloroacetic acid, kojic acid and hydrogen peroxide in the treatment of post-acne atrophic scars. ...
Introduction:
Acne vulgaris is a common, chronic disease. One of the most commonly encountered complications of acne is permanent atrophic scarring. Treatment of atrophic scars includes fillers, dermabrasion, laser resurfacing, microneedling and peelings and it is often difficult to treat. In our double-blind randomized controlled trial (RCT), we investigated the synergistic effect of microneedling with the application of trichloroacetic acid, kojic acid and hydrogen peroxide in the treatment of atrophic acne scars.
Aim:
To assess the clinical effectiveness and patients' quality-of-life (HRQoL) after three types of atrophic post-acne scar treatment, namely microneedling alone (MN) vs chemical peeling alone (CP) vs. a combination of microneedling and chemical peeling (MN + CP).
Material and methods:
A total of 120 patients were enrolled into the study following strict inclusion/exclusion criteria and randomized into the three treatment groups - MN, CP (a combination of trichloroacetic acid, kojic acid and hydrogen peroxide), and MN + CP. According to a preapproved protocol, each patient underwent four treatment sessions, each spread 20 days apart. Both pre- and post-treatment clinical status (using the Goodman-Baron scale; two expert raters blinded to the treatment used) and patients' HRQoL (using the Dermatology Life Quality Index) were assessed.
Results:
During the 5-month recruitment period, a total of 120 patients were approached and agreed to take part in the study (94 females - 78.3% and 26 males) (mean age of 30.14 ±3.64 years; range: 18-45 years). Only in the MN + CP group there was a statistically significant improvement according to the G-B scale post-treatment (2.87 ±0.83 vs. 2.03 ±1.16 respectively; p = 0.0005). Patients in all three treatment groups experienced a statistically significant improvement in their HRQoL post-treatment (all p's < 0.05).
Conclusions:
A combination of microneedling and chemical peeling produces the best, objectively measured effects in the treatment of atrophic post-acne scars. All examined treatments, even if not producing a clinically significant treatment outcome, improve patients' HRQoL.
... Two recently published literature reviews also concluded that microneedling monotherapy could be a favorable treatment choice for acne scarring [33,34]. However, in another study, laser peels exhibited comparable outcomes to microneedling in terms of acne scar improvement [35]. However, as a systematic review of multiple skin diseases treated by microneedling, the included samples involving treatment of atrophic acne scars are concerningly small. ...
... One study even reported that microneedling was better tolerated by patients than laser treatments because of less reported downtime [36]. Similarly, numerous studies have reported microneedling to be safe for treating several medical conditions, with fewer side effects and less downtime [35,37,38]. Conversely, one study on atrophic scars reported higher patient satisfaction with the control treatment than with microneedling [17]. ...
Acne scarring, formed by the deposition of collagen following inflammatory acne, not only represents a cosmetic problem but also poses a psychological health risk to patients. As microneedling has become a common treatment for acne scarring, an increasing number of studies have compared the efficacy and safety of microneedling. In this study, we conducted a meta-analysis of randomized controlled trials (RCTs) comparing microneedling with other treatments. Three databases, namely Embase, PubMED, and Cochrane library, were searched until June 20, 2021, for RCTs only. Studies using microneedling in both treatments were excluded. Twelve studies, totaling 414 participants, were included in our meta-analysis. For objective scar improvement, the pooled estimate analysis of the first group, treated with microneedling without radiofrequency, yielded a mean difference of 0.42 (95% CI—0.12–0.73%) with a significant difference at the 5% significance level. The second group, treated with fractional radiofrequency microneedling, exhibited no significance at the 5% significance level. Regarding subjective satisfaction, most results exhibited no significant difference between microneedling and other treatments. Although no case of secondary scarring or infection was reported in our study, the pooled result of postinflammatory hyperpigmentation was significant at the 5% significance level and preferred microneedling treatment. Microneedling without radiofrequency achieved superior results in terms of scar improvement. No form of microneedling caused postinflammatory hyperpigmentation—an advantage in acne scar treatment. Thus, microneedling is a favorable choice for the treatment of acne scarring. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... 93 More invasive interventions, including the use of microneedling or ablative CO₂ fractional laser, are increasingly being used in the treatment of paediatric burn scars. Most published literature in this area is for postburn scarring in adults, 94,95 and a substantial limitation remains with the poor understanding of the mechanisms involved in scar remodelling or extracellular matrix reorganisation. This lack of research leads to disparity in treatment protocols (energy settings, depth, timepoints postburn for application, duration of application, and combin ation with topical products), and potentially minimised or even negative effects through inappropriate or excessive use. ...
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
The Zn–22Al alloy was processed under different microextrusion conditions to fabricate long and smooth microtubes with good strength and ductility. After direct microextrusion, the outer diameter variation and microstructure evolution of micro-extruded Zn–22Al microtubes under different extrusion conditions were investigated, followed by tensile tests at ambient temperature. With an increase in extrusion temperature and a decrease in extrusion speed, the microhardness, elongation, and tensile strength of the Zn–22Al microtubes decreased. The optimal extrusion conditions including temperature and speed for the microtubes were 250 °C and 1 mm/min, respectively, which were selected for preparing billet microtubes in the following process for fabricating microneedles. The mechanical behavior can be controlled by the microstructure of the extruded microtubes. The extruded microtubes at 340 °C and 1 mm/min had the highest tensile strength and hardness owing to the thinner lamellar structure, whose composition was analyzed by EDS.
Facial rejuvenation treatments include any injectables or skin interventions that make the face appear younger. This article aims to improve treatment outcomes by assisting practitioners in selecting optimum treatment for patients depending on their individual needs, whether that is wrinkle reduction, long-term improvement of skin elasticity, reduction in pigmentation, tightening or all of these. This review includes clinical analyses of botulinum toxin, microneedling, hyaluronic acid dermal filler and intense pulsed light, including evidence and arguments for the benefits and limitations in each case.
The field of cosmetic dermatology has recently witnessed unbridled growth in the past several years. Part of this has been due to the increasing popularity of aesthetic treatments in men, who represent a growing patient population. Men tend to have higher levels of collagen density and greater skin thickness, but these begin to decrease earlier on. They can also more frequently have severe photodamage. Their clinical presentations can affect the selection of treatments. Physicians should be familiar with the subtle differences between treating men and women. Early studies and literature are beginning to shed more light on these important distinctions. We have reviewed the notable differences in facial aging, pathophysiology, and patient selection, as well as discussing available treatment options with these factors in mind.
Microneedling can accelerate skin repair through numerous complex processes triggered by micro-injuries it produces on the skin surface with very thin needles. The current growth in the application of microneedling in the treatment of cutaneous diseases can be explained by its numerous effects on the skin as reported in the literature. Despite the numerous studies conducted on the application of microneedling in the treatment of skin lesions, its effects on pigmented skin lesions have remained relatively unexplored. The present review comprises an examination of the evidence for the application of microneedling in skin diseases in general and a comprehensive review of the applications of microneedling in pigmentation disorders. The review involved a search of all clinical studies, including trials, case reports, and case series, in the databases MEDLINE/PubMed and Google Scholar using the following keywords: “microneedling”, “dermal needling”, “percutaneous collagen induction”, “skin needling”, “dermaroller”, and “dermatology disorder”. Pertinent data were extracted from all relevant articles published from 1990 to April 2021, and focused on the application of microneedling in the treatment of pigmented skin lesions. Despite the limited number of available studies, evidence suggests the effectiveness and safety of microneedling in treating vitiligo, melasma, and periorbitalhypermelanosis. It is noteworthy that the combination of any type of non-aggressive needing technique with other effective therapies (especially topical agents and mesotherapy) yields more promising therapeutic results than single therapy for melasma, dark cycles and vitiligo as the prototype of pigmentary disorders. However, single needling therapy is significantly effective, too.
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Microneedling, a minimally invasive technique utilized to induce neocollagenesis, is frequently combined with platelet-rich plasma (PRP) to enhance results for a variety of medical and cosmetic dermatological conditions. It is generally well-tolerated and effective with preliminary data demonstrating improved outcomes for the treatment of acne scarring, striae distensae, melasma, and photoaging.
Striae distensae (SD) are linear scar tissue in the dermis that arises from stretching the skin. There are two types of SD, striae rubrae and striae albae (SA) which is marked with a line hypopigmentation that cause a psychological problem, especially in the high skin type. The standard therapy is a 0.1% tretinoin cream, but it takes a long time to reach the collagen so it needs invasive measures to reach these targets. This study was comparing 0.1% tretinoin cream with combination therapy of fractional microneedle radiofrequency (FMR) and fractional CO2 laser for SA. The number of subjects in this study was 11 patients each group with Fitzpatrick skin types IV or V. Biopsy was taken before and after therapy. The clinical changes in SA lesions in this study were represented by measurements of the length and width. The percentage of collagen area is the amount of collagen fibers with Masson’s trichrome staining. The clinical changes of lesion in the combination therapy decreased. The percentage change in collagen area in the combination therapy group had a higher increase. The side effect experienced by all combination group subjects was postinflammatory hyperpigmentation, two subjects in 0.1% tretinoin cream group experienced irritation.
Objective:
To evaluate the individual effectiveness of needling therapy using the Dermapen (Dermapen, Salt Lake City, Utah) and topical therapy with silicone gel (Kelo-cote, Sinclair Pharma, London, England), and their combined effectiveness for the treatment of linear surgical scars, hypertrophic scars, and keloids.
Materials and methods:
Twenty patients were randomly selected and equally divided into 2 groups (A and B), with each group of 10 including 6 patients with keloids and 4 with hypertrophic scars. Treatment assignments were random. In group A, the entire scar was treated by skin needling, with silicone gel applied to half of the scar. Patients in group B were treated with silicone gel on the whole scar, with only half of the scar also treated with skin needling. During follow-up visits, clinical photographs, evaluation of the scars' thickness, skin ultrasound, and modified Vancouver Scar Scale were performed.
Results:
Group A showed an average improvement of 68% (P < .01) on the half of the scar with the combination treatment (skin needling plus silicone gel) compared with a 52% improvement on the half of the scar that was treated with only skin needling. Group B showed an average improvement of 63% (P < .01) where the combination treatment was performed, compared with 47% improvement on the area treated with only the silicone gel.
Conclusions:
In conclusion, the combination of these 2 treatments is safe and effective for the treatment of hypertrophic scars and keloids. These modalities achieved favorable results with each patient adhering to the study paramenters.
Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm(2) (15-250cm(2)) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars.
Background:
The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH).
Objective:
To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars.
Methods:
Forty-six patients with atrophic facial acne scars were randomized to microneedling and laser groups, receiving 3 sessions performed monthly. Two blinded dermatologists applied the validated "Quantitative Global Grading System for Postacne Scarring" scale, before, 2 months, and 6 months after the treatment. Side effects were recorded at each follow-up visit and patient's satisfaction was evaluated.
Results:
Both groups showed a significant improvement, and there was no statistically significant difference between results of both therapies (p = .264). The erythema after each session was longer in the laser group and 13.6% subjects experienced PIH. No PIH was observed in the microneedling group.
Conclusion:
This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars. Microneedling is well tolerated, with fewer side effects and lower down time.
Fractional microneedling radiofrequency (FMR) is one of the promising methods in acne treatment. Moreover, bipolar radiofrequency (BR) generates heat thereby which induces neocollagenosis. FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar. This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment. Furthermore, mechanism of the FMR treatment was investigated through skin tissues obtained from subjects. Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR. Two sessions of treatment was done 4 weeks apart in a total 12-week prospective single-blind, randomized clinical trial. Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety. Skin tissues were acquired for investigation of molecular changes. FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR. Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks, respectively. FMR treatment resulted in significant reduction of sebum excretion. Both treatments showed no severe adverse effects other than erythema. The FMR showed superior efficacy in acne and acne scar compared with BR. Increased expression of TGFβ and collagen I and decreased expression of NF-κB, IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR.
Introduction:
Skin aging occurs through both intrinsic and extrinsic processes. Fractional radiofrequency (RF) with a microneedling array is the newest form of fractional therapy to be useful in treating aging skin. The current study utilized a noninsulated fractional RF microneedling system.
Methods:
This multicenter clinical trial saw 49 patients complete 3 monthly treatments with the new fractional RF microneedling treatments and be followed for 3 months following their last treatment. Pain during treatment was recorded as well as overall improvement using a GAIS scale. Adverse events were also noted.
Results:
Forty-nine patients completed all of the treatments and follow-ups. Mild to moderate erythema were reported immediately after treatment which lasted up to 12 hours after the treatment. Pain, as measured on a 1-10 VAS, was noted to 4, on average. The average Fitzpatrick's wrinkle scale score at baseline was 5.04 ± 1.22, 1 month after 3 treatments 3.829 ± 1.69 and 3 months after 3 treatments 3.5 ± 1.66. These results are statistically highly significant (correlated T-test, P < 0.001). Improvement was shown in 100% of patients while 65% of patients had significant improvement (GAIS levels 3-5). Significant skin tightening and skin lifting were also observed. No unusual adverse events were noted throughout the course of the study.
Conclusion:
This multicenter study showed significant wrinkle reduction, skin tightening, and lifting of the mid and lower face with the noninsulated fractional RF microneedling system. Lasers Surg. Med. 2016 9999:1-7. © 2016 Wiley Periodicals, Inc.
Background and objectives:
Striae are atrophic dermal scars with overlying epidermal atrophy causing cosmetic concern. This study assesses and compares the efficacy and safety of needling therapy versus CO2 fractional laser in treatment of striae.
Methods:
Twenty Egyptian female patients with striae in the abdomen and lower limbs were involved in the study. The patients were treated with needling therapy and CO2 laser every 1 month for 3 sessions. Follow-up by digital photography and skin biopsy was conducted at baseline and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient's satisfaction before and after treatment.
Results:
Nine of 10 (90%) needle-treated patients showed improvement. Among them, 3 (30%) had good, 4 (40%) had fair, and 2 (20%) had poor improvements; however, 1 (10%) did not show any improvement after the treatment. In CO2-laser treated patients, 5 of 10 (50%) of the patients showed clinical improvement; 1 (10%) were good, 3 (30%) were fair, and 1 (10%) were poor; however, 5 (50%) did not show improvement.
Conclusion:
The results support the use of microneedle therapy over CO2 lasers for striae treatment.
Platelet-rich plasma (PRP) contains autologous growth factors, which could act synergistically with growth factors induced by skin needling in order to enhance the wound-healing response. The combination of treatments, carried out by using skin needling and PRP application, should enhance both efficacy of skin needling and PRP application. The objective of this study is to establish the effectiveness of the combined use of skin needling and PRP application in acne scarring treatment. Twelve patients affected with rolling acne scars were enrolled. Each patient underwent 2 sessions of treatments, each consisting of skin needling followed by PRP application on the right side of the face and skin needling alone on the left side of the face. Digital photographs of all patients were taken. Photographic data were analyzed by using the Sign Test (α<.05). The study showed that the scars severity grade in all patients was greatly reduced on all of the face, but the improvement was more efficient on the side treated with both skin needling and PRP. Our study showed that the combined use of skin needling and PRP is more effective than skin needling alone in improving acne scars.
Objective To compare the efficacy and safety of dermaroller treatment with that of TCA CROSS in acne scars. Methods We selected thirty patients of atrophic acne scars for the study. Group I patients underwent four sessions of dermaroller therapy four weeks apart. Group II were treated with four sessions of TCA CROSS technique four weeks apart. Results After four sessions of dermaroller and TCA CROSS each, marked improvement was seen in 40% patients in the dermaroller group and in 60% patients in the CROSS group. Moderate improvement was seen in 40% patients in dermaroller group and in 26.6% patients in the CROSS group and mild improvement was seen in 20% patients in dermaroller group and 13.3% patients in the CROSS group. Side effects were mild and infrequent in both groups. Conclusion Both treatments are equally effective and safe for the treatment of acne scars.