Microneedling for acne scars

Acne is the most common skin condition among young adults between the age of 11 and 30 years.^1,2 Acne scarring can affect a person’s appearance and has been associated with a profound psychological impact on patients such as depression, poor self-esteem, and general social impairment. ³ Microneedling for acne scars is a non-invasive treatment option to improve the appearance of scarring with minimal side effects and shorter downtime.⁴

Atrophic acne scars are imbalanced indented scars that result when the skin is unable to regenerate tissue. These textural changes in the skin occur when there is a loss of collagen, tissue damage, and a severe inflammatory response that happens because of acne.^1,3 It can be challenging for dermatologists to treat acne scarring because many treatments are partially effective, and patients are often disappointed with the results.³

How does microneedling work?

Microneedling – also referred to as collagen induction therapy – involves repeatedly puncturing the skin with sterilized microneedles.⁵ Microneedling can be done with a manual tool or an automated device – several of which are FDA approved.⁶

A derma roller is a manual tool that is rolled back and forth on the skin to induce tiny lesions (pores) in the skin. The automated device allows the dermatologist to control the speed and depth of needle penetration.⁴

Treatment of atrophic scars with microneedling stimulates the body’s regenerative mechanisms.⁴ It activates a non-inflammatory wound healing process by triggering the production of collagen and the thickening of the skin.^4,7

Each micro lesion creates a localized injury without disrupting the skin’s epidermis, the outermost layer of the skin.⁴ Growth factors are generated in the skin and a healing cascade occurs, triggering the formation of new skin.⁵ Collagen deposition is a slow process that might take several months.³ Several microneedling sessions are typically performed, and final results often appear after 6 to 12 months.³

Who should not have microneedling?

Microneedling is not recommended for patients with active acne, even if they have areas with scars, because it might trigger infection.⁴ It is also not used for patients with collagen injections or any other injectable filler within the past six months.³

Research on microneedling for acne scars

Several clinical trials have investigated microneedling as a single treatment and its effects on atrophic acne scars. Research shows promising results and a low complication rate when compared to more invasive treatments.⁴

In a study of ten patients with different types of atrophic scars, microneedling treatment over a period of three months resulted in mild side effects, such as edema (swelling) and slight pain, and the desired improvement took several months to be achieved.⁸

In another study, 31 patients were treated weekly with a microneedling derma roller for three months.⁹ All patients reported significant improvements 1 to 2 months after the last session. These results were confirmed by an additional observational study of 120 patients with facial and non-facial scars after monthly microneedling treatments.¹⁰ Over 80% of patients had 50% to 75 % improvement and 65% of patients reported over 75% improvement.

Microneedling has shown noteworthy results when combined with other topical treatments such as glycolic acid peels (GA peels) or platelet-rich plasma (PRP).^3,11 The tiny pores that the needles create act as a channel to deliver the topical agent such as PRP and increase its absorption.⁷ A 2019 meta-analysis shows that patients who underwent a combination therapy of microneedling and PRP had a significant improvement than patients who had microneedling alone.¹¹ The release of PRP factors augments the effects of microneedling to promote tissue remodeling.¹²

In a study of 30 patients between the ages of 20 and 40 years, a combination of microneedling with GA peels resulted in significant improvement in skin texture, superficial and moderately deep acne scars, and reduction in post-acne pigmentation.¹³ Similar results were reported in patients with dark skin color where acne scarring is often further complicated by hyperpigmentation.¹⁴ Thirty-nine patients had significant improvement in both scars and pigmentation. Compared to other mainstream treatments (such as lasers and peelings), microneedling avoids the risk of pigmentation.⁴

Microneedling has been increasingly used over the past few years as a relatively simple, cost-effective, and well-tolerated procedure.⁵ Research demonstrates that microneedling is a promising and safe aesthetic treatment for acne scars, with moderate efficacy. ^{7, 10, 15} A major concern with microneedling studies is that clinical results often depend on the patients’ subjective estimate of changes post-treatment.¹¹ Most of the studies are observational and lacking statistical analysis.⁷

Further long-term studies with a larger sample size are needed to establish microneedling as an evidence-based treatment for clinical practice and determine the most effective process for the best results.¹⁶ There is also limited research on combination therapies with microneedling treatments such as a standardized protocol of PRP that specifies the concentration.¹² It is crucial that dermatologists match individual needs with the appropriate treatment, compare the efficacies and safety of different modalities with the patient, and discuss realistic expectations.³

References

1. Afzal FF, Ahmad S, Mehrose MY, et al. Efficacy Of Micro-Needling On Post Acne Scars. Journal of Ayub Medical College, Abbottabad : JAMC. 2019;31(3):336-339.
2. Levy MD, Gold MH. Acne scars—Use of needling devices. Dermatological reviews. 2020;1(5):154-162. doi:10.1002/der2.28
3. Bhargava S, Cunha PR, Lee J, Kroumpouzos G. Acne Scarring Management: Systematic Review and Evaluation of the Evidence. American journal of clinical dermatology. 2018;19(4):459-477. doi:10.1007/s40257-018-0358-5
4. Lisa R, Henk H, Ali P, Filip S, Stan M. Microneedling: Where do we stand now? A systematic review of the literature. Journal of plastic, reconstructive & aesthetic surgery. 2017;71(1):1-14. doi:10.1016/j.bjps.2017.06.006
5. Iriarte C, Awosika O, Rengifo-Pardo M, Ehrlich A. Review of applications of microneedling in dermatology. Clinical, cosmetic and investigational dermatology. 2017;10:289-298. doi:10.2147/CCID.S14245
6. FDA – https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/microneedling-devices
7. Harris AG, Naidoo C, Murrell DF. Skin needling as a treatment for acne scarring: An up-to-date review of the literature. International journal of women’s dermatology. 2015;1(2):77-81. doi:10.1016/j.ijwd.2015.03.004
8. El-Domyati M, Barakat M, Awad S, Medhat W, El-Fakahany H, Farag H. Microneedling Therapy for Atrophic Acne Scars: An Objective Evaluation. The Journal of clinical and aesthetic dermatology. 2015;8(7):36-42.
9. Minh PPT, Bich DD, Hai VNT, et al. Microneedling Therapy for Atrophic Acne Scar: Effectiveness and Safety in Vietnamese Patients. Open access Macedonian journal of medical sciences. 2019;7(2):293-297. doi:10.3889/oamjms.2019.098
10. Alster TS, Li MKY. Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up. Plastic and reconstructive surgery (1963). 2020;145(2):358-364. doi:10.1097/PRS.0000000000006462
11. Chang H-C, Sung C-W, Lin M-H. Combination Therapy With Microneedling and Platelet-Rich Plasma for Acne Scarring: A Systematic Review and Meta-analysis. Dermatologic surgery. 2020;46(8):1118-1122. doi:10.1097/DSS.0000000000002033
12. Schoenberg E, O’Connor M, Wang JV, Yang S, Saedi N. Microneedling and PRP for acne scars: A new tool in our arsenal. Journal of cosmetic dermatology. 2020;19(1):112-114. doi:10.1111/jocd.12988
13. Sharad J. Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. Journal of cosmetic dermatology. 2011;10(4):317-323. doi:10.1111/j.1473-2165.2011.00583.x
14. Al Qarqaz F, Al‐Yousef A. Skin microneedling for acne scars associated with pigmentation in patients with dark skin. Journal of cosmetic dermatology. 2018;17(3):390-395. doi:10.1111/jocd.12520
15. Mujahid N, Shareef F, Maymone MB., Vashi NA. Microneedling as a Treatment for Acne Scarring: A Systematic Review. Dermatologic surgery. 2020;46(1):86-92. doi:10.1097/DSS.0000000000002020
16. Juhasz MLW, Cohen JL. Microneedling for the Treatment of Scars: An Update for Clinicians. Clinical, cosmetic and investigational dermatology. 2020;13:997-1003. doi:10.2147/CCID.S267192
17. Image by BELEN LOPEZ from Pixabay