Received: 22 July 2020 Revised: 23 August 2020 Accepted: 30 August 2020

DOI: 10.1111/dth.14267

REVIEW ARTICLE

Micro needling: A novel therapeutic approach for androgenetic

alopecia, A Review of Literature

Sonia Sofia Ocampo-Garza1 | Gabriella Fabbrocini2 |

1 2
Jorge Ocampo-Candiani | Eleonora Cinelli | Alessia Villani2

1
Dermatology Department, Univeristy
Hospital ¨Dr. José Eleuterio González¨, Abstract
Universidad Autónoma de Nuevo León, Androgenetic alopecia (AGA) is an androgen-dependent hereditary trait resulting in
Monterrey, Mexico
2 hair miniaturization. It is the most common type of alopecia in men and women. Dur-
Dermatology Unit, Department of Clinical
Medicine and Surgery, University of Naples ing the last years, multiple treatment modalities have been studied, but only topical
Federico II, Naples, Italy
minoxidil and finasteride have been approved by the US Food and Drug Administra-
Correspondence tion. Microneedling (MN) is a minimally invasive technique that induces collagen for-
Alessia Villani, Via Pansini, 5- 80131 Napoli,
mation, as well as growth factors production and neovascularization. Even though
Dermatology Unit, Department of Clinical
Medicine and Surgery, University of Naples not many studies of MN in alopecia have been performed, it remains a favorable
Federico II, Naples, Italy.
treatment modality; however, no standardized protocol for MN in hair loss has been
Email: ali.vil@hotmail.it
proposed yet. Current evidence is not sufficient to allow a direct comparison with
other therapies, but it shows promises to increase hair density, thickness, and quality
of hair, especially when combined with other treatments or when used as a drug
delivery system. This article aims to summarize the available literature regarding the
use of MN alone or associated with other therapies for the treatment of androge-
netic alopecia.

KEYWORDS

androgenetic alopecia, collagen induction therapy, dermaroller, hair loss, microneedling,

needling dermabrasion, pattern hair loss

1 | I N T RO DU CT I O N rich plasma (PRP), microneedling (MN) and low-level laser therapy

Androgenetic alopecia is the most common hair loss disorder affecting
both male and female sex. It occurs at any age, usually following
puberty with an incidence increasing with age. AGA is characterized
by progressive miniaturization of the hair follicle leading to vellus
transformation of terminal hair resulting in hair loss with pattern dis-
tribution.1,2 This condition represents not only a cosmetic problem
but it could frequently cause impairment in patients' quality of life,
representing a high-risk factor for depression, anxiety, and even sui-
cide.3,4 The aim of treatment in case of AGA is to inhibit hair miniatur-
ization and stabilize hair loss.5,6 Although minoxidil7 and finasteride8
represent the only two US Food and Drug Administration (FDA)-
approved medications for hair loss treatment, other non-surgical ther-
apies have been used, including dutasteride, spironolactone, platelet-
(LLLT).9 MN is a minimally invasive technique consisting of the use of
sterile microneedles for repetitive cutaneous puncturing.10 The first
concept of MN was described in 1995 by Orentreich and Orentreich
who suggested the so-called “Subcutaneous incisionless (subcision)
surgery” for skin depressions (scars and wrinkles).11 Almost 20 years
later, the first recent MN device was available.12 The procedure is
based on “collagen induction” following these repetitive
10
microtraumas. Microneedling is proposed to increase hair regrowth;
in particular, the needling-induced damage leads to growth factors
release (TGF-alpha, TGF-beta, and platelet-derived growth factor
[PDGF]) by platelets and neutrophils.11 Subsequently, fibroblasts pro-
vide collagen and elastin production in the papillary dermis.13 This
procedure has demonstrated efficacy in the treatment of hair loss, in
particular when combined with other treatments.9,10

Dermatologic Therapy. 2020;e14267. wileyonlinelibrary.com/journal/dth © 2020 Wiley Periodicals LLC. 1 of 7

https://doi.org/10.1111/dth.14267
2 of 7
The purpose of this review is to provide a complete overview on
the use of skin needling as non-pharmacological treatment for AGA,
used as single-therapy or in association with other treatments.
2 | MATERIALS AND METHODS
We searched for literature regarding skin needling as treatment for
AGA in the following databases through 30 April 2020: PubMed,
Embase, The Cochrane Library, Google Scholar, EBSCO, and Scopus.
The following key words were used: “needling”, “microneedling”,
“micro needling”, “needling dermabrasion”, “and collagen induction
therapy”. All terms are used in medical literature to describe skin nee-
dling and were combined with the terms “alopecia”, “hair loss”, “and
androgenetic alopecia”. All the published articles (case report, case
series, prospective and retrospective studies, clinical trials, reviews,
guidelines, and consensus) were reviewed. Also, references of the
included studies were examined to include the ones that could have
been missed. Treatment protocols that included microneedling alone,
with topical products, and fractional microneedling radiofrequency
were accepted.
A total of 35 articles were found and reviewed. All the papers
used the word “microneedling” when referring to the technique. A
summary of the included articles and protocols is shown in Table 1.
3 | D E V I C E S A N D T Y P E S OF M N
Microneedles are micro-scale needles with a typical length from 25 to
2000 μm, used to disrupt the stratum corneum of the epidermis and
14
to deliver drugs thanks to micro-scale channels. Microneedles can
reach a skin depth of 70 to 200 mm. Most of the MN devices derive
from the two principal ones, which are Dermaroller (Dermaroller
Deutschland GmbH, Wolfenbuettel, Germany)11 and the Dermapen
(Dermapen, Salt Lake City, UT). The first one is a 12-cm long hand-
held device composed of a cylindrical roller with a total of 192 fine
microneedles on 8 rows and 24 circular arrays.13 The needles usually
have a 0.5 to 3 mm length and a 0.1 to 0.25 mm diameter and they
are made by reactive ion etching techniques of silicon or medical-
grade stainless steel. When 2-mm long and 0.07-mm large micro-
needles are applied on the same area for 15 times, nearly 250 holes
per cm2 in the papillary dermis are made.15 Other models such as the
Beauty Mouse (Dermaroller Deutschland GmbH) were designed for
home use, too. 10
Dermapen is, as the name says, a “pen-like” electri-
cally powered handle device with 9 to 12 needles that has two speed
mode (high: 700 cycles/min; low: 412/min).10,16
Recently, new modalities of MN combine the mechanical punc-
turing activity with other additional technology.10 For example, in
fractional radiofrequency MN (FRM) the MN technique uses the
needles' tip to release radiofrequency, thus changing the structure of
dermal constituents. Others integrate microdermabrasion light emit-
ting diode (LED) light, and simultaneous dermal serum infusion
(DermaFrac (Genesis Biosystems, Lewisville, TX), or LED light alone
OCAMPO-GARZA ET AL.
(LED MN devices). Lastly, MN has also been used as transdermal
delivery system, as topical drug applications can either follow skin
puncturing or be delivered through hollow needles. Different types of
drug delivery have been designed according to the type of micro-
needles: solid one for the “poke and patch” approach; coated solid
ones for “coat and poke”; polymeric microneedles for “poke and
release”; and hollow ones for “poke and flow”.14
4 | P RO C E D U R E F O R M I C R O N E E D LI NG I N
ALOPECIA
The procedure normally takes between 10 and 25 minutes depending
on the Doctor's expertise and practice. For patchy alopecia or Nor-
wood Hamilton 5 to 7 alopecia the technique is usually performed as
follows. Typically a topical anesthetic cream, containing lidocaine and
prilocaine/tetracaine is applied 15 to 45 minutes prior.17 Once the
anesthetic cream has been effective, the area should be cleaned using
an ethanol or betadine solution for aseptic purposes. A pen or a roller
can be used. In case a pen is used, the needles should be adapted to
the desired level. The area should be treated with linear passes, lifting
the pen with each pass. Up to 3 passes can be made over the same
area. If a roller is used the physician should maneuver over the treated
area in vertical, horizontal, and diagonal passes between 15 and
20 times. The desired endpoint is mild erythema or pinpoints bleeding.
After blood wash-off with saline solution a topical antibiotic should be
applied. Once the procedure is finished a hair growth promoting topi-
cal solution can be rubbed; or if treated in conjunction with minoxidil
the patient is assessed to wait for 24 hours before applying it.18 The
procedure can be repeated biweekly to monthly.17
However, the above-mentioned technique is not suitable for
other type of alopecia or patients, such as, female suffering from
Ludwig 1 FPHL with long hair. Up to date, no standardized procedure
has been defined, thus this lack might affect treatment success.18
The most common side effects are erythema or pinpoint bleeding,
which are expected, seborrheic dermatitis, itching, infection, granulo-
matous reactions, or lymph node enlargement.19
5 | M I C R O N E E D LI N G F O R
ANDROGENETIC ALOPECIA
Microneedling for AGA has been used either alone,20 with saline solu-
tion, as a drug delivery system with minoxidil,19-24 or with growth fac-
tors and PRP.25-28
5.1 | Microneedling
In 2019 Starace et al. enrolled 50 patients; 36 females (29 with AGA
and 7 with telogen effluvium), and 14 males with AGA.20 Three ses-
sions of microneedling at an interval of 4 weeks, over a period of
6 months were made. After the 6 months, all patients reported a
TABLE 1 Summary of available evidence on microneedling for androgenetic alopecia

Author Year Patients (N) Protocol Cases Controls Results Adverse effects
26
OCAMPO-GARZA ET AL.

Lee et al. 2012 11 women 5-week, split-scalp, Growth factor solution on Normal saline on other half Increase of >10% in hair No adverse reactions
AGA investigator blinded, one half scalp with MN. 5 with MN shaft count compared
placebo-controlled study weekly treatments with baseline in treated
side (P < .05).
Dhurat et al.23 2013 100 men 12-week randomized, Weekly MN, 1 ml twice 1 ml twice daily 5% Hair count change 91.4 No significant adverse
AGA comparative, evaluator daily 5% minoxidil lotion minoxidil lotion cases vs 22.2 controls effects
blinded study (P = .039)
Dhurat et al.20 2015 4 men AGA 34-week, case series. Weekly MN 4 sessions and N/A 3 patients >75% N/A
fortnightly for 11 sessions improvement and 1
(15 sessions). Continued patient >50%
existent finasteride or improvement on patients'
minoxidil treatment subjective hair growth
Farid et al.25 2016 40 AGA 28-week, evaluator blinded, PRP and MN per month for 1 ml twice daily 5% Significant increase in hair 30% minoxidil group scalp
two-arm randomized 6 sessions minoxidil lotion count in both groups irritation, facial
comparative study (P = .016 in PRP group vs hypertrichosis in 5 women
P < .001 in minoxidil and headache in a single
group). Minoxidil worked case. PRP group pain
significantly quicker. during injection and
headache in 30%
Jha et al.28 2018 20 AGA N/A PRP with MN at 3-week Conventional treatment New hair growth was Mild pain
interval for 3 months (minoxidil or finasteride) noticed after the first
for a minimum of 1 year. session. Patient
satisfaction was >75% in
18 patients.
Yu et al.24 2018 19 men 20-week, Split-scalp, 1 mL twice daily 5% 1 mL twice daily 5% Combined therapy side had Well tolerated pain during
AGA evaluator blinded, minoxidil lotion and 5 minoxidil lotion in other a higher improvement in FRM, mild erythema and
randomized study sessions of FRM at half scalp hair count (P = .01) and pinpoint bleeding, and
4-week intervals in half hair thickness (P = .02) dandruff in 8 patients.
scalp
Jha et al.27 2019 93 men 12-week, three-arm B. 1 ml twice daily 5% A. 1 ml twice daily 5% Hair pull test was negative Transient pain in group B
AGA comparative study minoxidil lotion and PRP minoxidil lotion in 27 patients of group C, and C
(4 sessions, 3-week 20 patients of group B,
interval) and 15 patients of group
C. 1 ml twice daily 5% A. PRP with MN is better
minoxidil lotion, PRP, than minoxidil or PRP
and MN alone.

(Continues)
3 of 7
 4 of 7 OCAMPO-GARZA ET AL.

reduction in hair loss, hair density improvement, and hair shaft thick-

lymph nodes, and eczema

cervical lymph nodes in 8

infection, enlargement of
No serious adverse effects.
ening. All patients showed increase in frontal median density by

itching, increased scurf,

Pain during treatment,

enlargement of lateral

seborrheic dermatitis,
36.64% and a vertex median density improvement of 35.1%. The

mild erythema, and

10 adverse events:
vellus relative change decreased in both areas, and the medium hair
Adverse effects

diameter increased in frontal and vertex areas (9.75% and 9.08%,

patients.
respectively).

N/A 5.2 | Microneedling and minoxidil

group 1, 23.4cm2 in group

2, and 38.3cm2 in group 3
vertex areas (9.75% and
Increase in medium hair

density was 18.8cm2 in

Improvement in total hair
diameter in frontal and
vertex median density

displayed a significant
diameter significantly

Dhurat and colleagues carried out a study on the use of microneedling

(36.64% and 35.1%)
Increase in frontal and

increased. Pull test

Hair density and hair

combined with minoxidil lotion in men affected by mild to moderate

(Norwood-Hamilton III vertex or IV grade) AGA.23 A total of
reduction.

94 patients received either weekly microneedling with twice daily

9.08%).
Results

1 ml 5% minoxidil lotion (treatment group) or minoxidil lotion alone

(1 ml, 5%, twice daily; control group) for 12 weeks. For the micro-
needling protocol, the 1.5 mm-needles dermaroller was applied on the
scalp previously treated with betadine and normal saline solution,
tracking multiple movement trajectories (longitudinal, vertical, and
1.5% minoxidil lotion

diagonal) until the skin showed mild erythema.23 Topical minoxidil use
Abbreviations: AGA, androgenetic alopecia; FRM, fractional radiofrequency microneedling; MN, microneedling; TE, telogen effluvium.

was not recommended the day of microneedling and for 24 hours

twice daily.

later. The treatment group showed statistically significant superior

Controls

results in all the efficacy outcomes: hair counts, patient and investiga-
N/A

N/A

tor assessment. The most striking datum was the mean change in hair
count at week 12, as patients who received microneedling had 91.4
2. Local electrodynamic MN.

vs 22.2 in the control group.

3. Local electrodynamic MN
carboxytherapy monthly
Minoxidil 20% by MN and

plus 5% minoxidil twice

Later, Dhurat and Mathapati investigated the use of micro-

3 treatments of MN at
intervals of 4 weeks

needling as additional therapy along with finasteride and minoxidil on

12 sessions every

a longer period (6 months).21 The study involved four patients with

for 4 sessions

stable AGA, but without new hair growth in spite of the existing topi-
2 weeks.

cal (minoxidil) and systemic (finasteride) treatment. The dermaroller

daily
Cases

application was the same as the one of Dhurat's previous work.23

Microneedling sessions lasted about 20 to 25 minutes and the first
4 were scheduled every week, whereas the following 11 fortnightly.21
24-week, pilot study, open-

28-week, not randomized,

comparative, three-arm

All the participants had a good response with a moderate to great

label, not randomized,

24-week, randomized,

increase in the evaluation scale and patients' satisfaction was high,

single-group study

single group study

evaluator blinded,

too. The achieved response was maintained also in the following

18 months.
More recently, Bao et al. conducted a randomized trial where the
Protocol

study

topical minoxidil was used in combination with electrodynamic micro-

needling.19 Electrodynamic microneedling consists of needles oscillat-
ing at a high frequency, thus decreasing pain and increasing drug
(5 women
men AGA
Patients (N)

and 7 TE)
(29 AGA
36 women

delivery.19 A total of 60 patients with Norwood-Hamilton type III-VI

9 patients
and 14

60 male
and 4
men)
AGA

AGA

AGA were recruited to either minoxidil alone (5%, 1 ml, twice daily;
group 1), microneedling alone (group 2), or microneedling and minoxi-
dil solution (group 3). Microneedling was applied every 2 weeks for a
2019

2020

2020
Year
(Continued)

total of 12 sessions. At the end of the study (week 24) the total hair
density was significantly different in the three groups (18.8/cm2 in
Nilforooshzadeh

group 1, 23.4/cm2 in group 2, and 38.3/cm2 in group 3), but on the

Starace et al.19

other hand the toxicity profile was not. Moderate improvement was
Bao et al.22
TABLE 1

et al.21

observed in 44.4% (8/18) of the patients in group 1, 27.8% (5/18) of

Author

the patients in group 2, and 60% (12/20) of the patients in group

3, respectively. The authors found no patient with worsening of AGA
OCAMPO-GARZA ET AL.
after the treatments. Regarding toxicity, a total of 10 adverse events
were reported. In group 1, three patients reported seborrheic dermati-
tis, itching, and eczema; in group 2 other three patients experienced
increased scurf, infection, and enlargement of cervical or posterior
auricular lymph nodes. Four of twenty patients from group 3 pres-
ented seborrheic dermatitis (1/4), increased scurf (1/4), and enlarge-
ment of cervical or posterior auricular lymph nodes (2/4).
A recently new technique for minimally invasive procedure is
fractional radiofrequency microneedling (FRM).24 The device works
with insulated microneedles to deliver bipolar radiofrequency, thus
generating a controlled thermal zone setting the depth of the tissue.
Yu and colleagues used FRM in combination with minoxidil to treat
male pattern hair loss (MPHL) in 19 patients.24 Patients were treated
on one-half of the scalp with 5% topical minoxidil twice daily, and on
the other half FRM at a 1.5-mm depth was applied, too. FRM sessions
were performed 5 times every 4 weeks. At the end of the study the
FRM-treated side had a higher mean hair count compared with mon-
otherapy from baseline (respectively: at baseline 44.12 ± 21.58 to
73.14 ± 25.45 at 5 months; 46.22 ± 18.77 to 63.21 ± 19.22; P = .01)
with thicker hair (respectively: at baseline 53 ± 13 μm to 71 ± 15 μm;
52 ± 16 μm to 66 ± 14 μm; P = .02).
The most recent study on minoxidil combined with microneedling
is a case series by Nilforooshzadeh et al. who added carboxytherapy
mediated by needling in the treatment protocol.22 In fact, 9 patients
(men and women) with AGA received first of all carboxytherapy by
needling (gage 27), and then 5% topical minoxidil (20%) by micro-
needling in the same area. A good response was noticed in hair diame-
ter increase particularly after 3 months of treatment from baseline
with a significant difference between men and women (91.9 ± 2.3 μ
vs 53.2 ± 2.5 μ in female patients and 74.5 ± 2.1 μ vs 46.5 ± 2 μ in
male patients). Also, hair density improved from baseline in both
groups with a significantly higher increase in women compared with
men (respectively at month 3, 1 vs before treatment: 249 ± 3 and
178 ± 5 vs 110 ± 3 in female patients and 217 ± 3 and 145 ± 5 vs
90 ± 3 in male patients).
5.3 | Microneedling + growth factors and PRP
Lee et al. reported results from a study on women with female pattern
hair loss (FPHL) in a grade I of Ludwig.26 The 11 participants received
on one side of the scalp a Growth factor solution (SGF57; Mediway,
Seoul, Korea) and on the other simple normal saline. Afterwards, both
sides were treated by microneedling, for a total of five treatments
every week. The nine microneedles were 33-G, reaching a 0.5-mm
depth with a 1500 rpm speed. The authors noticed differences in the
hair shaft comparing the two sides, with an increase higher than 10%
on the treated one and statistically significant from week 2 to 5. More-
over, patients' satisfaction had an upward trend for the treated side,
but not for the control. No adverse reactions were noticed.
Other subsequent studies focused on the Platelet-rich plasma
(PRP) combined with microneedling.25,29 PRP is prepared through
released platelet-derived growth factors from activated platelets by
5 of 7
adding either calcium chloride or thrombin before or after PRP
injection.30
In the first study carried out on 2016, Farid and colleagues evalu-
ated 40 patients who received either PRP with microneedling or
minoxidil lotion (5%, 1 ml, twice daily) for 6 months.25 The PRP group
was treated with 1 ml PRP scalp mesotherapy and 1 ml PRP with
microneedling in six monthly sessions. The dermaroller was a manual
0.5 mm-needle device that was passed in multidirectional ways on the
same area until the appearance of mild erythema. The microneedling
was performed twice in the same session (one after mesotherapy and
another one after having sprayed another 1 ml of PRP). Results
showed comparable tolerability and efficacy for both treatments,
regarding hair density, alopecia grade, and patients' satisfaction. The
only difference was reported for the timing of the efficacy, as minoxi-
dil had a faster action onset. Thus, the authors suggest PRP with
microneedling as a second-line treatment option.
PRP and microneedling use was reported also in a 10-case series
of Sasaki.29 The author underlined how 5 ml (on average) of PRP per
session with a microneedling of 0.5 to 2.5-mm depth, improved hair
growth in a 12-month period. In fact, the good results were testified
by an average hair count raise to 133.6 after treatment (vs 88.3 at
baseline; 10 mm evaluated area).
In 2018, Jha et al. evaluated the efficacy of the same therapeutic
scheme above-mentioned (PRP and microneedling) as adjuvant ther-
apy to minoxidil in 93 patients.27 Here the participants were divided
in 3 groups: group A/control group (minoxidil 5% lotion twice daily),
group B (PRP and minoxidil), and group C (minoxidil, PRP, and micro-
needling). PRP was applied every 3 weeks for 4 sessions. The group C
had a significantly higher number of negative pull test compared with
both group B and A (respectively: 87.1%, P < .01; 64.5%, P < .05;
48.4%), and terminal-to-vellus hair ratio. A higher number of patients
with hair growth were found in group C compared with B and A
(respectively: 26/31; 17/31; 10/31). Moreover, patients' assessment
(satisfaction score) had a statistically significant difference in the
3 groups.
5.4 | Other techniques
A recent suggested study protocol described in 2019, by da Silvera
and colleagues aims to verify if the use of 660 nm red laser photo-
biomodulation combined with microneedling will increase the capillary
density in female pattern hair loss.31 They report a randomized, dou-
ble blind trial where 66 female patients with FPHL received G1—
microneedling with 0.5 mm needles and a 660 nm red laser photo-
biomodulation sham (a beep will be triggered for the laser simulation);
G2—660 nm red laser photobiomodulation and a microneedling sham
(pen at 0.0 mm, without touching the skin, just simulating the move-
ments in the intervention); and G3—microneedling with 0.5 mm
needles + 660 nm red laser photobiomodulation (ie, everything will
work, there will be no sham treatments involved, allowing the blind-
ness of the participant). They expect to find a difference in growth
rates, density, and diameter; as well as in anagen/telogen ratio.31
6 of 7
6 | DISCUSSION
The use of ablative treatments to stimulate and remodel collagen has
been long utilized in Dermatology. Microneedling or percutaneous
collagen induction is a new treatment modality that consists of creat-
ing multiple micropuntures, long enough to reach the dermis. This pro-
cess causes bleeding, triggering an inflammatory stimulus resulting in
collagen production. When the cutaneous barrier loses its integrity
cytokines are released (interleukin-1α, interleukin-8, inteleukin-6,
TNF-α, and GM-CSF), with vasodilation and migration of
keratinocytes. 32
Transforming growth factor α and β, platelet-derived,
fibroblast, epidermal, and vascular endothelial growth factors, as well
as Wnt proteins, and β-catenin signaling pathways are considered to
be involved33; modulating the hair cycle and stimulating the dermal
34
papilla with consequent hair growth. This technique can also be
used as an effective delivery system for cell fragments, peptides, cos-
meceutical, or medications.29
The procedure involves multiple, repeated, sequential movements
of a roller or pen with firm pressure until pinpoint bleeding or ery-
thema is visible.35 There is no standard procedure for microneedling
in hair loss. Normally a 0.5 to 2.5-mm-length needle is used, but to
date no clear evidence on depth has been stablished.33 Sasaki et al.
excised pre-auricular skin of patients undergoing facelift to determine
actual depth of tissue penetration and the presence of pigment parti-
cles on histological examination.29 They found that needle penetra-
tion closely matched settings when 1 mm-depth needles where used,
but found it to be less consistent when setting from 1.5 to 2.5 mm
was applied. The optimal time for PRP and pigment particles to go
down a 1 mm micro-channel was between 5 and 30 minutes after the
MN was performed. Further studies including scalp skin could help us
determine the exact parameters for microneedling in hair loss.
7 | C O N CL U S I O N
Microneedling has shown many advantages; it is a fast, easy, and inex-
pensive procedure. It can be performed with topical anesthesia with
little discomfort and patients are able to continue their normal lives.
Also, MN can be combined with other procedures or medications,16
and has proven effectiveness for patients with AGA when combined
with minoxidil, growth factors, or PRP. MN can be used in patients
that do not want or cannot take systemic treatments, or who have
been unresponsive to other therapies.
MN succeeded to deliver results that could complement and even
in some cases replace more invasive or time-consuming therapeutic
regimens with few or no side effects.
Several points should be considered for future studies. No clear
needle length has been established; it should be long enough to pene-
trate through the cutaneous barrier for enhancing drug delivery or
stimulation, but short enough to produce minimal pain and skin
injury.33
Studies using less needle length generally showed less promising
results than those utilizing longer ones. However, more qualitative
OCAMPO-GARZA ET AL.
randomized controlled studies with larger study population should be
made to define a standardized protocol; including frequency of treat-
ment, depth of penetration, and optimal time for drug application
after MN.
CONFLIC T OF INT ER E ST
Sonia Sofia Ocampo-Garza, Gabriella Fabbrocini, Jorge Ocampo-
Candiani, Eleonora Cinelli, and Alessia Villani have nothing to disclose.
All named authors meet the International Committee of Medical Jour-
nal Editors (ICMJE) criteria for authorship for this manuscript, take
responsibility for the integrity of the work as a whole, and have given
final approval to the version to be published.
ET HICS S TAT E MENT
This article is based on previously conducted studies and does not
contain human participants or animals performed by any of the
authors.
DATA AVAILABILITY STAT EMEN T
Data were searched in the following databases: PubMed, Embase,
The Cochrane Library, Google Scholar, EBSCO and Scopus. Data are
available at the corresponding references reported in the text.
OR CID
Sonia Sofia Ocampo-Garza https://orcid.org/0000-0002-0508-
5117
Gabriella Fabbrocini https://orcid.org/0000-0002-0064-1874
Jorge Ocampo-Candiani https://orcid.org/0000-0002-0213-0031
Eleonora Cinelli https://orcid.org/0000-0003-3046-5493
Alessia Villani https://orcid.org/0000-0001-6430-268X
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How to cite this article: Ocampo-Garza SS, Fabbrocini G,
Ocampo-Candiani J, Cinelli E, Villani A. Micro needling: A
novel therapeutic approach for androgenetic alopecia, A
Review of Literature. Dermatologic Therapy. 2020;e14267.
https://doi.org/10.1111/dth.14267