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Microneedling Advances and Widening Horizons
Microneedling Advances and Widening Horizons
54]
Review Article
Department of ABSTRACT
Dermatology and
Venereology, AIIMS, Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially
New Delhi, India introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including
acne scar, acne, post‑traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch
marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the
initial instrument, which was used for microneedling. This technique can be combined with other surgical
techniques to provide better results. In particular, it is a very safe technique for dark skin types, where risk of
postinflammatory pigmentation is very high with other techniques that damage the epidermis. In this review
article, we are updating on the different instruments now available for this procedure, and its efficacy when
performed alone or in combination with other techniques for various indications.
244 © 2016 Indian Dermatology Online Journal | Published by Wolters Kluwer - Medknow
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APPLICATIONS OF MICRONEEDLING IN
DERMATOLOGY
Table 1: Microneedling trials for skin rejuvenation (literature search after year 2010)
Author Year No. of patients Objective Outcome
Clementoni et al. [28]
2010 21 Photodynamic photorejuvenation of the 90% of patients judged clinical
face with a combination of microneedling, improvement to be greater than 50%
1 hour ALA incubation followed by red at 6 months compared to baseline
light and broadband‑pulsed light photography
Calderhead et al.[27] 2013 499 Multicentre study to evaluate efficacy of 80-89% overall improvement, 30-36%
microneedling fractional radiofrequency decrease in wrinkle size, 25-29% decrease
in wrinkle depth after 2-3 sessions
Seo et al.[29] 2013 15 Comparison of FMRF with and without Combination found to be better
stem cell medium
Lee et al.[26] 2014 25 To study efficacy of microneedling with Combination better than microneedling
human stem cell conditioned medium alone (P<0.05)
El‑Domyati et al.[25] 2015 10 To study objective and histological Increased collagen I, III, VII, and
efficacy of microneedling tropoelastin (P<0.05)
a b a
c d b
e f
Figure 4: Pre (a, c, e) and post (b, d, f) treatment photographs of c
post‑acne atrophic scar patients after 4 sittings of microneedling done Figure 5: Post‑burn scar on the thigh of 1 year duration treated
1 month apart with a combination of microneedling and laser (a) Baseline
photograph; (b). Scar showing improvement after 3 fortnightly sessions
of microneedling; (c) Further improvement in scar following 1 session of
Fraxel laser RE: STORE SR 1500nm (Solta Medical, USA) with following
parameters: 70 mj beam energy, 20% density, 8 passes. (Courtesy:
Dr Arshdeep, Consultant Dermatologist, Kubba Skin Clinic, New Delhi)
a b
Table 2: Studies using miconeedling for facial post acne atrophic scars (literature search after year 2010)
Author Year No. of patients Objective Outcome
Sharad[30] 2011 60 Comparison of microneedling with and Combination found to be better
without glycolic acid peels
Dogra et al.[31] 2014 36 To study efficacy in atrophic facial acne scars Mean improvement of 50-75% from baseline
Chawla et al.[32] 2014 30 Microneedling with PRP vs Microneedling PRP combination found better (P=0.01)
with vitamin C
Chandrashekar et al.[24] 2014 31 Evaluation of Microneedling Fractional Improvement-58% moderate and 29% minimal
Radiofrequency Device Adverse effects-mild erythema, postinflammatory
hyperpigmentation, track marks of the device
Gadkari et al.[33] 2014 30 Comparison of subcision with dermaroller Cryorolling better than microneedling
vs. subcision with cryoroller
Fabbrocini et al.[34] 2014 60 To analyze efficacy in different skin Significant reduction in scars (P<0.05) in all
phototypes phototypes without dyspigmentation in any,
31% reduction in skin irregularity
Hassan[35] 2015 70 Comparison of microneedling with and 100% efficacy with combination, 77% with
without subcision microneedling alone
El‑Domyati et. al.[36] 2015 10 To assess objective and histological efficacy Improvement seen, increased collagen (P<0.05)
Pandey et al. [37]
2015 30 To assess efficacy of microneedling alone Mean 80% improvement
Puri[38] 2015 30 Comparison of microneedling with TCA CROSS Comparable results
Cachafeiro et al.[39] 2016 46 Comparison of Nonablative Fractional Comparable results
Erbium Laser 1340 nm and Microneedling
Table 3: Microneedling for non‑acne scar treatment (literature search after year 2010)
Indication Author Year No. of patients Objective Outcome
Burn scars Kim et al. [40]
2010 25 To study the effectiveness of Dermastamp Improvement seen (P<0.05)
Burn scars Aust et al.[15] 2010 16 To study efficacy of microneedling 80% improvement in scarring,
in reducing post‑burn scars without 45% thickened stratum spinosum,
damaging epidermis normal rete ridges after 1 year
Burn scars Sofanov[41] 2011 1 Good improvement
Varicella scars Costa et al.[42] 2014 1 Assessment of efficacy Significant improvement
Table 4: Fractional microneedling radiofrequency trials for acne vulgaris (literature search after year 2010)
Indication Author Year No. of patients Objective Outcome
Acne vulgaris Lee et al. [43]
2012 18 To assess the efficacy of FMRF Reduced number of lesions
Acne vulgaris Lee et al.[44] 2013 20 To assess the efficacy of FMRF 70-80% reduced sebum
Acne vulgaris Kim et al.[45] 2014 25 Treatment of acne vulgaris 76% reduction in acne, 37%
with FMRF reduction in sebum (P<0.05)
Acne and acne scars Min et al.[46] 2015 20 Comparison of FMRF with Superior efficacy of FMRF
bipolar radiofrequency
Table 5: Microneedling trials for alopecia (literature search after year 2010)
Indication Author Year No. of patients Objective Outcome
Androgenic alopecia Dhurat et al.[47] 2013 100 Comparison of topical minoxidil with Combination
and without microneedling better (P=0.039)
Alopecia areata Chandrashekar et al.[50] 2014 2 To study the efficacy of microneedling Response seen
with topical triamcinolone acetonide
Androgenic alopecia Dhurat et al.[48] 2015 4 To study efficacy in patients not Up to 75%
responding to minoxidil and finasteride improvement
Patterned hair loss Farid et al.[49] 2016 40 Comparison of PRP microneedling Minoxidil
with topical 5% minoxidil remains better
Table 6: Microneedling trials for pigmentation (melasma and periorbital hypermelanosis) (literature search after
year 2010)
Indication Author Year No. of patients Objective Outcome
Melasma Fabbrocini et al.[51] 2011 20 Comparison of combined skin needling Reduction in MASI score more on
with depigmenting serum and combination side compared to serum
depigmenting serum alone alone (P<0.001)
Periorbital Sahni et al.[20] 2013 1 To study the efficacy of Dermafrac 75-90% improvement
hypermelanosis
Melasma Budamakuntla 2013 60 Comparison of tranexamic acid 44.41% reduction in MASI score in
et al.[52] microinjections against tranexamic microneedling group compared to
acid with microneedling 35.72% reduction with microinjections
Melasma Lima[53] 2015 22 To evaluate efficacy in recalcitrant cases Improvement seen
Periorbital Markantoni 2015 13 Combination of microneedling and Improvement in 92.3% patients
hypermelanosis et al.[54] 10% TCA peels
Periorbital Kontochistopoulos 2016 13 Combination of microneedling and Improvement seen
hypermelanosis et al.[55] 10% TCA peels
Table 7: Microneedling trials for miscellaneous indications (literature search after year 2010)
Indication Author Year No. of patients Objective Outcome
Actinic keratosis Bencini et al.[56] 2012 12 To study efficacy of microneedling 83% showed complete response
with topical PDT
Acinic keratosis and Torezan et al.[57] 2013 10 Comparison of PDT with and without Combination better (P=0.004)
photodamage microneedling
Primary axillary Kim et al.[58] 2013 20 To study efficacy of FMRF Reduced number and size of
hyperhidrosis sweat glands
Striae rubra Sanad et al.[59] 2015 30 Comparison of microneedling with and Combination better (P<0.05)
without trichloroacetic acid peeling
Rosacea Park et al.[60] 2015 To study efficacy of microneedling 25-58% improvement
fractional radiofrequency
Post‑acne erythema Min et al.[61] 2015 25 FMRF in post inflammatory acne Improvement seen (P<0.05)
erythema
less efficacious in some types of scars such as pitted scars, understand that their names and initials will not be published
linear scars, and deep boxcar scars. However, combining other and due efforts will be made to conceal their identity, but
surgical procedures to microneedling can improve its results. anonymity cannot be guaranteed.
Certain adverse events are also known with the procedure, the Financial support and sponsorship
common ones being potential erythema and irritation which Nil.
usually subside within a few hours. Other events noted are
post‑inflammatory hyperpigmentation, aggravation of acne Conflicts of interest
and reactivation of herpes, systemic hypersensitivity, allergic There are no conflicts of interest.
granulomatous reactions and local infections following the use
of a nonsterile instrument.[6,9,17,22] Allergic contact dermatitis
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