Tuesday, May 17, 2022

Efficacy, Side Effects, and More

  • Microneedling is a cosmetic procedure that involves repeatedly puncturing the skin with microneedles to create tiny wounds that trigger the body’s natural healing process
  • This prompts skin cell turnover to lighten pigmentation and remodels the skin by boosting collagen and elastin production
  • Microneedling is a minimally invasive procedure that is safe for all skin types and tones 
  • This procedure should be avoided by those with a chronic skin condition such as acne, any skin infection or if prone to scarring

Microneedling is a professional treatment for a number of skin concerns such as skin rejuvenation, acne scars, enlarged pores and melasma. Hyperpigmentation refers to dark spots or pigmented patches of skin that develop due to a variety of factors. With microneedling, hyperpigmentation can be effectively treated by breaking up the pigment beneath the skin’s surface.

How Can Microneedling Treat Hyperpigmentation?

Hyperpigmentation refers to spots or patches of skin that are darker than the surrounding area. They develop due to several factors including sun exposure, hormonal fluctuations, inflammation, and with age. 

Melanocytes within skin cells produce melanin which is responsible for providing skin its color. When overproduction occurs, excess melanin accumulates and forms hyperpigmented patches.  

Microneedling involves piercing the skin with small sterile needles to produce a controlled skin injury. This triggers the skin’s wound-healing process which prompts skin cell turnover and allows fresh, new cells to replace damaged ones. At the same time, it boosts collagen and elastin production to remodel skin by altering tissue formation.

Does it Work?

Although there are a paucity of studies examining microneedling and hyperpigmentation, it has been determined to be a viable treatment for several reasons. In addition to showing promise as a skin-lightening solution, it is well-tolerated among all skin tones, including skin of color.

Additionally, it has been studied as one part of combination therapy that includes transdermal drug delivery. This involves microneedling the skin and then applying a topical medication to allow for better absorption to achieve better results.  

These results were clearly demonstrated in one study on melasma, a difficult-to-treat pigment disorder. Researchers examined patients treated with combined skin needling and depigmenting serum on one side of the face versus depigmenting serum alone. The side with combined treatment was significantly improved compared to the single treatment. 

How many sessions you will need will depend on your skin concern and its severity. As an example, 3–6 sessions may be effective to treat hyperpigmentation; for melasma, 2 sessions have been demonstrated to decrease pigmentation and increase collagen levels.

Melasma

Melasma is a chronic skin disorder that causes brown or gray-brown patches of discolored skin. It is notoriously difficult to treat, and follows a sequence of relapse and repeat, however there is strong evidence supporting microneedling as an effective treatment for this condition

In one small study that administered 2 sessions of microneedling, patients reported 100% satisfaction with their results. One conclusion researchers reached was that microneedling used without the addition of topical solutions can effectively lighten the skin of patients with melasma. 

For the most part, microneedling is used as an adjuvant to increase the efficacy of other agents.   

In a review of studies that combined microneedling with other topical treatments such a tranexamic acid, vitamin C, nonhydroquinone and hydroquinone-based depigmenting agents, the combination therapy provided greater results than topical therapy alone. 

Periorbital hyperpigmentation

Periorbital hyperpigmentation, also known as periocular hyperpigmentation, refers to dark circles under the eyes. It is a very common skin condition that is considered to be genetically based.

Microneedling as adjunct therapy has also been proven to be effective in treating this type of hyperpigmentation. One study combined trichloroacetic acid (TCA) peels with microneedling to achieve significant improvements.

Another study divided treatment into phenylethyl resorcinol (a skin-whitening agent) with microneedling and phenylethyl resorcinol alone. The skin-whitening gel achieved significant improvement in depigmenting skin but the combined therapy provided greater results.  

Microneedling under the eye can also reduce hyperpigmentation by adding lost volume through increased collagen. Typically 4–6 sessions are required to achieve the best results.

Postinflammatory hyperpigmented scars 

Hyperpigmented scars typically result due to a skin injury such as burns, cuts, skin infections and skin conditions such as acne. These scars are referred to as postinflammatory hyperpigmentation (PIH), and can form once an injury or inflammation has healed, leaving dark pigmented marks in its place.

Microneedling to treat hyperpigmented scars works the same way as for any forms of hyperpigmentation – by prompting skin cell turnover and stimulating collagen production to smooth skin texture and lighten tone. The number of treatments will depend on the amount of scars and their severity; typically 3–6 sessions.

Sunspots

Liver spots, sunspots or solar lentigines refer to flat brown spots that develop on skin due to overexposure to UV light. Microneedling can provide greater delivery of skin lightening serums through the layers of skin to regenerate the skin. Fresh, undamaged skin cells replace dark patches, and collagen formation allows for healthier, firmer skin.    

Side Effects of Microneedling for Hyperpigmentation

Microneedling is a noninvasive procedure and is therefore associated with mild side effects; serious side effects are rare.

  • Bruising
  • Dryness
  • Erythema (redness)
  • Peeling
  • Swelling

Can microneedling make hyperpigmentation worse? 

Microneedling can cause hyperpigmentation to worsen but it is difficult to discern the cause as there are so many variables involved: sun exposure, skin type and tone, genetics, environmental factors, hormones, skin care products, etc. 

As this procedure inflicts controlled damage to the skin some inflammation will occur, and this is a wanted and expected part of the treatment. However, sometimes this inflammation leads to worsening hyperpigmentation— especially for people of color—as they have higher levels of pigment in their skin.

Can microneedling make melasma worse?

The same issues that worsen hyperpigmentation hold true for melasma; an inflammatory response can worsen existing melasma. 

Alternatives to Microneedling for Hyperpigmentation

There are several over-the-counter (OTC) or professional-strength skin-lightening creams, as well as other professional treatments that can successfully treat hyperpigmentation:

  • Chemical peels are available in light, medium and deep formulas to remove the epidermis and the accompanying dark patches of skin
  • Corticosteroids can be used alongside primary treatments for greater efficacy and after, to reduce irritation and risk of additional hyperpigmentation
  • Hydroquinone is a skin-lightening agent that inhibits melanin production
  • Laser treatments resurface skin’s outer layers and stimulate collagen production 
  • Microdermabrasion uses a diamond-tipped handpiece or a spray of crystals to gently exfoliate the outermost layer of skin
  • Retinol can increase skin cell turnover to fade dark spots and inhibits melanin synthesis

Takeaway

Microneedling for hyperpigmentation is an effective treatment on its own but most often combined with topical agents to increase their efficacy. Nevertheless, as a sole treatment, it has been shown to produce results, as it prompts the skin to shed damaged skin cells and promotes the development of collagen and elastin to remodel skin.

As this is a noninvasive treatment, several sessions are required to achieve skin lightening effects. Side effects are minimal, but this treatment should be avoided who scar easily or have an active skin condition.

Sources

  • Liebl H, Kloth LC. Skin cell proliferation stimulated by microneedles. J Am Coll Clin Wound Spec. 2012;4(1):2-6. Published 2012 Dec 25. doi:10.1016/j.jccw.2012.11.001
  • Singh A, Yadav S. Microneedling: Advances and widening horizons. Indian Dermatol Online J. 2016;7(4):244-254. doi:10.4103/2229-5178.185468
  • Iriarte C, Awosika O, Rengifo-Pardo M, Ehrlich A. Review of applications of microneedling in dermatology. Clin Cosmet Investig Dermatol. 2017;10:289-298. Published 2017 Aug 8. doi:10.2147/CCID.S142450
  • Al Qarqaz F, Al-Yousef A. Skin microneedling for acne scars associated with pigmentation in patients with dark skin. J Cosmet Dermatol. 2018 Jun;17(3):390-395. doi:10.1111/jocd.12520
  • Fabbrocini G, De Vita V, Fardella N, et al. Skin needling to enhance depigmenting serum penetration in the treatment of melasma. Plast Surg Int. 2011;2011:158241. doi:10.1155/2011/158241
  • Lima EVA, Lima MMDA, Paixão MP, Miot HA. Assessment of the effects of skin microneedling as adjuvant therapy for facial melasma: a pilot study. BMC Dermatol. 2017 Nov 28;17(1):14. doi:10.1186/s12895-017-0066-5
  • Lima Ede A. Microneedling in facial recalcitrant melasma: report of a series of 22 cases. An Bras Dermatol. 2015;90(6):919-921. doi:10.1590/abd1806-4841.20154748
  • Bailey AJM, Li HO, Tan MG, Cheng W, Dover JS. Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis. J Am Acad Dermatol. 2021 Apr 12:S0190-9622(21)00767-2. doi:10.1016/j.jaad.2021.03.116
  • Kontochristopoulos G, Kouris A, Platsidaki E, Markantoni V, Gerodimou M, Antoniou C. Combination of microneedling and 10% trichloroacetic acid peels in the management of infraorbital dark circles. J Cosmet Laser Ther. 2016 Oct;18(5):289-92. doi:10.3109/14764172.2016.1157363
  • Yu CQ, Xu XG, Chen HD, Li YH. Clinical efficacy and safety of nano-microneedle-assisted phenylethyl resorcinol for the treatment of infraorbital dark circles. J Cosmet Dermatol. 2021 Mar;20(3):884-889. doi:10.1111/jocd.13641
  • Lawrence E, Al Aboud KM. Postinflammatory Hyperpigmentation. [Updated 2021 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559150/
  • Loesch MM, Somani AK, Kingsley MM, Travers JB, Spandau DF. Skin resurfacing procedures: new and emerging options. Clin Cosmet Investig Dermatol. 2014;7:231-241. Published 2014 Aug 28. doi:10.2147/CCID.S50367
  • Gowda A, Healey B, Ezaldein H, Merati M. A Systematic Review Examining the Potential Adverse Effects of Microneedling. J Clin Aesthet Dermatol. 2021;14(1):45-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869810/

» Show all

Latest Articles