The Effectiveness of Microneedling Therapy on The Severity of Acne Scars According to Goodman and Baron: A Systematic review and meta-analysis

Background: The emergence of acne scars due to skin damage in the acne healing process and causes psychological effects. The management of acne scars can be done in several methods. Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique compared to other therapeutic modalities in acne scars. The resulting wound is micro-sized, and promotes the growth of growth factors and collagen production. We aimed to assess the effectiveness of using microneedling as an acne scar treatment option. A systematic review and meta-analysis were qualitatively and quantitatively conducted from RCTs, assessing the effectiveness of microneedling in reducing the severity of acne scars according to Goodman and Baron in the treatment of acne scars. Methods: Medline Pubmed, PMC, Scopus, Google Scholar, and JDC library, eligible search. Ten studies (n=514) were analyzed qualitatively with 2 studies (n=53 subjects) and quantitatively analyzed by 2 studies (n=90 subjects). Both analyzes were included in the meta-analysis. The mean age of the participants was 40.5 years. The application of microneedling intervention as monotherapy or a combination in patients with acne scarring was followed for at least 16 weeks, the results obtained were the mean reduction in the degree of acne scarring after microneedling. Result: The combination of microneedling treatment obtained a qualitative decrease in the degree of acne scars according to Goodman and Baron with a Z value (-4.299) and P=<0.001 lower than the control (PRP) with a significant difference. The quantitative decrease in the degree of acne scars according to Goodman and Baron obtained a Z value (-4.681) and P=<0.001 lower than the control (PRP) with a significant difference. Quantitative reduction in the degree of acne scars according to Goodman and Baron on single therapy between treatment and control with a value of Z (-3.536) and P=<0.001 lower than control (fractional CO2) with a significant difference. The results of the degree of acne scars in the group treated with microneedling alone or in combination were lower than the control group. The mean before and after therapy compared to the control there was a significant difference. Conclusion. The results of a systematic review, concluded that the group treated with microneedling had a decrease in the degree of acne scarring according to Goodman and Baron with P=<0.001 compared to before treatment. The decrease was shown in the difference in Z values, which was significantly greater than the control given other therapies. Microneedling therapy can be an alternative therapy option for acne scar patients who are unresponsive to previous therapy or in conditions where there are contraindications to other therapies.

Efficacy and outcome of Microneedling (Dermaroller) in post-acne scars

Acne vulgaris is a common dermatological disorder affecting teenagers and young adults with the consequence of scarring. As acne is considered as a normal occurrence and neglected or delayed treatment of severe acne lead to cosmetically disfiguring scarring leading to much psychological trauma to youngsters. Acne scarring can be atrophic or hypertrophic. There are multitude of treatment options for atrophic acne scars like dermabrasion, chemical peels and lasers. But these cosmetic procedures are have drawbacks like requiring fine skills and long downtime (dermabrasion), or expensive for most of the population(laser). Microneedling using dermaroller is an inexpensive safe therapeutic option for the Indian skin type with less complication. The aim of this study was to evaluate the efficacy of microneedling (dermaroller) in different types of atrophic acne scar and it’s complications.A descriptive study was performed using 30 patients with atrophic acne scar treated with microneedling for a period of two years. Details of duration, site, type and depth of acne scar along with skin types was recored. Patients were given dermaroller treatment for 4 session, each spaced at one month interval and results assessed at the end of each session and at end of six months. In this study, 30 patients with atrophic acne scars of grade 2 and 3 were treated with microneedling therapy and efficacy and complication of this therapy were evaluated. These patients had all three types of atrophic scars- rolling, ice- pick and boxcar, these 27 patients showed 50 % improvement in their scar score at the end of the study (6 months). Among above mentioned scar types, rolling and boxcar scar showed improvement by 47.42% and 65.40% respectively at the end of the study, whereas ice-pick scars showed no significant improvement. According to the modified acne scar scoring system, 55.6% of the patients had improvement in their scar scoring between 41 and 50% (good response) and 44.4 % had improvement of more than 50 % (very good response). All patients were satisfied with the outcome of the procedure.Microneedling is a safe, cost effective, innovative procedure in the treatment armamentarium of acne scars without major complications. This is found to be safe to use in Fitzpatrick type IV and V scars. However, further studies are necessary to validate these findings.