Effect of minoxidil combined with triamcinolone acetonide on alopecia areata by microneedle injection.

OBJECTIVE: Alopecia areata (AA) is often characterized by sudden onset of patchy hair loss. Topical corticosteroid injection is the most common treatment. This study retrospectively observed the clinical efficacy of microneedle minoxidil combined with triamcinolone acetonide in the treatment of AA. METHODS: A total of 230 patients with AA were selected. The experimental group (n = 120) received physician training and home microneedle treatment with minoxidil combined with triamcinolone acetonide once a week. Topical minoxidil and triamcinolone acetonide were used twice daily at other times. The control group (n = 110) was treated with minoxidil combined with triamcinolone acetonide, twice a day. Cure rate, response rate, SALT, dermatological Quality of Life Index (DLQI), visual analogue (VAS), and cost were assessed at weeks 4 and 12. RESULTS: Treated group SALT score(Severity of Alopecia Tool) remarkable lower than control group after treated 4 and 12 weeks. After 12 weeks treatment, DLQI score of the treated group (1.8 ± 1.67) were significantly lower than those of the control group (2.45 ± 1.88) (p < 0.05). VAS score and adverse reaction between two group showed no significant different (p = 0.823, p = 0.484 respectively). The total cost was 53.93 ± 15.85 in the treatment group and 53.26 ± 11.51 in the control group. There was no significant difference between the two groups (p = 0.72). In the treated group, the complete response rate (CR: 78.33%) and total effective rate (CR+PR: 95%) were significantly higher than those in the control group (CR: 40.91% and CR+PR: 51.82%), with statistically significant differences (p < 0.001). CONCLUSION: Microneedle introduction of minoxidil and triamcinolone acetonide in the treatment of AA is a safe, effective, economical, and convenient method, with few adverse reactions, and has a good application prospect.

Evaluation and comparison of the efficacy and safety of the combination of topical phenytoin and microneedling with microneedling alone in the treatment of atrophic acne scars: A controlled blinded randomized clinical trial.

INTRODUCTION: Severe acne breakouts often lead to atrophic acne scars, which affect millions of people worldwide and can significantly affect a person's self-confidence and self-image. Given the difficulty in treating atrophic acne scars, this study aims to investigate the efficacy of topical phenytoin in the treatment of atrophic acne scars. METHOD: This split face clinical trial on 25 patients between the ages of 18 and 40 involved the application of microneedling on one side of the face, with three sessions taking place over the course of a month. On the other side, a 1% phenytoin cream was administered three times daily for 1 week following the microneedling procedure. Baseline information was collected for all patients, and follow-up assessments were conducted during the treatment sessions and 2 months after the last session. The assessments included evaluating the number and area of pores and spots, determining scar severity, assessing patient satisfaction, and recording any potential complications. RESULTS: Among patients, 20 individuals (80%) were females, and the average age of the participants was 35.96 ± 9.23. In terms of the fine pore area, despite the fine pore count, both groups showed improvement over time (p: 0.03 vs. 0.06). Also, regarding large pore count and area, and the count and area of spots, both groups showed improvement over time (p: 0.001). However, there were no significant differences between the two groups (p > 0.05). On the other hand, when it comes to acne scar grade and patients' satisfaction, the phenytoin group outperformed the control group in all follow-up sessions and this difference was found to be significant (p: 0.001). It is worth noting that no complications were observed among any of the patients. CONCLUSION: It appears that combining phenytoin cream with microneedling has a more effective therapeutic outcome in enhancing atrophic acne scars, when compared to microneedling alone, and this method can be regarded as a viable alternative in treating these types of scars.

Use of Optical Coherence Tomography to Assess Properties of Cutaneous Defects Following Radiofrequency Microneedling and Laser Treatment.

OBJECTIVES: To characterize the properties of cutaneous defects created by energy-based devices using optical coherence tomography. MATERIALS AND METHODS: Radiofrequency (RF) microneedling and non-ablative fractional laser (NAFL) treatment were performed in vivo with various parameters. Following treatment, optical coherence tomography (OCT) was used to image and measure cutaneous defects at multiple time points over a 24 h period. RESULTS: Channel-like cutaneous defects were visible with OCT following bipolar RF microneedling and NAFL treatment. Using a double pulse technique with RF microneedling yielded a greater number of defects visible with OCT, as well as defects that were deeper and more durable over time. Following treatment with 1927 nm thulium fiber laser, the average diameter of the defects was greater when the energy level was 20 mJ as compared to 10 mJ (0.33 mm vs. 0.27 mm, p < 0.01). CONCLUSIONS: Cutaneous defects were observed following both RF microneedling and NAFL treatment. Properties of the cutaneous defects varied based on device, treatment setting, and technique, which may be useful in guiding further study of device-assisted drug delivery.

Effective treatment of corticosteroid-induced facial erythema using fractional radiofrequency microneedling.

OBJECTIVES: To investigate the efficacy of Fractional Radiofrequency Microneedling (FRM) in treating corticosteroid-induced facial erythema. METHODS: A retrospective study was conducted involving eight patients diagnosed as corticosteroid-induced facial erythema. Each patient underwent a single session of FRM. Evaluative measures included Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA), assessment of telangiectasia severity, procedure-associated pain (10-point scale), patient satisfaction (3-point scale) and secondary outcomes. RESULTS: The study found a 75% success rate and 100% effectiveness rate in alleviating erythema symptoms. CEA and PSA scores decreased by 67.7% and 78.1%, respectively. No cases of erythema rebound were recorded during the 3-month follow-up period. CONCLUSIONS: FRM demonstrated effectiveness and safety in treating facial erythema, offering promising advancement in dermatologic therapeutics.

Review of laser and energy-based devices to treat rosacea in skin of color.

The prevalence of rosacea in skin of color (SOC) populations is estimated to be as high as 10% in some countries. Traditionally, intense pulsed light (IPL) and pulsed dye laser (PDL) have been the laser and energy-based devices (EBDs) used to treat rosacea. However, not all laser and EBDs are safe for SOC (Fitzpatrick skin types IV-VI) due to increased absorption of energy in pigmented skin and increased risk of post-inflammatory hyperpigmentation and scarring. This review summarizes the use of the top seven laser and EBDs for treating rosacea in SOC.

Management of androgenic alopecia: a systematic review of the literature.

We aimed to determine the efficacy of the various available oral, topical, and procedural treatment options for hair loss in individuals with androgenic alopecia. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the National Library of Medicine was performed. Overall, 141 unique studies met our inclusion criteria. We demonstrate that many over the counter (e.g. topical minoxidil, supplements, low-level light treatment), prescription (e.g. oral minoxidil, finasteride, dutasteride), and procedural (e.g. platelet-rich plasma, fractionated lasers, hair transplantation) treatments successfully promote hair growth, highlighting the superiority of a multifaceted and individualized approach to management.

Treatment of Palmar Hyperhidrosis With Radiofrequency Microneedling-Based on Ultrasound Measurements.

This study addresses the treatment of palmar hyperhidrosis, which has been difficult to manage. A new treatment has been developed using radiofrequency microneedling to reduce sweating non-surgically by ablating sweat glands. Based on ultrasound measurements of the dermis and precise microneedling damage, effective energy was applied to locate the sweat glands and disabled their function. Radiofrequency microneedling with ultrasound can safely and effectively treat hyperhidrosis in a minimally invasive way.

Long-term efficacy of fractional microneedle radiofrequency versus botulinum toxin-A in primary axillary hyperhidrosis: a randomized controlled trial.

Primary axillary hyperhidrosis is an idiopathic disorder that creates severe psycho-social burden due to excessive uncontrolled sweating. Various therapeutic agents have been described, but each has its own limitations. The use of fractional microneedling radiofrequency has emerged lately with promising results. This study aimed to determine the efficacy and safety of fractional microneedle radiofrequency in comparison to Botulinum toxin-A (BT-A) in patients with primary axillary hyperhidrosis. In this randomized controlled clinical trial, 20 patients (40 sides) were randomized to either fractional microneedle radiofrequency (4 sessions at 3-week intervals) or BT-A (single session), where each side received one of the treatment modalities. Efficacy was measured at 3, 6 and 12 months using Minor's starch iodine test, HDSS score, Hqol questionnaire, and patient satisfaction. Fractional microneedle radiofrequency, although showed moderate efficacy, is inferior to BT-A regarding longitudinal efficacy at 12 months, as well as patients' satisfaction. Both treatment modalities showed to be equally safe, but fractional microneedle radiofrequency procedure was substantially more painful. In conclusion, fractional microneedle radiofrequency does not offer a better substitute to BT-A in primary axillary hyperhidrosis. BT-A shows higher efficacy, is less painful, less expensive, and needs a smaller number of sessions.

Efficacy and safety of fractional micro-needling radiofrequency for the treatment of enlarged pores on the cheeks of a chinese cohort: a retrospective study.

To explore the efficacy and safety of fractional micro-needling radiofrequency (FMRF) in the treatment of enlarged pores on the cheek in a Chinese cohort. Patients with enlarged facial pores who underwent FMRF between January 2020 and December 2022 were included in this study. Blinded clinical assessments were performed by two independent dermatologists using a six-grade photographic enlarged pore scale and a quartile grading scale. Patients were asked to rate the degree of pain related to treatment on a visual analog scale (VAS), with scores ranging from 0 (no pain) to 10 (worst pain ever). A paired t-test was used to analyze the six-grade photographic enlarged pore scores. A total of 22 patients received three consecutive sessions of FMRF treatment, with intervals of 1-3 months, and underwent follow-up as scheduled. The mean six-grade photographic enlarged score was 3.55 ± 0.96 at baseline, while the score decreased significantly to 2.59 ± 0.59 after three treatment sessions (P < 0.05). The improvement score of the patients, assessed by two independent dermatologists, was 2.31 ± 0.71, according to the quartile grading scale. The mean VAS score was 6.42 ± 1.44. FMRF is effective and safe for the treatment of enlarged facial pores after three sessions.

The role of laser and energy-assisted drug delivery in the treatment of alopecia.

It has been recently established that laser treatment can be combined with topical or intralesional medications to enhance the delivery of drugs and improve overall results in a variety of different dermatological disorders. The aim of this review is to evaluate the use of laser and energy-assisted drug delivery (LEADD) for the treatment of alopecia with a specific focus on ablative fractional lasers (AFL), non-ablative fractional lasers (NAFL), and radiofrequency microneedling (RFMN). A comprehensive PubMed search was performed in December 2022 for "laser-assisted drug delivery" as well as "laser" and "alopecia." The evidence regarding LEADD for alopecia treatment is limited to two specific alopecia subtypes: alopecia areata (AA) and androgenetic alopecia (AGA)/pattern hair loss (PHL). LEADD with minoxidil and platelet-rich plasma (PRP) were evaluated for efficacy in both treatments of AA and AGA. LEADD with topical corticosteroids and intralesional methotrexate were studied for the treatment of AA, while LEADD with growth factors and stem cells were studied for the treatment of AGA. Multiple RCTs evaluated LEADD for topical corticosteroids with ablative fractional lasers for the treatment of AA. There is evidence in the literature that supports the use of topical minoxidil in combination with all devices for the treatment of AGA/PHL. All the reviewed studies show a positive treatment effect with LADD; however, some trials did not find LEADD to be superior to monotherapy or microneedling-assisted drug delivery. LEADD is a rapidly emerging treatment modality for the treatment of AGA and AA.

Microneedling Therapy for Striae Distensae: Systematic Review and Meta-Analysis.

INTRODUCTION: Striae distensae (SD), linear scars of derma, caused by disproportionate skin stretching, which indicates a cosmetic problem and even endangers individuals' psychosocial health. Microneedling, representing a relatively new procedural therapy, has shown brightening but diverse results in the remedy of SD. Our study systematically investigates and further evaluates the efficacy of microneedling for SD. METHOD: This study was conducted following the PRISMA guidelines. According to the preplanned search strategy, four electronic databases were comprehensively searched for eligible clinical controlled studies. Standardized mean difference (SMD) and odd ratio (OR) with 95% confidence intervals were calculated for continuous data and dichotomous data, respectively. RESULTS: According to the predetermined criteria, eleven eligible articles of six RCTs and five non-RCTs were included. Concerning clinical improvement, a significant difference was observed in the microneedle radiofrequency treatment subgroup (SMD: 0.57, 95% CI 0.20-0.94, P = 0.003). The pooled result of the second subgroup revealed that microneedling and lasers producing almost comparable effectiveness for treating SD with no significant difference (P = 0.35). The analysis result of the third subgroup of microneedling versus non-laser therapy indicated significant difference at the 5% significance level (SMD:1.01, 95% CI 0.51-1.51, P < 0.0001). With regard to patient satisfaction, the pooled estimate concluded that participants' satisfaction with therapeutic effect between MRF and laser group was comparable (P = 0.26), whereas microneedling exhibited significant superiority than both laser (P = 0.04) and non-laser treatments (SMD: 0.95, 95% CI 0.52-1.38, P < 0.0001). Occurrence of post-inflammatory hyperpigmentation (PIH) was not obvious in microneedling therapy compared to other treatments, and a statistically difference was observed (P = 0.0003). Microneedling treatment caused significant pain compared with laser therapy (P < 0.00001). CONCLUSION: This systematic review and meta-analysis has provided initial evidence of the efficacy and safety of microneedling technology for SD. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Microneedling in the Treatment of Post-burn Hypertrophic Scars.

INTRODUCTION: Post-burn hypertrophic scars are an important cause of physical discomfort, limitation of movements, psychological disorders, low self-esteem and reduced quality of life. Treatment for this condition is complex and involves several options. Microneedling, also known as minimally invasive percutaneous collagen induction, is an affordable minimally invasive option that can be combined with other treatments, including ablative ones. OBJECTIVE: The goal of this study was to present our microneedling approach for the treatment of hypertrophic scars after burns. METHOD: A prospective study of 15 patients with post-burn hypertrophic scars was conducted between October 2016 and June 2022. All patients were treated with microneedling and drug delivery of triamcinolone. Scars were evaluated using Vancouver Scar Scale (VSS), Burn Scar Assessment Scale (BSAS) and angle measurement for amplitude of movement evaluation of joints. RESULTS: A significant improvement in the VSS score was obtained after microneedling (8.8 ± 0.44 to 4.1 ± 0.98; p = 0.012), especially in the acute group (less than 1 year after burns): 9.3 ± 0.49 to 3.5 ± 1.36; p = 0.041. There was a significant and progressive improvement of the scars throughout the treatment sessions in all criteria evaluated and in the ranges of joint movement (p = 0.012). CONCLUSION: Our microneedling protocol promoted a significant improvement of post-burn scars, especially in acute hypertrophic scars, and in the amplitude of joint motion. Sequential treatments provided progressive improvement. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A comparative interventional study of narrowband ultraviolet B alone and narrowband ultraviolet B in combination with microneedling in patients with stable vitiligo.

BACKGROUND: Vitiligo is a cosmetically concerning common disorder of depigmentation. Narrowband Ultraviolet B (NB-UVB) phototherapy is a well-established mode of treatment for vitiligo. Microneedling is a simple method that has been used for vitiligo treatment in adjunct with NB-UVB and has been shown to induce repigmentation in a few studies; however, there is limited study in the literature. AIMS: To compare the efficacy of NB-UVB alone versus NB-UVB in conjunction with microneedling in patients of stable vitiligo. METHODS: Thirty patients of non-segmental vitiligo with patches tending toward symmetry, stable for at least 6 months were included. Patches on right side of body (side A) were subjected to both microneedling every 2 weeks and NB-UVB three times a week, while patches on left side of body (side B) were subjected to NB-UVB alone thrice weekly for 4 months or till complete resolution of lesions whichever was earlier. Patients were followed up for another 2 months. Response was assessed by photographic record and Vitiligo Area Severity Index (VASI score) calculated at baseline and every month for 6 months. RESULTS: The mean VASI score improvement in both the groups as compared to baseline was statistically significant (p-value < .01). However, the difference in mean VASI scores between the two groups was not statistically significant (p-value = .17). CONCLUSION: NB-UVB is an effective modality for treatment of vitiligo, but there is no additional benefit of combining microneedling with it.

Split-face evaluation: Gluconolactone plus oxybrasion versus gluconolactone plus microneedling. The effects on skin parameters.

BACKGROUND: The application of polyhydroxy acids and alpha-hydroxy acids to the skin is often used in cosmetology. To enhance the effect of gluconolactone chemical peeling, a combined method including water-oxygen oxybrasion or microneedle mesotherapy can be used. OBJECTIVES: To evaluate skin parameters such as hydration, sebum, pH and TEWL after application of a 10% gluconolactone chemical peel in combination with oxybrasion and microneedling. MATERIALS AND METHODS: Twenty-one Caucasian women participated in the study. A series of three split face treatments was carried out at 1-week intervals. Oxybrasion was performed on the right side of the face and micro-needle mesotherapy on the left side. A 10% gluconolactone solution was applied to the entire face. Before the first and third treatments and 2 weeks after the last treatment, skin parameters were evaluated. Photographic documentation was also made before and after the treatment series. RESULTS AND CONCLUSION: Evaluation of skin parameters using Courage & Khazaka 580 Multi Probe Adapter probes (Courage + Khazaka electronic GmbH, Cologne, Germany) showed an increase in hydration and a decrease in sebum, pH and TEWL for both treatments. There were no statistically significant differences between the treatments. Combining chemical peeling of gluconolactone with oxybrasion and microneedle mesotherapy is a good method to seal the hydrolipid barrier and increase skin hydration.

Review of radiofrequency microneedling: history, devices and uses.

Radiofrequency microneedling (RFM) has recently become a popular choice for the treatment of various dermatologic conditions and rejuvenation. Many studies have sought to evaluate the efficacy of RFM. However, its role in the management of these conditions remains unclear. A comprehensive literature search including randomized controlled trials, cohort studies, and case series evaluating the efficacy of RFM in various skin conditions was performed. In this review, we discuss the history and mechanism of RFM, describe various device features, and discuss the use of RFM in various skin conditions and rejuvenation.

A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars.

The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.

A Clinical Guide to the Treatment of Cellulite and Comprehensive Review of the Etiology, Pathophysiology, and Utility of Intervention.

INTRODUCTION: Cellulite is a common esthetic concern affecting most women. Despite its prevalence, there is no consensus on the optimal treatment approach for cellulite, partly due to the complex and multifactorial nature of its pathophysiology. Understanding the underlying biological processes along with available treatment options is important to be able to effectively counsel patients on effective management of this condition. This review aims to focus on high-quality evidence behind pathophysiology of cellulite, severity and grading, and its available treatment options. METHODS: A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to pathophysiology, grading scales, and applications of treatment options were utilized. RESULTS: Using the existing CSS classification, an evidence-based algorithm is proposed for treatment of cellulite. Mild cellulite is best served with lifestyle modifications such as healthy diet, hydration, and exercise. Use of topicals in mild cellulite patients as adjuncts to lifestyle modifications have the highest efficacy, although there are inconsistent data on topical treatments. Moderate cellulite is best targeted with noninvasive treatment options including laser therapy, radiofrequency, and ultrasound. Radiofrequency demonstrates the strongest efficacy in the current peer-reviewed literature. Severe cellulite is recommended to be treated with minimally invasive approaches such as subcision and injectables. CONCLUSION: Cellulite is a challenging cosmetic problem to treat, and thus multimodal treatment options should be considered in an attempt to achieve optimal outcomes and patient satisfaction. As the pathophysiology of cellulite is further elucidated, more targeted treatments may be developed in the future. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Delayed hypersensitivity reaction from microneedling twenty years after silicone fillers.

Skin rejuvenation procedures have increasingly flooded the aesthetic market, one of which includes microneedling. In microneedling, multiple fine punctures of the skin are performed with a needle to induce neocollagenesis. Microneedling has increasingly been used to treat inflammatory acne, acne scarring, photodamaged skin, and even radiation dermatitis. We present a patient with a stable history of liquid injectable silicone (LIS) given 20 years prior who developed chronic periocular and facial hypersensitivity after undergoing microneedling at a medi-spa. Long-term steroids and immunosuppressants were needed for control. The patient's severe reaction and resistance to treatment highlights the potential complications of microneedling administered by a non-medical professional in the setting of prior injectable silicone.

Evaluation of the efficacy of RF microneedling and oral isotretinoin in comparison with oral isotretionoin alone in the treatment of acne vulgaris.

Introduction: Acne vulgaris is one of the most common skin illnesses in teenagers, affecting 80% of people aged 11-30 years. Scars on the face are caused by high inflammation, severe acne, physical manipulation of the skin, and delayed treatment. Aim: To compare the effectiveness and safety of an automated RF micro needling device and oral isotretinoin with oral isotretinon alone alone for treating active acne. Material and methods: A cross-sectional study of 40 moderate acne sufferers. Twenty patients with active acne were treated with an automated RF microneedling device and isotretinoin 0.5-1 mg/kg. Group B included 20 people with active acne, who were given a single dose of 0.5-1 mg/kg isotretinoin. Results: In this cross-sectional research, 40 acne vulgaris patients were divided into 2 groups: group A: 23.8 ±3.2 years old, 58.95 ±5.5 kg, 13 females, and 7 males. There were 15 females and 5 males in group B: 24.4 ±3.7 years old and weighing 56.4 ±8.46 kg. After 12 weeks, group A shows better global acne assessment scale (GAAS) outcomes than group B than group B. After 6 months, group A showed better results than group B. The GAAS meaning global acne assessment scale did not change after 4-8 weeks of treatment. There was no age or weight difference. Conclusions: Acne vulgaris may be treated with fractional RF microneedling. Active acne treatment with RF microneedling is safe and effective, has a quicker response, causes less scarring, and reduces recurrence.

Regression of calcinosis cutis after inkless tattoo in a patient with dermatomyositis: therapeutic potential of microneedling.

Calcinosis cutis is defined as abnormal deposition of calcium salts in the skin and subcutaneous tissues. Dystrophic calcification, the most common form of calcinosis cutis, is associated with autoimmune connective tissue diseases. This condition is associated with severe pain and can affect the patient's quality of life and lead to long-term disability. Treatment is often challenging, and there is a very limited evidence base for potential treatments of calcinosis cutis associated with systemic sclerosis and dermatomyositis. Inkless tattoo is very similar to microneedling, a minimally invasive procedure stimulating the wound-healing cascade contributing to elastin and collagen formation as well as neovascularization. This technique has not been reported as a potential therapeutic option for calcinosis cutis. Here, we present a patient with calcinosis cutis in the setting of dermatomyositis that responded dramatically to inkless tattoo application. Our results support the need for future studies of microneedling in patients with this disorder.