New 540 Microneedle Derma Roller Micro Needle Pen Therapy Skin Recovery Reviews

• Periodical List
• Indian Dermatol Online J
• five.seven(4); Jul-Aug 2016
• PMC4976400

Indian Dermatol Online J. 2016 Jul-Aug; vii(4): 244–254.

Microneedling: Advances and widening horizons

Aashim Singh

Section of Dermatology and Venereology, AIIMS, New Delhi, India

Savita Yadav

Department of Dermatology and Venereology, AIIMS, New Delhi, India

Abstruse

Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, all the same, now information technology is being used for a very broad range of indications including acne scar, acne, mail service-traumatic/burn scar, baldness, skin rejuvenation, drug commitment, hyperhidrosis, stretch marks, and many more. Moreover, during the concluding 10 years, many new innovations have been fabricated to the initial instrument, which was used for microneedling. This technique can be combined with other surgical techniques to provide improve results. In particular, it is a very safe technique for night peel types, where risk of postinflammatory pigmentation is very high with other techniques that impairment the epidermis. In this review commodity, nosotros are updating on the different instruments now bachelor for this procedure, and its efficacy when performed solitary or in combination with other techniques for diverse indications.

Keywords: Dermaroller, dermatosurgery, microneedling, percutaneous collagen consecration

INTRODUCTION

Microneedling is a relatively new minimally invasive process involving superficial and controlled puncturing of the peel by rolling with miniature fine needles. Over a short period of time, it has gained mass popularity and acceptance as it is a elementary, inexpensive, safe, and effective technique requiring minimal training. Traditionally used as a collagen consecration therapy for facial scars and pare rejuvenation, it is also widely used now as a transdermal delivery system for therapeutic drugs and vaccines. In this review, we highlight the constantly evolving enquiry and developments in microneedling techniques, instruments, and its applications in dermatology.

THE INVENTION

The appearance of the concept of microneedling dates back to 1995 when Orentreich and Orentreich described dermal needling in the form of subcision for scar treatment and then independently in 1997 by a plastic surgeon Camirand who used tattoo guns without ink to take-off tension from postsurgical scars.[one,ii] Microneedling technique was given further shape by a German inventor Liebl in 2000 and a plastic surgeon Fernandes in 2006 who self-designed a drum-shaped device with multiple fine protruding needles and used it for percutaneous collagen induction.[3,4]

Bones Instrument

The standard medical dermaroller [Figure 1] has a 12 cm long handle with a ii × ii cm wide drum-shaped cylinder at one end studded with 8 rows and 24 round arrays of 192 fine microneedles, unremarkably 0.5–iii mm in length and 0.1–0.25 mm in diameter.[3] These single use microneedles are synthesized by reactive ion etching techniques on silicon or medical-grade stainless steel. The instrument is presterilized past gamma irradiation. Rolling with a standard dermaroller containing 192 needles of 2 mm length and 0.07 mm bore over an area of peel for 15 times results in approximately 250 holes per square cm upto the papillary dermis depending on the pressure practical.[v] Each pass produces 16 micropunctures in the stratum corneum per square cm without damaging the epidermis significantly.[6]

Unlike variety of Dermarollers: (a) Dermaroller with narrow width of drum meant for smaller areas such as eyelids and nose; (b) Dermaroller with 540 needles; (c) Standard dermaroller with 192 needles

Principle and mechanism of action

Micropunctures are created using microneedles which produce a controlled skin injury without actually damaging the epidermis. These microinjuries lead to minimal superficial haemorrhage and set up a wound healing pour with release of various growth factors such as platelet derived growth factor (PGF), transforming growth factor alpha and beta (TGF-α and TGF-β), connective tissue activating protein, connective tissue growth gene, and fibroblast growth cistron (FGF).[seven] The needles besides breakup the onetime hardened scar strands and allow it to revascularize. Neovascularization and neocollagenesis is initiated by migration and proliferation of fibroblasts and laying down of intercellular matrix.[8,9] A fibronectin matrix forms after 5 days of injury that determines the deposition of collagen resulting in skin tightening persisting for 5–7 years in the form of collagen Iii. The depth of neocollagenesis has been found to be 5–600 µm with a 1.5 mm length needle. Histological examination of the skin treated with 4 microneedling sessions one month apart shows upto 400% increment in collagen and elastin deposition at 6 months postoperatively, with a thickened stratum spinosum and normal rete ridges at one twelvemonth postoperatively.[x] Collagen fibre bundles announced to have a normal lattice pattern rather than parallel bundles as in scar tissue.[6]

Liebl et al. have proposed another hypothesis to explicate how microneedling works.[11] Resting electrical membrane potential of cells is approximately −70 mV, and when needles come near the membrane, the inner electrical potential increases quickly to −100 mV. This triggers increased cell activity and the release of various proteins, potassium, and growth factors from the cells into the exterior leading to the migration of fibroblasts to the site of injury, and hence, collagen consecration. Thus, the needles do non create a wound in a real sense, merely rather body cells are fooled into believing that the injury has occurred.[ix,11,12,13]

The expression of matrix metalloproteinases induced by microneedling is speculated in reduction of hyperpigmentation.[11] In addition, the hyperproliferation of keratinocytes is downregulated by microneedling in acne patients considering it overall balances out the cell equilibrium.[11] Nevertheless, more research needs to be done to elucidate the concatenation of events clearly.

Microneedling enhances the delivery of various drugs across the pare bulwark as it bypasses the stratum corneum and deposits the drug directly upward to the vascularized dermis. Information technology has also been shown to cause meaning widening of the follicular infundibulum by 47%, which may partly explain the increased penetration of the medication beyond the skin barrier. In addition, it removes the scales and sebum residues in the neighbourhood of the infundibulum.[14]

Hence, this process extrapolates the body's own physiology of wound healing and the new collagen deposition results in skin tightening and filling-up of atrophic scars with an overall meliorate aesthetic appeal since overlying epidermis is not ablated.

Procedure

Microneedling is a simple office-based process lasting 10 to 20 minutes depending on the expanse to be treated. The patients must be counselled prior to the procedure explaining the expected outcomes, delayed response, and need for multiple sittings. The skin should preferably exist prepared preoperatively for at least a month with vitamin A and C formulations twice a mean solar day to maximize dermal collagen formation. Vitamin A influences 400–1000 genes that control proliferation and differentiation of all major cells in epidermis and dermis, and Vitamin C is essential for production of normal collagen.[10]

The procedure is performed under topical anesthesia containing eutectic mixture of lignocaine and prilocaine/tetracaine for 45 minutes to 1 hour. After grooming of the area with antiseptic and saline, the skin is stretched with one hand, and perpendicularly, rolling is done five times each in the horizontal, vertical, and oblique directions with the other hand [Figure two]. The treatment endpoint is identified as uniform pivot-indicate bleeding which is easily controllable. Postal service-procedure, the area is made wet with saline, or ice packs can be used for comforting the patient. Thereafter, the patient is advised to use sunscreen regularly and follow sun-protective measures. The procedure is well-tolerated by the patients and there are usually no post-treatment sequelae except slight erythema and edema lasting for two–3 days. There is no reanimation and the patient can resume daily work the very next 24-hour interval. Treatments are performed at three–viii week intervals and multiple sittings are needed to accomplish the desired effect on the skin. The final results cannot be viewed immediately because new collagen continues to be laid down for approximately 3–6 months afterwards treatment has ceased.[x,15]

Pin-point bleeding over the cheek following microneedling process

VARIOUS INSTRUMENTS AND TECHNIQUES

A uncomplicated dermaroller has evolved over the past decade through a variety of advancements. The current market is booming with an assortment of devices based on needle length, drum size, and automation [Figure 1].

The most important is the diversity of needle lengths. Loftier ratio of tip length versus diameter of 13:i is an important holding of skillful needles.[6] The length of needle selected for an individual patient depends upon the indication for microneedling. For treating acne and other scars as a routine, a needle length of 1.5–2 mm is usually used. When microneedling is used as a procedure to treat ageing skin and wrinkles, the needle length of 0.5 mm or 1.0 mm is usually recommended.[9] When the needles are only up to 0.5 mm long, the procedure is essentially painless, and the perception of pain increases as the depth of needle penetration increases. It as well depends on the thickness of epidermis and dermis of the skin.

The minimum fourth dimension interval between two sittings of microneedling depends upon the indication for which the procedure is being done as well as the needle length of the dermaroller being used. More is the needle length, greater should be the interval between two sittings of microneedling. When using ane.5 mm dermaroller, at least iii weeks gap should exist in that location between two procedures.

Five basic types of medical dermarollers, which are registered with the FDA, have been described in the dermaroller serial by Konstantinos, and most dermarolling devices are adopted from these unproblematic types:[sixteen]

• C-viii (Corrective type), is the bones dermaroller as described in a higher place with a needle length of simply 0.13 mm (130 μm) used for enhancing penetration of topical agents. Information technology is completely painless.

• C-8HE (Corrective blazon for hair-bearing surfaces, scalp) has a needle length of 0.two mm (200 μm). Even this length is below the pain threshold.

• CIT-8 (CIT: Collagen Induction Therapy, Medical type) has a needle length of 0.v mm (500 μm) and helps in collagen induction and skin remodelling.

• MF-8 type has a needle length of 1.five mm (1500 μm). This creates deeper microchannels on the whole epidermis and dermis and at the same time destroys scar collagen bundles.

• MS-4 is the only dermaroller that has a smaller cylinder, one cm length, ii cm diameter, and later iv circular arrays of needles (total 96 needles) that have 1.5 mm length. It is used on areas where better precision and deeper penetration is required. It is mostly used on facial acne scars.

• Devices like to MS-four are bachelor with needle lengths of 0.five–0.75 mm, which are used for thin-skinned areas such equally the periorbital and perioral regions.

Home intendance dermaroller

Dwelling house-intendance dermarollers (C-8) are used by patients themselves as they are of needle length less than 0.15 mm and are available for reduction of pore size, fine lines, and sebum product, as well as for transdermal commitment of substances such every bit lipopeptides and other antiageing products. They can exist used twice or thrice a week for up to 100 times. Afterward apply, the rollers should exist cleaned in hot tap h2o and shaken dry.[iii,17] Beauty Mouse is another approved device intended for dwelling employ. It contains a total of 480 needles of approximately 0.2 mm size on three separate drums strategically placed within a computer mouse shaped device. It has been developed to ensure coverage of larger skin surface areas, such equally the artillery, legs, and buttocks for the treatment of stomach or thigh stretch marks and cellulite.[18]

Derma-stamp

These are miniature versions of the dermaroller available in different needle lengths (0.2–iii mm) and a diameter of 0.12 mm that are used for localized scars such as varicella scars. Advantage over the dermaroller is that a more focussed treatment of individual scars is possible. It causes vertical penetration to create infusion channels in the skin and is considered ideal for utilize on isolated scars and wrinkles.[3,5,17,18]

Dermapen

Dermapen [Figure 3] is an automated microneedling device which looks similar a pen. This ergonomic device makes use of disposable needles and guides to adjust needle length for fractional mechanical resurfacing. The tip has 9–12 needles arranged in rows. Information technology makes utilize of a rechargeable battery to operate in two modes, namely, the high speed mode (700 cycles/min) and the low speed mode (412 cycles/min) in a vibrating stamp-like mode.[xix] It has the advantage of being reusable in different patients equally the needles are disposable, safe as the needle tips are subconscious within the guide, and more convenient to treat narrow areas such as the nose, around the eyes and lips without dissentious the adjoining peel. Information technology makes the process less painful and more than economic equally there is no need to buy a new instrument every fourth dimension.[xx] This technology has been designed to overcome the issues of varying pressure level application and the subsequent depth of penetration achieved.[xviii]

Dermapen with bombardment charger

DermaFrac

DermaFrac treatment is a newer modification of microneedling combining microdermabrasion, microneedling, simultaneous deep tissue serum infusion, and light emitting diode (LED) therapy. DermaFrac treatments target aging and sunday damaged skin, acne, enlarged pores, uneven skin tone, wrinkles, fine lines, hyperpigmentation, and superficial scars. Information technology takes approximately 45 min to consummate total face treatment when all four modalities are used. This noninvasive, price-effective handling carries the reward of having no downtime with individualized choice of serums for infusion.[20,21]

Microneedle commitment systems

Microneedle commitment systems offer a minimally invasive and painless method of transdermal drug administration, especially useful for vaccines.[22] The various types of microneedles bachelor for this purpose tin can be solid, coated, dissolving, hollow, and swellable polymer microneedles synthesized by microfabrication technique.[18] Silicon, metals such every bit titanium, natural and synthetic polymers, and polysaccharides are the various materials used to fabricate these microneedles. Solid-coated microneedles are used to pierce the superficial skin followed by topical application and delivery of the drug, whereas dissolvable or biodegradable and hollow needles deliver drugs directly into the dermis.[22]

Fractional radiofrequency microneedling

The amalgamation of microneedling with radiofrequency has further expanded the prospects of awarding of this technology. Insulated needles are used to penetrate the peel and release radiofrequency currents from the needle tips producing thermal zones in the dermal structural components and accompaniment glands without damaging the overlying epidermis.[23] This triggers long-term dermal remodelling, neoelastogenesis, and neocollagenesis. The depth of the needles tin be adjusted from 0.5 mm to 3.v mm allowing us to target unlike layers of the dermis discretely.[24] Operating person can exercise a good control over tissue damage past adjusting the power level and duration of energy pulse. The master energy delivery system has a dispensable tip with 49 aureate plated needles. Microneedling radiofrequency (MNRF) technology does non damage the epidermis, and is therefore, safe in darker skin types. Its indications include scar treatment, hyperhidrosis, skin tightening, rejuvenation, and many more.

Calorie-free emitting microneedling device

LED microneedling rollers accept been recently launched. These incorporate titanium microneedles and LED low-cal to combat wrinkles and scarring.[19] These devices have not however been explored and no published information is available regarding its efficacy.

APPLICATIONS OF MICRONEEDLING IN DERMATOLOGY

Dermarolling has been used for a wide range of indications with many trials supporting testify for its usefulness.[5,vi,17,23] Information technology has been tried alone every bit well as in combination with other handling modalities such as chemical peeling, platelet rich plasma, radiofrequency, subcision, punch acme, and lasers. Information technology is often used in conjunction with a topical formulation, and hence, enhances its penetration and activeness.

Skin rejuvenation

Microneedling leads to reorganization of former collagen fibres and laying downward of new collagen, elastin, and capillaries leading to the upshot of peel tightening. A significant increase in level of collagen type I, III, and VII, newly synthesized collagen and tropoelastin from baseline was observed after half-dozen microneedling sessions at ii-calendar week intervals by El-Domyati et al.[25] This percutaneous collagen consecration leads to an overall youthful appearance of the skin by reducing fine lines and wrinkles, reducing pore size, more suppleness, and elasticity.

The effects are enhanced when the procedure is combined with topical antiageing vitamin C serum and tretinoin application. Microneedling has too been combined with human embryonic stalk cells derived endothelial precursor cell conditioned medium and has shown significant reduction in wrinkles and pigmentation.[26,29] Fractional microneedling radiofrequency has been studied in a large multicentre trial and has found to exist effective in reducing wrinkles [Tabular array i].[27]

Table one

Microneedling trials for peel rejuvenation (literature search later on year 2010)

Scars

Acne scars

The most often used indication of microneedling is post-acne facial atrophic scars [Figure iv], and a big number of trials have been conducted to evaluate the same alone as well as in combination with chemic peels, platelet-rich plasma, subcision, cryotherapy, and CROSS technique. Microneedling has been found to exist more effective for rolling and boxcar scars, and relatively less constructive in ice-selection scars. It is prophylactic for all skin types with minimal reanimation. Simply the affected area needs to exist treated and at that place is minimal risk of post-inflammatory dyschromia. Withal, a minimum of 4–half dozen sessions are required for a significant improvement [Table 2].

Pre (a, c, due east) and mail (b, d, f) treatment photographs of post-acne atrophic scar patients after 4 sittings of microneedling done 1 month apart

Table 2

Studies using miconeedling for facial post acne atrophic scars (literature search afterward year 2010)

Nonacne scars

Post-burn scar, postal service-traumatic scar, hypertrophic scars, varicella scars [Table 3].

Table iii

Microneedling for non-acne scar treatment (literature search afterward year 2010)

Post-surgical scars were the first to be studied by Camirand[2] who used tattoo gun needles to reduce the scars. Since then, microneedling has been used for almost all types of surgical scars and are to exist constitute useful. Microneedling has been found to be effective in reducing even fire scars [Figure v] past upward to fourscore% in a study on 16 patients past Aust et al. It was stipulated that at that place is normalization of collagen-elastin matrix in the dermis at one twelvemonth.[ten,xv] Microneedling is too constructive for varicella scars [Figure 6] and post-traumatic scars [Effigy 7].

Post-burn scar on the thigh of ane year duration treated with a combination of microneedling and laser (a) Baseline photograph; (b). Scar showing comeback afterward 3 fortnightly sessions of microneedling; (c) Further comeback in scar post-obit 1 session of Fraxel light amplification by stimulated emission of radiation RE: STORE SR 1500nm (Solta Medical, United states of america) with following parameters: lxx mj beam energy, 20% density, 8 passes. (Courtesy: Dr Arshdeep, Consultant Dermatologist, Kubba Skin Clinic, New Delhi)

Post-varicella scars (a,c) showing improvement (b,d) after 3 microneedling sittings done 1 month apart

Significant improvement in post-traumatic scar over the nose after 1 sitting of subcision followed by iii sittings of microneedling washed 1 month apart

Acne vulgaris

The advent of fractional microneedling radiofrequency has expanded the application of microneedling to acne vulgaris equally well. It straight targets the sebaceous glands and helps in reducing the sebum production. It is also known to reduce the hyperproliferation of keratinocytes [Table 4].

Table four

Fractional microneedling radiofrequency trials for acne vulgaris (literature search after year 2010)

Androgenic alopecia and alopecia areata

Utilize of microneedling over scalp for alopecia is one of its contempo advances. It has been compared with minoxidil alone and has been found to be ameliorate in combination.[47,48] Home-employ dermarollers are prescribed to patients who are using minoxidil, and a better pilus growth is observed. However, when topical minoxidil was compared with Platelet Rich Plasma (PRP) and microneedling therapy in a recent study, minoxidil lonely continued to remain improve.[49] Microneedling has besides been combined with topical triamcinolone acetonide application in baldness areata and better response has been observed [Tabular array five].[50]

Table v

Microneedling trials for alopecia (literature search afterwards yr 2010)

Pigmentation—Melasma and periorbital hypermelanosis

The introduction of Dermafrac technique and smaller drums with needles sizes approximately 0.5 mm has made the microneedling to periocular peel acquiescent. Microneedling has been combined with diverse skin lightening agents and chemical peels to reduce melasma likewise equally periorbital hypermelanosis [Tabular array 6].

Table 6

Microneedling trials for pigmentation (melasma and periorbital hypermelanosis) (literature search subsequently yr 2010)

Miscellaneous conditions

Extended applications of microneedling include stretch marks, axillary hyperhidrosis, and actinic keratosis in photodamaged skin. MNRF has been used even in patients with rosacea and mail-acne erythema with favorable results [Table 7].

Table vii

Microneedling trials for miscellaneous indications (literature search afterward year 2010)

Skin laxity

1. Lax skin on arms, abdomen, neck, thighs, areas between breast and buttocks[5,6,17]

2. To tighten skin after liposuction.

TRANSDERMAL Delivery OF DRUGS

The technique of microneedling has been well-exploited to increment penetration of drugs beyond the skin barrier. This has been proven in in-vitro skin models where enhanced absorption of larger molecules such as calcein has been observed.[62,63] Microneedles cover a range of activity between that of a transdermal patch and a hypodermic needle attempting to proceeds the advantages of both and eliminate the disadvantages of each one of them. Microneedling has been used for the transdermal delivery of various types of drugs including macromolecular biopharmaceuticals such as insulin, growth hormone, heparin, and albumin; immunobiologicals such as hepatitis B, tetanus toxoid, and influenza vaccines; proteins, peptides and drugs such every bit aspirin, minoxidil, tretinoin, and Fifty-ascorbic acid.[21,64,65] Microneedling has likewise been combined with other avant-garde techniques such as micropumps, sonophoresis, iontophoresis, and electroporation for improve drug penetration.[21]

With respect to dermatology, microneedling is often combined with topical tretinoin and vitamin C for the treatment of acne scarring and skin rejuvenation, as described above. Penetration enhancement of minoxidil and platelet-rich plasma for androgenic baldness is another application. Microneedling enhances the effect of 5-aminolevulinic acid for more efficacious photodynamic therapy.[66] They accept been used in combination for the treatment of actinic keratosis[56] and photoaging.[28]

CONTRAINDICATIONS[v,6]

1. Active acne

2. Herpes labialis or any other local infection such as warts

3. Moderate to severe chronic pare affliction such equally eczema and psoriasis

4. Blood dyscrasias, patients on anticoagulant therapy

5. Extreme keloidal tendency

6. Patient on chemo/radiotherapy.

LIMITATIONS AND Adverse Furnishings

Dermarolling has its own set of limitations despite its assembly of effective uses and advantages over other procedures. Information technology is less efficacious in some types of scars such as pitted scars, linear scars, and deep boxcar scars. Withal, combining other surgical procedures to microneedling can amend its results.

Sure adverse events are also known with the process, the common ones being potential erythema and irritation which normally subside within a few hours. Other events noted are post-inflammatory hyperpigmentation, bedevilment of acne and reactivation of canker, systemic hypersensitivity, allergic granulomatous reactions and local infections post-obit the use of a nonsterile instrument.[6,nine,17,22] Allergic contact dermatitis to materials used in the needles has also been observed.[67] Tram-track effect later on ii sessions of microneedling has been reported in a patient with acne scars who adult regularly placed linear papular scars over bony prominences of the face.[68] This tin be avoided by using less force per unit area and smaller needles over these areas.

Microneedling is relatively safety to use in Indian skin because it rarely leads to hyperpigmentation dissimilar other ablative and resurfacing procedures.[23] It carries a better safe contour with regards to risk of dyspigmentation in all pare types.[34]

Futurity PROSPECTS

Considering skin is an easily accessible tissue, has a good regenerative capacity, and is easily scrutinized directly, it serves as a potential organ for the evolution of therapeutic and prophylactic genetic medicines. It was demonstrated past Chabri et al. that microneedling tin can exist used for intradermal delivery of a nonviral vector which can be exploited for localized treatment of genetic diseases such as epidermolysis bullosa.[69]

Dermarolling may be useful to dye poorly pigmented hairs and improving laser pilus removal because it has been shown that it dilates the follicular infundibulum and increases the transfollicular absorption of melanin.[14]

Decision

Microneedling is an effective modality of treatment, especially in patients with Fitzpatrick's Four and 5 peel types because it overcomes the side effects of scarring and hyperpigmentation resulting from other procedures in which the epidermis is compromised. Information technology certainly promises to exist a valuable technique with its numerous applications and its ever-expanding modifications every bit well as feasibility of home use.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the course the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the periodical. The patients understand that their names and initials will not be published and due efforts will exist fabricated to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976400/