Microneedling in skin of colour
Microneedling in skin of colour
Additional precautions should be taken to avoid pigment changes in dark skin, but microneedling appears to be safe and effective in this patient group (1,600 words, 8 minutes)
The Skin Spectrum Weekly e-newsletter is supported by Bausch Health, Canada
Microneedling has a role in treating darker skin types, and some precautions can be taken to lower the risk of post-inflammatory hyperpigmentation (PIH) or other adverse events.
This message was part of a presentation by Dr. Jaishree Sharad at the American Academy of Dermatology’s 2021 annual meeting.
Dr. Sharad is a cosmetic dermatologist in practice in Khar, Mumbai. Previously, she has been Vice President of the Cosmetic Dermatology Society of India and an Executive Board Member of the European Society of Cutaneous and Aesthetic Surgery.
She cited several studies showing microneedling is an effective treatment for acne scars, melasma and striae distensae in Fitzpatrick skin types up to type V.
Microneeding induces controlled skin injury with minimal epidermal damage and stimulation of the wound healing cascade, she noted. This leads to a release of multiple growth factors, neovascularisation and neocollagenesis.
Dr. Sharad said that the advantages of microneedling include minimal risk of infection, a short healing period, no permanent injury to the dermis, no scarring, and no nerve injury or pain. “There is minimal downtime, and it is very safe in dark skin. The adverse effects are very transient.”
Adverse events that have been reported are usually bruising—in some cases, hematoma, scabbing, secondary bacterial infections, and PIH. “All of these are temporary side effects,” she said. “All in all, it is a very safe treatment in skin of colour.”
To reduce the risk of PIH, Dr. Sharad recommends a ‘priming’ period.
In her clinic “we give topical bleaching agents such as hydroquinone, vitamin C, Kojic acid, arbutin, licorice, or sometimes glycolic acid and retinol, at least two to three weeks before the procedure,” she said. In cases where the patient is treated with a retinoid or an alpha hydroxy acid, the patient is directed to stop the treatment at least about five days before the procedure.
“The patient should be counselled about the importance of strict sun protection. They should get into the habit of using sunscreen at least two to three weeks before undergoing the [microneedling] procedure.”
For patients with a history of active acne, Dr. Sharad said her clinic will often treat the patient with low-dose (10 mg) isotretinoin. “Along with that we have done microneedling and found no side effects.”
Dr. Sharad gave several tips for avoiding side effects from microneedling in dark skin:
Topical skin lightening agents should be used for priming
Patients should avoid facial scrubs, depilatory creams, waxing, bleaching, microdermabrasion and laser hair removal for at least a week before and a week after microneedling
Sun protection is mandatory, including when patients are indoors near windows
Further cosmetic procedures should be avoided for 12 hours after microneedling
Patients should avoid washing with tap water. Cases have been reported of atypical mycobacterial infection when patients had used tap water immediately after a procedure which involved needles
After microneedling, for one week patients should avoid loofahs, picking, saunas, swimming, scrubbing and using creams that cause exfoliation
Bottom line: Microneedling can be a safe and effective treatment approach, but precautions should be taken before and after treatment in dark skin to avoid some adverse events.
From the literature on microneedling in skin of colour
An innovative approach of treating acne scars using bipolar rotational stamping and monopolar criss-cross technique with insulated microneedling radiofrequency in Asians
The authors of this study aimed to assess the efficacy and safety of a novel technique for radio frequency microneedling using insulated needles to improve facial acne scars in Asians.
Thirty-two patients were recruited—20 women, 12 men—with Fitzpatrick skin types III to V who had atrophic acne scars on their faces. Each patient was treated with the novel technique in four sessions, one month apart. Most patients reported improvement four to six weeks after the first treatment session.
The participants self-reported a 30% to 90% (mean––62.50%) improvement in their acne scars. Unbiased physicians graded the improvement as 40% to 80% (mean––58.44%) at a six-month follow-up visit. All of the patients reported a 30% to 90% (mean––61.88%) improvement in facial contour and skin tightening, with many saying they saw an improvement in their open pores.
Efficacy and safety of using non-insulated microneedle radiofrequency alone versus in combination with polynucleotides for the treatment of melasma: A pilot study
In this study, 30 adults with Fitzpatrick skin types III to V and melasma received three treatments with a microneedling radiofrequency (RF) device on both sides of their faces. The treatment sessions were two weeks apart.
One side of each patient’s face was treated with polynucleotides or control after the RF treatment.
Of the original 30, 26 participants were followed up to the six-month assessment point.
The researchers observed significant improvements from baseline in melanin index, skin roughness, and mMASI (modified melasma area severity index) scores at six months for both sides of patient faces. There were no statistically significant differences between the sides.
Three patients had a recurrence of their melasma at two, three, and four months after their last treatment.
A comparison study of the 0.1% tretinoin cream versus fractional microneedle radiofrequency combination with fractional CO2 laser for the treatment of striae alba in Indonesian patients
This study compared treatment with 0.1% tretinoin cream to fractional microneedle radiofrequency (FMR) and fractional CO2 laser treatment for striae alba (SA). A total of 22 patients with Fitzpatrick skin types IV or V were included in this study, 11 in each treatment arm.
The researchers observed a significant decrease in the width of lesions in the combination therapy group. While the lesion length in this group also decreased, it was not significant. There was no decrease in length or width in the tretinoin group. Treatment with the combination therapy also resulted in a larger increase in collagen in the combination therapy group than in the tretinoin group.
All patients in the combination group experienced post-inflammatory hyperpigmentation. Two subjects in the tretinoin group experienced irritation quickly resolved with topical steroids.
A retrospective study of neck rejuvenation using a non-insulated microneedle radiofrequency in Chinese subjects
The authors of this paper conducted a three-year retrospective observation of Chinese subjects treated with non-insulated microneedle radiofrequency (NIMNRF) for neck rejuvenation.
Of all the patients evaluated, 28 subjects (28.6%) received only one treatment session. Of those, roughly one-half of subjects achieved 50% or greater improvement in neck aging scores. The average improvement was 37.0% at three months follow-up and 41.6% at six months follow-up.
Another 70 subjects (71.4%) had three sessions of treatment. For those patients, their neck aging scores were 3.57±1.28 at baseline and significantly decreased to 1.10±0.84 at three months (p<0.05) and to 1.04±0.86 (p<0.05) at six months. The average improvements seen in this group were 73.3% at three months and 75.1% at six months.
The investigators found a trend of better efficacy with an increasing number of sessions (p<0.05).
Six subjects were followed up for one year. Of those, five subjects who received three treatment sessions achieved about a 70% improvement after their final session, and another subject who received one session retained an improvement of 40%.
VIDEO: Why facial microneedling causes hyperpigmentation in darker skin, and importance of aftercare
At the intersection of skin and society
In June 2022, the first class will graduate from a law degree program that combines the study of Indigenous and non-Indigenous laws at the University of Victoria, B.C. (UVic), according to a press release from the university.
According to the release, launched four years ago, this is the world’s first law degree program that combines these two areas of study. The curriculum includes Canadian Common Law and Indigenous Legal Orders (JD/JID). This first cohort consists of 23 graduates.
“This is a historic moment, and I am honoured to recognize and congratulate the graduating students of the first JD/JID cohort,” said UVic President Kevin Hall. “They are equipped with unique knowledge, skills and experiences that will enable them to build bridges between multiple legal systems. I look forward to seeing the impact they make on the legal landscape in Canada and on our ability to move meaningfully and collaboratively towards resolution of the significant and ongoing problems caused by colonialism.”
At a recognition event in April 2022, the graduating class was recognized and celebrated by several national leaders including Governor-General Mary Simon, Justice Minister and Attorney General of Canada David Lametti, B.C. Advanced Education Minister Anne Kang and former Senator and Chief Commissioner of the Truth and Reconciliation Commission Murray Sinclair.
“Congratulations to the graduating students in this unique program. They are leading the change that we hoped for when we issued the TRC Report,” said Sinclair. “I encourage them to go out into the world and to be bold and creative with their unique legal skills and knowledge.”
Interim Dean of Law and JD/JID co-founder Val Napoleon hosted the recognition event. He expressed great enthusiasm for how the new graduates are poised to improve the practice of law and society.
“Indigenous law is an essential part of Indigenous peoples being peoples, and it is foundational to Canada’s multi-juridical system,” she said. “Law is an essential ingredient of every society because it is a part of governance, it is a part of how we manage ourselves, and it is a part of how we are responsible to ourselves, to each other, and to our global community. I hope our graduates will take with them the ability to centre Indigenous law in the world as a collaborative and principled way to solve problems, so that is never reduced to just words on paper because it is so much more than that.”
UVic will be home to the National Centre for Indigenous Laws in the future.
This week
June is Pride Month
June 6 to 12 is Child Safety Week in the U.K.
June 11 is Global Wellness Day
Something to think about in the week ahead…
Next week
Virtual, remote dermatology care has the potential to reduce some of the inequalities faced by individuals living in remote areas. However, Dr. Boluwaji Ogunyemi explains that cultural competencies and other resources are needed for such care to be as effective as possible.
Indigenous Skin Spectrum Summit
Registration is open for the 2022 Indigenous Skin Spectrum Summit, which will be held on Sat. June 11, 10:00 AM to 2:00 PM EDT.
First held in March 2021, the Indigenous Skin Spectrum Summit is a special session of the Skin Spectrum Summit addressing specific challenges in treating Canada’s Indigenous community.
The second Indigenous Skin Spectrum Summit will be held during National Indigenous History Month in Canada. As we recognize the history, heritage and diversity of First Nations, Inuit and Métis peoples in Canada, we must also acknowledge the persistent health gaps that these communities experience.
Learning objectives for the event are:
Be able to identify skin disorders in richly pigmented skin and recognize prevalent dermatologic diseases in Indigenous populations
Improve diagnosis of dermatologic conditions in First Nations, Inuit, and Métis patients
Understand how historical and systemic factors contribute to health gaps for Indigenous people
Understand how NIHB program coverage works for treating skin conditions
Adopt an experience-based approach to more effectively manage Indigenous patients and the unique treatment challenges they may face
Register for the 2022 Indigenous Skin Spectrum Summit here: