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A Dermatologist’s Guide to Dermarolling

April 28, 2018

 

Derma rolling, also known as microneedling, has become popular in treating acne scars and it can be used safely in a dermatologist’s clinic by an accredited dermatologist, as a simple office-based procedure.

It is a minimally invasive procedure that uses fine needles to puncture the epidermis to create micro wounds that stimulate the release of growth factors and induce collagen production. The procedure is painful and a prescription numbing cream is used to numb the skin before the treatment. Overall, the epidermis remains relatively intact and doesn’t seem to have many side effects when performed by a trained professional and with sterilised equipment. To this date, the procedure seems to be generally safe and low-cost method of improving acne scars, however, there are insufficient studies as yet to support the use of microneedling for various conditions as an evidence-based method. Microneedling can also be used for enhanced delivery of applied medications, “transdermal delivery” of cosmeceuticals such as vitamin C and vitamin A derivatives (retinoids) but this is best used with caution. In my personal experience, it can cause irritation and there is no conclusive evidence to suggest that it is superior to an optimised topically applied cosmeceutical alone. It has also been used for the treatment of hair loss, with steroids delivered for conditions such as alopecia areata, although it is not preferred over conventional methods of steroid injections for this autoimmune condition.

It lasts 10 to 20 minutes and informed consent is obtained about the expected outcomes, delayed response, and need for multiple sessions. Dermatologists also prepare the skin preoperatively for at least a month with vitamin A and C formulations twice a day to optimise results, such as enhancing dermal collagen formation.

There has been a proliferation of ‘home-care dermarollers’, which are of shorter needle length less than 0.15 mm for improvement of skin texture such as pore size, fine lines, sebum production and delivery of anti-ageing products. Some have also been developed for coverage of larger surface areas such as legs and buttocks for stretch marks and cellulite. In my view, there is insufficient data supporting the safety and effectiveness of home care dermarollers and is not recommended. For conditions such as acne scars, it is far more effective to recommend ablative fractional resurfacing.

On a related note, dermarollers carry risks which may be far more pronounced in the at-home group such as the following:

Infection. Medical microneedles are currently made of medical-grade stainless steel presterilized by gamma irradiation and are for single use only. Home dermarollers are usually made of smaller shorter needles, for multiple uses (other than washing in hot water, but this does NOT eliminate all viruses and bacteria, including a type of tap-water tuberculosis bacteria known as atypical mycobacteria). It is hard to predict how deep a home user may end up traumatising their skin, whereas when it is performed by an accredited dermatologist, sterility of the instrument as well as proper technique is applied.

Dermarollers should NOT be used in patients with anyone with these following problems i.e. active acne, skin infection such as Herpes labialis or warts, chronic skin diseases such as eczema and psoriasis. Those with blood clotting abnormalities, or on anticoagulant therapy, chemo/radiotherapy are at high risk of bleeding and suffering rare infections using non-medical dermarollers.

Patients with keloidal tendency should also not use dermarollers.

Dermarolling may seem like a ‘less invasive’, easier or more novel option to traditional ways of treating acne scars, but it is definitely less effective than laser therapies. However, it has been used mainly in medical studies as a combination treatment with surgical/laser therapies to enhance results. It is also popular in darker skin types, as these patients can have a higher risk of developing hyperpigmentation as a side effect to ablative laser treatments, whereas microneedling does not seem to carry the same risk in such groups.

Dermarolling is only recommended when performed by an accredited dermatologist.  Even then, common side effects are redness and irritation (which usually subside within a few hours) and patients are often informed of the risks of scarring:  post-inflammatory hyperpigmentation, worsening of acne and reactivation of herpes, systemic hypersensitivity, allergic granulomatous reactions (such as sarcoidosis) and local infections following the use of a nonsterile instrument, such as home-use dermarollers. In addition, there have been reports of allergies to materials used in the needles. Improper technique, such as when performed by a non-medical professional, can result in worsened acne scars, and injury.

There is not yet clear data available to substantiate the length of time which effects of dermarolling could last. Also, depending on the severity of the condition and what dermarolling is used for, it is important to note that severe conditions such as ice pick or box car acne scars or photoaging will not have dramatic improvement effects from dermarolling alone, but will benefit from a combination of laser/injectables/cosmeceuticals with or without dermarolling. Skin healing goes through different phases and occurs differently at different ages, with individual genetic differences, which will all play a factor in determining how long and how dramatic the benefits of dermarolling and treatments in general will present.

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

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