Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis - 12/05/21

Doi : 10.1016/j.jaad.2021.03.116

Adrian Joseph Michel Bailey, BSc ^a, Heidi Oi-Yee Li, BSc ^a, Marcus G. Tan, MD ^a,^b, Wei Cheng, PhD ^c, Jeffrey S. Dover, MD, FRCPC ^d,^e,^f,^⁎
^a Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
^b Division of Dermatology, The Ottawa Hospital, Ottawa, Ontario, Canada
^c Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
^d SkinCare Physicians, Chestnut Hill, Massachusetts
^e Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
^f Brown Medical School, Providence, Rhode Island

^∗Correspondence to: Jeffrey S. Dover, MD, Yale University School of Medicine, 1244 Boylston Street, Suite 103, Chestnut Hill, MA 02467.Yale University School of Medicine1244 Boylston Street, Suite 103Chestnut HillMA02467

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Abstract

Background

Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma.

Objective

To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma.

Methods

This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded.

Results

Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported.

Limitations

Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling.

Conclusion

Microneedling is useful adjuvant to topical therapies for the treatment of melasma.

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Key words : ascorbic acid, chemical peels, hydroquinone, laser, melasma, meta-analysis, microneedling, skin of color, systematic review, topical therapy, vitamin c, tranexamic acid

Abbreviations used : AE, RCT, MASI, SD, SMD, TXA

Plan

	Authors Bailey, Li, and Dr Tan are cofirst authors.
	Funding sources: None.
	IRB approval status: This study met the definition of Institutional Review Board exempt research.