Topical therapy plus microneedling safe, effective in melasma management

Use of microneedling appears to be a beneficial adjunct to topical medications in the treatment of melasma, suggests a recent study.

A group of investigators conducted a systematic review and meta-analysis using the PRISMA guidelines. They identified all comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma. Those involving radiofrequency microneedling were excluded from the analysis.

Twelve studies met the eligibility criteria. A total of 459 patients from seven different countries were included. Topical therapies used were as follows: tranexamic acid, vitamin C, platelet-rich plasma, nonhydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents.

Topical therapy plus microneedling led to improvements in melasma severity, with a large effect (standardized mean difference >0.8) beyond 8 weeks and best results at 12 weeks. Compared with topical therapy alone, combination treatment with microneedling further improved melasma severity, with a moderate effect at 8 weeks and a large effect at 12‒16 weeks.

Microneedling was well-tolerated across studies and showed no serious adverse events.

The study was limited by heterogeneity in research designs, which did not allow for a comparison of the efficacy of various topical therapies with microneedling.

“Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma,” the investigators said.