Abstract
Background: Post-inflammatory hyperpigmentation (PIH) and atrophic acnes scars are severe physiological consequences of acne vulgaris and they often lead to major psychological distress. Although there are many dermatological procedures such as superficial chemical peels and mechanical percutaneous collagen induction, comparative data on the comparative efficacy and safety of these two procedures especially in patients with melanin-rich skin phenotypes is a crucial field of clinical inquiries.
Objectives: To compare clinical efficacy, patient satisfaction and safety of microneedling and glycolic acid peeling in treatment of atrophic acnes scarring.
Methodology: A comparative clinical trial was carried out with 40 participants (mean age 26.97 ± 4.90 years) who presented with predominantly rolling and boxcar atrophic scars and Fitzpatrick Skin Types III-V. The subjects were randomly and equally split into two treatment groups (Group 1 (n=20) and Group 2 (n=20)) whereby, Group 1 received the assessments of efficacy were conducted after 4 months follow-up period on the standardized scales of scar severity and pigmentation 1-10 clinical grading scales. With the help of the SPSS 27.0, statistical analysis was conducted, with paired t-tests, independent t-tests, and linear regression.
Results: The clinical improvements of both interventions were highly significant (p < 0.001) within-group improvements. Nevertheless, between-group comparisons indicated that the microneedling had a statistically better absolute mean of reduction of scar severity over the glycolic peel (3.15 vs. 2.10 points; p < 0.001). Moreover, microneedling was much more effective in the removal of concurrent hyperpigmentation (3.30-point improvement compared to 1.45-point improvement; p < 0.001). In terms of safety, the glycolic peel group had a significantly higher rate of PIH due to treatment (40) than the microneedling group (15%). There was no significant difference in subjective patient satisfaction scores in both cohorts (p = 0.212).
Conclusions: Microneedling is better clinically and statistically than 35% glycolic acid peeling in terms of structural reduction of atrophic acne scars as well as clearance of coexisting dyschromia. Micro-needling also has a better safety profile, as it conserves the epidermal barrier, and thus is the best evidence-based modality to use in revising acne scars across a wide range of skin phenotypes.