Percutaneous collagen induction (microneedling) for the management of non-atrophic scars: literature review

Abstract

Introduction: Percutaneous collagen induction (PCI) or needling techniques are increasingly popular in the reconstructive and aesthetic arena. The underlying mechanisms of action rest on producing a pattern of non-ablative and non-confluent puncture wound pattern to the dermis with a resulting regenerative effect to the skin. Methods: A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to level of evidence as well risk of bias. Results are presented in descending order of evidence for non-atrophic scars. Discussion: On the basis of level 1 evidence currently available, the combination of needling and silicone gel can improve the short-term pliability, height and vascularity of hypertrophic and keloid scars. According to level 2 evidence, needling alongside spray keratinocytes can produce a statistically significant improvement to patient/observer scar ratings and improve pigmentation in hypopigmented burn scars at 12-month follow-up. Results from mixed cohort studies also point towards needling having a beneficial effect on fat graft retention. Level 3 data suggest that needling can render significant resurfacing effects to both mature and actively hypertrophic burn scars at 12-month follow-up based on objective scar scales; furthermore, favourable histological changes are seen, including better collagen alignment in the dermis and increased epidermal thickness. Conclusion: Needling techniques are promising adjuncts to non-atrophic scar management. Further research with long-term follow-up and comparative design protocols incorporating other resurfacing modalities is warranted before the exact value of needling is delineated in scar management protocols. Lay Summary Needling techniques are increasingly popular and involve the use of a device to produce numerous tiny perforations in the skin, stimulate collagen production and resurface the treated area. We undertook this study to find out whether the use of needling can have a beneficial effect on scars that are raised (hypertrophic and keloidal). We conclude that, at present, there is some evidence that needling in combination with silicone gel can improve the appearance of bulky scars in the short term; additionally needling can enhance the appearance of discoloured burn scars if used in combination with spray skin cell preparations and improve the take of fat transferred to the treated area. There are also a number of studies that have confirmed the beneficial effects of needling in the architecture of treated skin, which include improved skin structure and increased collagen production. Further research is eagerly awaited to determine the exact position of needling techniques in scar management protocols.