الفهرس 
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Abstract
Summary and Conclusion
Acne vulgaris is a prevalent skin condition that affects the pilosebaceous unit and is observed in 80% of teenagers. Acne can lead to face scars and cause psychological stress.
Minimally invasive treatments are techniques employed to repair scars. They improve the dermal extracellular matrix (ECM) proteins without removing the epidermis, therefore reducing adverse effects and lowering recovery time. Microneedling is widely recognized as the most proven and successful method for treating atrophic post acne scars, gaining popularity worldwide.
Microneedling, also known as percutaneous collagen induction, is a minimally invasive procedure that involves the use of microneedles to create thousands of microwounds in the dermis by penetrating through the epidermis. These wounds trigger the wound healing process, leading to the release of various growth factors that stimulate the migration of fibroblasts and the formation of new collagen. As a result, microneedling can be utilized for the treatment of various skin conditions and as an additional method for managing post acne atrophic scars.
Microneedling is regarded as a straightforward, uncomplicated, secure, and cost-effective technique for stimulating collagen production. It may be performed using various instruments such as a tattoo gun, dermastamp, dermaroller, dermapen, and others.
Several factors influence the effectiveness of the microneedling treatment, including patient-related factors, operator-related factors, the specific microneedling device utilized, and the operation itself. Factors connected to the patient include pre-procedure subject preparation, phototype, and the type and severity of the disease. The dermatosurgeon’s efficiency and skill are additional crucial factors. The success and efficacy of the microneedling procedure are influenced by several important factors related to the device and technique used. These factors include the number of sessions, the interval between sessions, the use of combination treatments, the specific device selected, the length of needles, the number of passes, the extent of injury, and the applied pressure.
The Dermapen is a pen-shaped automated instrument used for microneedling. This device utilizes disposable needles and guides to precisely alter the length of the needle for fractional mechanical resurfacing. The tip is composed of a variable number of needles, ranging from 9 to 36, which are organized in rows. It utilizes a rechargeable battery to function with a vibrating stamp-like motion.
Platelet-rich plasma (PRP) is a substance made from a person’s own platelets that have been concentrated in plasma. Platelet-rich plasma functions by the degranulation of platelet granules, which house the produced and prepared growth factors. Fibroblasts amass and initiate the deposition of collagen. Activated platelets secrete various growth factors, cytokines, and chemokines, such as vascular endothelial growth factor, platelet derived growth factor, epidermal growth factor, fibroblast growth factor, transforming growth factor-b, insulin-like growth factor, IL-8, macrophage inflammatory protein-1a, and platelet factor-4. The utilization of Platelet-Rich Plasma (PRP) is increasingly widespread in the domain of dermatology. The addition of platelet-rich plasma (PRP) to microneedling has varying outcomes.
Vitamin C enhances and stimulates the process of tissue regeneration and the formation of new collagen. It functions as a co-factor for the proline and lysine hydroxylases, which help fix the tertiary structure of the collagen molecule. Additionally, it stimulates the production of collagen genes.
Insulin shows promise as a new and effective therapy for reducing scarring. However, further research is needed to determine the specific characteristics of individuals who are most likely to benefit from this treatment, as well as to identify the most effective method of delivering the insulin formulation.
Application of topical insulin has been demonstrated to enhance and facilitate wound healing by regulating the inflammatory response and reducing tissue levels of reactive oxygen species (ROS). Furthermore, the use of topical insulin for wound treatment has been demonstrated to effectively remove necrotic tissues by attracting neutrophils and promoting the movement and ingestion of macrophages.
Combination therapy refers to the use of two or more distinct treatments in order to enhance results and increase the capacity to tolerate treatment.
The objective of this split-face research was to assess the effectiveness of microneedling using a dermapen combined with topical vitamin C, compared to microneedling with topical insulin and microneedling with platelet-rich plasma (PRP), in the treatment of atrophic post-acne scars.
The current study examined 40 individuals who reported post acne atrophic scars. They were divided into two groups of equal size. group I consisted of 20 patients who used dermapen with topical PRP on the right side of their face and dermapen with topical Insulin on the left side. group II included 20 patients who used dermapen with topical vitamin C on the right side of their face and dermapen with topical Insulin on the left side. Both groups underwent microneedling treatment on both sides of the face, with 6 sessions spaced 2 weeks apart, using a 1 mm needle length.
Every patient underwent a comprehensive process that included obtaining a complete medical history, doing a thorough assessment of the entire body and specific areas, capturing photographs of the face before and after needling sessions, and performing a punch biopsy at the initial stage.
After undergoing 6 treatment sessions, all patients with atrophic acne scars in both groups exhibited clinical improvement on both sides of their face. However, there was a somewhat more substantial improvement observed on the left side while utilizing dermapen with topical Insulin.
Both groups had no adverse effects save for mild discomfort, temporary redness, and swelling following each session.
In the current study, both groups exhibited acanthosis in the epidermis and well-organized keratinocytes during histological examination conducted two weeks after treatment. There was a substantial and meaningful increase in the thickness of the epidermis following treatment with dermapen and topical application of Insulin. Concerning collagen bundles, there was an augmented accumulation of collagen bundles, which exhibited a more refined and orderly structure with reduced gaps between the fibers, as opposed to the chaotic bundles observed initially.The therapy with dermapen and topical Insulin resulted in a substantial enhancement of collagen and elastin character and distribution.
Type I collagen is more abundant than type III collagen in a mature PAS. Following microneedling, collagen is deposited in the typical lattice arrangement, while growth factors from PRP enhance the healing process of PAS. Application of topical insulin stimulates the activation of phosphatidyl inositol 3-kinase (PI3K)/ protein kinase B (Akt) pathways, leading to an increase in vascular endothelial growth factor y type III. This rise is observed in a basket weave-like pattern in normal skin, as opposed to a crisscross pattern in scar tissue. Therefore, the combination of PRP or insulin with microneedling enhances the enhancement in PAS.
Conversely, the utilization of many procedures has demonstrated greater advantages and is recommended over the use of a single process (such as dermapen alone).
Ultimately, microneedling is widely regarded as a straightforward, secure, and efficient technique for skin rejuvenation. Although most volunteers demonstrated significant improvement after treatment based on clinical and histological evidence, the combined application of dermapen with topical Insulin takes precedence over the use of dermapen with PRP or dermapen with Vit C for volunteers with postacne atrophic scars. However, it is worth noting that both combinations are effective.
Nevertheless, achieving the intended outcome typically requires numerous sessions. In certain instances, it may be advisable to consider the concurrent use of other therapies or topical substances with microneedling in order to augment its efficacy.
Additional comprehensive, extensive, and meticulously planned objective trials, encompassing a larger patient cohort and an extended follow-up period, are necessary to assess the ideal duration of treatment required to obtain the best possible outcomes and to objectively evaluate the efficacy of microneedling in dermatological therapy.