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

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.