Comparative Evaluation of Therapeutic Efficacy and Safety of Microneedling Alone Versus Microneedling with Hyaluronic Acid in Post-Acne Scarring.

Background: Facial acne scars are perceived negatively by society; in an era where everyone wants to look their best, acne and its sequelae are a great source of stress driving down self-worth and elevating the risk of depression and anxiety. It affects over 95% of acne patients, particularly in nodulocystic, conglobate, and fulminans varieties. Various treatment modalities are available, but no single modality is 100% curative. Microneedling produces controlled skin injury, releasing various growth factors and setting up a healing cascade, and laying down collagen as a result. Hyaluronic acid plays an important role in wound healing by creating physiological conditions in the extracellular matrix for the proliferation, migration, and organization of dermal cells.

Aims and objectives: To compare the therapeutic efficacy and safety of microneedling alone and microneedling with hyaluronic acid in acne scars.

Materials and methods: Sixty patients of age 18-40 years with clinically diagnosed acne scars were recruited and randomly divided into two groups of 30 each. Three sittings were done at an interval of 3 weeks of microneedling alone to Group A and microneedling with hyaluronic acid to Group B and followed up with two visits 4 weeks apart. Scoring was done with Goodman Quantitative Global Scarring Grade System. Side effects, patient satisfaction score, and pre and postprocedure Dermatological Life Quality Index (DLQI) were also recorded.

Results: The female:male ratio was 3:2, mean age was 26.90 ± 4.90 years in Group A and 24.43 ± 5.39 years in Group B. Overall, 60% patients had a duration of 2-5 years, and unmarried patients outnumbered married ones in both groups. The combination morphology of the scars was the most common finding. In Group A mean Goodman Quantitative Global Scarring Grade System score reduced from baseline 24.13 ± 7.96 to 16.3 ± 7.2, and in Group B, from 27.73 ± 7.86 to 18.20 ± 7.12 at 17 weeks, this decrease was gradual and statistically significant. The patient satisfaction score for Group B (6.20 ± 1.45) was only slightly higher than that of Group A (5.73 ± 1.31). DLQI for Group A decreased from 7.77 to 4.10 and in Group B from 7.63 to 5.00. Both procedures were safe, with over 80% patients experiencing no side effects.

Conclusion: The majority of patients showed "moderate" improvement in both groups; however, more patients in microneedling with hyaluronic acid group showed "good" and "very good" results at the end of the treatment completion. These are easy, office-based procedures not requiring training or any high-end machine, especially useful in resource-limited setups; the use of hyaluronic acid can enhance the efficacy of microneedling alone.