Dermapen® Treats Acne Scars with Low Incidence of Post Inflammatory Hyperpigmentation

Requiring only topical anesthetic, fractional micro-needle therapy with Dermapen® (Derma Pen LLC, Salt Lake City, Utah) is FDA registered and provides a safe, viable and repeatable alternative to energy-based modalities that may also be more cost-effective. Fractional microneedle therapy has an extremely low risk of complications, especially post-inflammatory hyperpigmentation (PIH). The device is about the size of a large felt-tip pen and features disposable single-use microneedle tips to prevent cross-contamination.

Fractional microneedle therapy works by the same basic principle as many aesthetic modalities in that controlled wounding stimulates the healing cascade to promote neocollagenesis and create thicker, healthier skin. This can be harnessed for a variety of indications, including acne scar revision. The difference lies not just in the way wounds are created, but in the way the body’s healing processes respond to this less traumatic injury.

Dermapen tips are festooned with an array of 11 surgical steel microneedles, with different penetration depths available between 0.25 mm and 2.5 mm. Unlike dermal rollers, Dermapen microneedles are driven vertically by a frequency-adjustable piston (up to 90 Hz) so penetration depth is independent of the operator, and thus more consistent from treatment to treatment. Micro Wounding is much less traumatic in comparison as well due to the vertical needle insertion, as opposed to dermal roller wounding which resembles more of a tear or dig.

The relative gentleness of Dermapen therapy, which contributes greatly to the almost nonexistent downtime seen with fractional microneedle therapy, makes it possible to repeat treatment almost without limit. Energy based modalities regularly employed to treat acne scarring are not so gentle in comparison, especially ablative fractional laser therapy. Tissue ablation and coagulation seen with energy-based therapies creates thermal damage which by nature is necrotic, which has been histologically shown1 to induce a more chaotic response with higher levels of inflammation. The relatively atraumatic wounding seen with Dermapen causes apoptosis, or programmed cell death, which stimulates a more regulated and orderly healing response1 featuring much reduced levels of inflammation, which in turn strongly mitigate the risk of PIH.

Regardless of the indication, lasers have always been difficult to use on patients with darker skin because dermal melanin serves as a competing chromophore, making it harder to create therapeutic thermal damage without increased pain or burning. And while fractional laser resurfacing has definitely improved since its inception, recent research into the modality has suggested its safety profile isn’t as strong as previously thought, according to a review article by Gold.2 Most notorious is the risk of PIH, especially in darker skin types or Asian skin, due to the induction of necrotic damage and resultant inflammatory cascade.

Much of the literature on fractional microneedle therapy deals with its use for acne scar revision. At this time no research has directly compared the safety and efficacy of Dermapen with fractional laser resurfacing for acne scarring or any other indication.

1. Ziegler U, Groscurth P. Morphological features of cell death. Physiology 2004;19:124-128.

2. Gold MH. Update on fractional laser technology. J Clin Asthet Dermatol 2010;3(1):42-50.