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<p>Atrophic acne scars are frequent and lasting complications of acne vulgaris and may significantly impact both cosmetic results and psychosocial functioning. Microneedling (MN) is a commonly employed technique to stimulate dermal remodeling, and topical insulin has been suggested as a low-cost additive due to its wound repair properties. This systematic review and meta-analysis examined the efficacy of topical insulin in conjunction with MN on outcomes of post-acne atrophic scars versus microneedling plus other adjuncts or controls. We conducted a comprehensive search across PubMed, Scopus, and Web of Science from their inception to January 2026 to identify comparative studies of topical insulin added to MN compared with MN combined with other adjuncts or controls in adult patients with post-acne atrophic scars. We performed random-effect meta-analyses using R (version 4.5.2). Twelve studies involving 566 patients were included. Eight studies contributed to the primary meta-analysis. MN plus topical insulin did not significantly improve scar severity versus controls (SMD = 0.01, 95% CI [− 0.20 to 0.23]; <i>p</i> = 0.907; I² = 25.8%). Subgroup analysis showed no significant comparator interaction (<i>p</i> = 0.467), and leave-one-out analysis did not materially change the estimate. Satisfaction outcomes were also comparable: excellent (RR = 1.01, 95% CI [0.13 to 7.65]; <i>p</i> = 0.995; I² = 85.7%), good (RR = 1.05, 95% CI [0.43 to 2.58]; <i>p</i> = 0.918; I² = 58.8%), fair (RR = 1.31; <i>p</i> = 0.521), and poor (RR = 0.95; <i>p</i> = 0.928). Qualitative evidence generally suggested greater improvement with insulin-assisted MN. These findings were limited by inconsistent outcome reporting. There was no significant additional benefit of using topical insulin in combination with MN for atrophic acne scars and satisfaction was comparable, although some individual studies reported favorable outcomes which should be interpreted with caution. There is a need for larger standardized trials with validated clinician- and patient-reported outcomes to better elucidate any incremental value.</p>

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Topical insulin as an adjunct to microneedling for atrophic acne scars: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Ibraheem Altamimi,
  • Abdulelah Alqahtani,
  • Abdulaziz Saad AlQuhaibi,
  • Turki Saeed Alkahtani,
  • Lojain Abdulsalam Alkhaldi,
  • Hajar Abdullah Alanazi,
  • Fares Fahad Alammari,
  • Atheer G. Almutairi,
  • Turki Alahmari,
  • Abdullah M. Alharbi,
  • Renad Ibrahim Alsulaiman,
  • Osama Talal S. Alanazi,
  • Khuzama Alfalah

摘要

Atrophic acne scars are frequent and lasting complications of acne vulgaris and may significantly impact both cosmetic results and psychosocial functioning. Microneedling (MN) is a commonly employed technique to stimulate dermal remodeling, and topical insulin has been suggested as a low-cost additive due to its wound repair properties. This systematic review and meta-analysis examined the efficacy of topical insulin in conjunction with MN on outcomes of post-acne atrophic scars versus microneedling plus other adjuncts or controls. We conducted a comprehensive search across PubMed, Scopus, and Web of Science from their inception to January 2026 to identify comparative studies of topical insulin added to MN compared with MN combined with other adjuncts or controls in adult patients with post-acne atrophic scars. We performed random-effect meta-analyses using R (version 4.5.2). Twelve studies involving 566 patients were included. Eight studies contributed to the primary meta-analysis. MN plus topical insulin did not significantly improve scar severity versus controls (SMD = 0.01, 95% CI [− 0.20 to 0.23]; p = 0.907; I² = 25.8%). Subgroup analysis showed no significant comparator interaction (p = 0.467), and leave-one-out analysis did not materially change the estimate. Satisfaction outcomes were also comparable: excellent (RR = 1.01, 95% CI [0.13 to 7.65]; p = 0.995; I² = 85.7%), good (RR = 1.05, 95% CI [0.43 to 2.58]; p = 0.918; I² = 58.8%), fair (RR = 1.31; p = 0.521), and poor (RR = 0.95; p = 0.928). Qualitative evidence generally suggested greater improvement with insulin-assisted MN. These findings were limited by inconsistent outcome reporting. There was no significant additional benefit of using topical insulin in combination with MN for atrophic acne scars and satisfaction was comparable, although some individual studies reported favorable outcomes which should be interpreted with caution. There is a need for larger standardized trials with validated clinician- and patient-reported outcomes to better elucidate any incremental value.