Some ingredients introduce immunogenic particles during needling
that can cause hypersensitivity and irreversible damage
Dermarolling: it’s the collagen-inducing treatment that many swear by.
But the ingredients you use could make all the difference between plump and smooth or irreparably damaged.
That’s right – precisely what you apply on your skin pre, during, and post-treatment will make the difference between a poor or successful outcome.
This article will explore the challenges around ingredients used during micro needling.
We will examine what you should use on your skin directly after treatment.
And we’ll explore finding the balance between the degree of injury, acceptable downtime, and the most effective outcome.
This article is also relevant for those who have had other skin rejuvenation modalities, such as ablative treatments, lasers, resurfacing, or deep peels.
What our Clients have to Say
We receive hundreds of emails about the side effects of poor facial needling treatments, a topic we discuss in greater detail in the article, “Microneedling, Beware“.
Susan from Australia wrote: I had micro-needling and was given a topical Vitamin C product to use 24 hours after treatment. Initially, my skin looked calm, but after applying the Vitamin C product for three days, my skin developed a rash, five days in and my face started to swell and break out and became extremely painful; I was hospitalised and, after a biopsy, found that I had a granulomatous reaction. Three months later, the swelling has gone down, but the scarring has left me permanently disfigured.
Sarah from the USA wrote: As soon as I started using the product my skin had a protracted inflammatory reaction. My dermatologist explained that my skin had healed as fibrotic tissue, also known as “micro-scarring” instead of normal, nice basketweave collagen”. Its really devastating,
Michelle from New Zealand wrote: Initially, my treatment was ok, the worst part seems to be the aftercare from my aesthetician, Vitamin A. Lactic acid and Vitamin C on me. My skin immediately flared up, but I was told to continue using the products as this was part of my healing treatment. My skin looked like it had been dragged through gravel; I lost all my confidence and beauty. Fortunately, I came across the Naked Chemist, and it was explained to me that I was suffering from a histamine reaction. It has been a long road to get my skin under control, two years, infact! Quite why my aesthetician recommended applying these products with such active ingredients when my skin was impaired is beyond me; all this could have been avoided.
Take the approach less is best.
After reading these case studies, you can see how important it is to use the right ingredients on your skin to avoid a negative outcome because your skin’s immune response is highly sensitive at the time of barrier impairment.
Let us first consider the physiology of your skin layers:
The protective layer consists of multiple layers of keratinised cells, which creates an impenetrable barrier that protects the deeper, living cells.
The epidermis is the outer layer with a brick-and-mortar-like structure in which corneocytes act as bricks, and intercellular lipids act as the mortar.
These lipid structures protect you against foreign substances and harmful agents, be they chemical or biological; they also prevent water loss.
Invasive treatments such as skin needling, laser or harsh peels disrupt the delicate microflora that makes up your acid mantle, breaking down your protective barrier function and upsetting the pH balance.
When you commit to needling treatments, you ignore these essential physiological factors, exposing your skin to whatever it comes into contact with.
Within the industry, there is a school of thought that because the channels are open immediately after skin needling, the active ingredients applied during and after treatment will infuse into the deeper layers. Yet, we are seeing more and more people in our clinic with skin problems and systemic illnesses because of this.
We believe many of the recommended products contain ingredients that are too active to use during maximum barrier disruption.
As a result, some clients experience poor side effects such as orange peel texture, rashes, inflammation, erythematous papules forming into plaques, and erythema nodosum and granulomatous infections. Sometimes, they need intravenous antibiotics, steroids, or immunosuppressive drugs to heal their skin.
This study (1) looks at three women who developed granulomatous facial reactions after micro needling; the reactions are thought to be due to applying products “during” and “immediately” after treatment.
This is a subject we cover extensively in the article micro needling beware, and as you will see from all the comments on the page, it is a real problem.
Needling Mimics the Patch test Procedure.
In the industry, this procedure involves a diluted drop of a substance applied to the skin that is then pricked with a small needle. After 15 minutes, the area is observed to see if a reaction occurs – if an allergy or antibody is present, the skin flares up in a red, raised area – the larger the surface, the greater the sensitivity.
Repetitive MICRO-INJURY of the epidermis, your outer layer of skin, is not dissimilar to patch testing. CHANNELS are OPENED in your skin, which INCREASES the ABSORPTION of topical SUBSTANCES beyond the natural protective surface.
This is sustained over prolonged periods to achieve optimal results. INGREDIENTS interact with your skin’s CHEMICAL COMPOSITION and anything that it does not recognise as its own; it considers HARMFUL, triggering an IMMUNE RESPONSE.
Cytokines (communicating molecules) signal the immune system to send cells to the site of the injury as they try to repair your skin’s integrity, thus creating inflammation and, on occasion, a pathological response such as granulomas (scar tissue), allergic reactions, contact dermatitis, pain, and even loss of function – including speech or visual distortions and breathing difficulties.
A simple example is an allergy to nuts or bee stings – all it takes is a small amount of the toxin to enter your body to trigger anaphylaxis, a potentially deadly reaction.
What Should I Use on my Skin?
So far, we have established that any time there is an injury to living tissue, your barrier function is disrupted. If this damage is extensive due to a treatment like pinpoint needling, your protective barrier function will be impaired, so you don’t want to use anything irritating.
We recommend using saline or pure high molecular weight hyaluronic acid (HMW-HA) during treatment to prevent friction and help glide.
A cool-off period should last several hours before applying anything to your skin, even when using a shallower cosmetic needle. This is because your skin’s vulnerability period lasts for as long as the micro-perforations are open.
Published studies (2) show that any dermal absorption of ingredients triggers an immune response, varying from 15 minutes to a couple of hours. We recommend being more conservative and waiting at least 24 hours to see how your skin responds.
What you use should purely be for “sealing” your skin to prevent transepidermal water loss and replenish moisture which is where your high molecular weight hyaluronic acid (HMW-HA) comes into play.
This ingredient serves this purpose well because it is part of your skin’s normal physiology – it is film-forming and is known to be safe, providing you use one that does not contain actives or microbes – aloe vera and snail slime are examples of high microbial ingredients.
We emphasise the high molecular weight similar to ourH20 hyaluronic complex, as the low weight has been known to cause pro-inflammatory reactions.
Hyaluronic acid is an essential structural molecule, one of the critical components of the connective tissue that your body makes naturally. Because of this, it is unlikely to cause an allergic reaction.
Being a large molecule, it doesn’t penetrate easily and instead sits on the surface of your skin, where it binds to water to maintain hydration. It cross-links with other Hyaluronic Acid molecules to knit together a temporary barrier while your skin heals.
Once your skin has settled to continue with the healing phase, look for very gentle healing products that mimic the physiology of your skin containing skin-identical ingredients.
To conclude. The naked truth
Needling is an invasive treatment that disrupts your acid mantle and breaks down your barrier function, opening channels in your skin and increasing topical substances’ absorption; repeatedly needling harsh actives into the deeper layers of your skin can trigger an immune response that can lead to long-term complications.
From our experience, there is an assumption that skincare companies only provide safe products specifically formulated to combine with needling treatment and other modalities like lasers or peels.
Sadly, this could not be further from the truth; the lack of regulation that measures the true scope of the complications tied to products when combined with these types of treatment is an underlying weakness in the industry.
We recommend only using high molecular weight hyaluronic acid pre, during, and post-treatment. Being a large molecule, it sits on the surface of your skin, where it binds to water to maintain hydration and cross-links with other hyaluronic acid molecules to form a temporary barrier while your skin heals.
After 36 hours, providing your skin hasn’t reacted, introduce skin-identical ingredients to replenish, like ceramides, cholesterol, or copper peptides; these mimic the ingredients found in your skin and are extremely replenishing and barrier repairing.
You must avoid Vitamin C as this can cause unusually conditions such as orange peel texture, allergies and granulomatous infections.
Finally, be sensible in your approach to your product selection. If you are not confident in what your aesthetician recommends, then take a step back and think, ‘less is best.
Become your own label detective, read this case study on skin needling before embarking on your treatment and the other articles in the series, and ensure you do your research well.
Because as you can see, this is not a treatment to be taken lightly.
Razieh Soltani-Arabshahi. Facial allergic Granulotamous reactions. [Google Scholar]
Inflammatory responses and inflammation. [PubMed]