Application of topical products prior to dermarolling can introduce immunogenic particles
into the skin, leading to hypersensitivity reactions 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 sore.
That’s right – exactly what you apply on your skin pre, during, and post-treatment could make all the difference between a poor or successful outcome.
So join us, as we explore the challenges around ingredients used during micro-needling whilst also trying to find a balance between the degree of injury, acceptable downtime, and the most effective outcome.
This article may also be relevant for those who have incorporated other modalities for skin rejuvenation into their wound-healing process such as ablative treatments, laser, resurfacing, and deep peeling.
We receive hundreds of emails about the side effects many people have received as a result of facial needling, a topic we discuss in greater detail in the article, “Microneedling, Beware“.
One of my clients, who would prefer to remain anonymous, reported chronic and persistent dryness, “orange-peel” texture, and fine lines, which all got progressively worse when she had applied the recommended skincare by her therapist.
As soon as I started using the product my skin had a protracted inflammatory reaction, which resulted in the skin healing as fibrotic tissue, also known as “micro-scarring” instead of normal, nice basketweave collagen”.
The adverse reaction my client had to the topical solution placed on the skin was at a time of maximal barrier function disruption; This is especially true within the first 24 hours; the early phase of healing.
Michelle from New Zealand wrote: Initaly my treatment was ok, the worst part seems to be the aftercare from the provider who pushed Retin-A on to me and Vitamin C, although my skin immediately flared up I continued to use as recommended as I thought this was part of the aftercare treatment. As a result, I now suffer histamine intolerance and constantly battle with perioral dermatitis flareups. I was finally approved antibiotics and non-corticosteroid Eilidel topical to stop the rashes. Two years after my microneedling nightmare, my skin still looks like it has been dragged through gravel. I really am at such a loss, I have lost all my confidence and my beauty has never recovered.
Less is best when it comes to needling ingredients
It makes sense then, that the ingredients you use on your skin should be carefully selected to avoid a negative outcome.
This is because your skin’s immune response is highly sensitive. The protective layer of your skin is composed of multiple layers of hard, keratinised cells that create an impermeable barrier that protects the deeper, living cells. When you commit to dermarolling, you are ignoring these basic physiological factors and making your skin vulnerable to whatever it comes into contact with.
Within the industry, there is a school of thought that because the channels are open immediately after dermarolling, the products applied during and after treatment are there for the express purpose of infusion. We believe this is completely wrong, as more and more people are referred to our clinic with skin problems and systemic illnesses as a result of needling. The recommended products used are just too active at a time of maximum barrier disruption.
As a result, a number of those clients have required serious treatment involving intravenous antibiotics, steroids, and immunosuppressive drugs. Symptoms include rashes, erythematous papules that form into plaques, fever, and erythema nodosum.
If you need more convincing, this article studies three women who developed facial granulomas following microneedling therapy for skin rejuvenation. Their reactions are thought to be secondary to the application of products “during” and “immediately” after treatment. This is a real cause for concern, especially in light of the multitude of products used more and more frequently without regard to ingredients.
The skin science
Let us first consider the physiology of the skin layers:
- The epidermis, which plays a critical role in protecting the body from the outside environment
- The dermis, the active layer that houses all the blood and nerve endings
- The hypodermis, the subcutaneous layer that gives rise to all the cells above it
The Stratum Corneum – the outer layer of the epidermis – has a brick-and-mortar structure in which corneocytes act as bricks, and intercellular lipids act as the mortar. These lipid structures protect us against foreign substances and harmful agents of all sorts, be they chemical or biological; it also prevents water loss through the epidermis.
Invasive treatments like needling disrupt the delicate microflora of the acid mantle and break down the protective barrier function. Where a longer needle depth is used, this can disrupt the dermis – where repeatedly testing the body’s immune system with harsh ingredients can lead to long-term consequences.
How does Micro-needling affect the Skin?
The procedure mimics the common “patch test” procedure, where a diluted drop of a substance is applied and the skin is then pricked with a small needle. After 15 minutes, the area is observed to see if a reaction occurs; if an allergy antibody is present, the skin flares up in a red, raised bump – the larger the surface, the greater the sensitivity.
Repetitive MICRO-INJURY of the epidermis is not dissimilar to patch testing; CHANNELS are OPENED in the skin, which INCREASES the ABSORPTION of topical SUBSTANCES beyond the natural protective surface. This is sustained over prolonged periods of time to achieve optimal results. INGREDIENTS interact with the CHEMICAL COMPOSITION of the skin 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 the skin’s integrity, thus creating inflammation, and on occasion, a pathological response such as granulomas (scar tissue), allergic responses, contact dermatitis, pain, and even loss of function – including speech or visual distortions and breathing difficulties.
A very real example of this is an allergy to nuts or bee stings – all it takes is a small amount of the toxin to enter the body to trigger anaphylaxis, a potentially deadly reaction.
We discussed the three stages of wound healing, and whether micro-needling actually works in this article.
So, What Should you Apply to your Skin?
So far, we have established that any time there is an injury to living tissue, the normal barrier function is dramatically reduced. If the injury is extensive, especially where there is a lot of pinpoint bleeding, then chances are that the protective barrier will be non-existent.
In view of this, to prevent friction and help with glide, we recommend only using saline or pure High Molecular Weight Hyaluronic Acid (HMW-HA) during the treatment.
We also recommend a cool-off period of several hours before applying anything to the skin, even when using a shallower cosmetic needle, as the period of vulnerability within the skin lasts for as long as the micro-perforations are open.
Even then, what you use should purely be for the purpose of “sealing” the skin, to prevent transepidermal water loss and replenish moisture. HMW-HA serves this purpose well – it is part of one’s normal physiology, it is film-forming, and it is known to be safe; providing you use one free from actives or additional ingredients that may house microbes.
Published studies show that any dermal absorption of ingredients risks triggering an immune response, which can vary from 15 minutes to a couple of hours, we recommend being more conservative and suggest waiting at least 24 hours to see how your skin responds.
Hyaluronic acid could just save your skin
Hyaluronic Acid is an important structural molecule, one of the key components of the connective tissue that our bodies make naturally. Because of this, it is unlikely to cause an allergic reaction.
Being a large molecule, it doesn’t penetrate and instead sits on the surface of your skin, where it binds to water to maintain hydration. Here, it cross-links with other Hyaluronic Acid molecules to knit together a temporary barrier while your skin heals. We emphasise high molecular weight, as low and medium weight have been known to cause a pro-inflammatory reaction.
After 36 hours, providing there are absolutely no side effects, you can consider introducing a very gentle moisturiser into your skincare routine.
Collagen synthesis requires the following ingredients, which are especially active on day five as that is when your skin’s fibroblast cells kick into high gear.
It is important to note that these can only be introduced into your skincare routine if your skin is not displaying any potential side effects from the treatment or inflammation.
- Vitamin A (Retinyl Palmitate, Retinyl Acetate, Retinol, or Tretinoin). Considered the gold standard anti-ageing treatment and the most well-researched ingredient in skincare, Vitamin A is a molecule that is naturally found in human biochemistry which causes the release of key growth factors. It amplifies the natural healing process, and can help with post-inflammatory hyperpigmentation – the blotchy darkening of the skin that can occur after micro-needling. It is really important to note here, that certain forms of Vitamin A can be irritating. For this reason, our A+ Retinoid Complex is formulated to be extremely gentle but effective.
- Ceramides and fatty acids for cellular function and membranes make up 50% of the uppermost layer of your skin. They replenish and repair the skin barrier, helping with healing.
- Gly-His-Lys (GHK) occurs naturally in our skin and as a widely-researched ingredient, a lot is known about its biochemistry. Copper peptides modulate multiple cellular pathways in skin rejuvenation; stimulating fibroblasts to produce good, “basket-weave” collagen and elastin. It also has positive effects on growth, regulation, and repair genes. It is both safe and effective, with anti-inflammatory effects on wound healing, inflammation, and tissue repair.
From our experience, there is an assumption that skincare companies only provide safe products that have been specifically formulated to combine with micro-needling treatment. This could not be further from the truth; the lack of regulation is an underlying weakness in measuring the true scope of the complications tied to products when combined with this treatment.
Naked Chemist recommendations
All of the following products contain ingredients that are found within the skin as part of one’s normal physiology. Just to reiterate, other than H2O, no products should be applied for at least 36 hours after treatment, and only once you are confident your skin has settled down.
- Miracle Cleanse, an oil-cleansing formula rich in fatty acids that removes makeup, dirt, and debris without stripping skin of its essential oils
- H₂O Hyaluronic Complex is the one formula we recommend pre, during, and post-treatment. Not only is it used to prepare your skin before treatment, but it also enhances “glide” during treatment. Used as aftercare it soothes, calms, and repairs. High molecular weight Hyaluronic Acid promotes rapid re-hydration within the upper layers of skin after the treatment.
- DNA Copper Peptide Complex helps to re-densify thin, fragile skin, and enhances volume within the upper layers, improving ageing and irritation. Relieves burns, bruises, scarring, and post-surgical redness.
- A+ Retinoid Complex gently increases skin renewal at the cellular level and stimulates blood flow. Enhanced with non-irritating retinol for maximum anti-ageing capability whilst mitigating the sensitising potential.
- Fortify Barrier Repair Moisturiser contains an array of fatty acids, ceramides, and cholesterol; ingredients naturally found within your skin’s tissues, which deeply nourish and restore the barrier function.
- Bio Lipid Complex is formulated with a number of skin-identical ingredients that help to repair and replenish, improving the texture of scars by making them softer and less visible. Super-antioxidants protect from free radicals that weaken the defences of your skin, aiding in wound healing and reducing inflammation.
- Ceramide Barrier Repair Balm has all the benefits of your daily moisturiser, but is supercharged to promote your skin’s natural repair process. Its combination of healing botanicals will leave your skin feeling smooth and hydrated.
Ingredients to Avoid
What you don’t use is just as important as what you do use on your skin.
One must remember that nearly all products have multiple ingredients and some contain non-degradable substances or microbes that have no place being “injected” into living tissue. These substances also provide a habitat for biofilms that are associated with antibiotic resistance and chronic infection, increasing the risk of allergies and contact dermatitis.
Needling increases the absorbed dose of your ingredients, so it is not surprising that side effects are magnified. Below are just some of the potential ingredients that can cause problems.
- Low Molecular Weight Hyaluronic Acid (LMW-HA): Because it is engineered to be fragmented, it is now thought to be a potent stimulus for inflammation and scarring.
- Acidic products: Glycolic, lactic, and salicylic acids are used in chemical peels to remove accumulating dead keratinocyte cells. They gain access to the skin’s deeper layers, which is just asking for trouble if your skin barrier is not intact.
- Snail growth factors: Mucus of snails certainly sounds like something out of Harry Potter, but the defensive mucus produced when a snail is under threat is often recommended for use in facial needling. This has resulted in some people developing nodular granulomatous dermatitis – little disfiguring gnarls of scar tissue in the skin, so a big “no!” in our book.
- Vitamin C: We are seeing an influx of people with major, deep skin problems – including acute inflammation and granulomatous dermatoses – that can last for years. Not due to the Vitamin C per se, but the other ingredients in Vitamin C formulas do appear to be causing a big issue, so we recommend avoiding the use of this product if you have had or are going to have dermarolling treatment.
- Vaseline: This contains mineral oil, which is not a human molecule and can cause foreign-body inclusion cysts to form.
- Preservatives: These are an essential part of skincare products. Typically, these ingredients have been known to cause trouble, which is all based on dosage and frequency of use. Look for formulas with more natural preservatives in them.
- Aloe Barbadensis Leaf Extract: This is another ingredient associated with granuloma conditions, which we feel may be due to microbial load within the ingredient.
- Anaesthetic toxicity is another issue, but because micro-needling typically requires multiple treatments, the potential for developing an allergic reaction to the anaesthetic is also of concern. As we discussed, allergic reactions can be life-threatening. Therefore, it makes sense to avoid topical anaesthetic whenever possible; applying ice or a cooling device should be considered a substitute for topical anaesthesia.
Other ingredients associated with allergy and irritation are fragrance, alcohol, essential oils, methylparaben, propylparaben, mineral oil, sorbitan sesquioleate, titanium dioxide, and benzyl peroxide.
Reactions to ingredients
- Granulomas: These are are a type of scar where the body tries to “wall off” foreign material that it is unable to eliminate.
- Low-grade inflammation: Not all inflammatory events are immediate – some are slower and may not cause the surface signs of redness and swelling for many weeks. Referred to as “sub-clinical”, this smouldering, low-grade inflammation wreaks havoc on the skin while not being visible. In actual fact, below the surface, inflammation is taking its toll on the matrix proteins and structural cells of the dermis. This is what is referred to in the industry as “skinflamm’ageing”, simply because it resembles the skin changes associated with ageing and accelerates the process. What is worse, is that it may be temporarily masking signs of ageing on the surface, because swelling caused by inflammation can distort the skin and reduce the appearance of lines and wrinkles. Incidentally, this is what happens with many products touted for “pore shrinkage”; they are usually so astringent that they actually distort the skin.
- Infections: Needling foreign ingredients into the deeper layers of the skin raises the risk of infection considerably, even when adequate precautions of pre-surgical skin cleansing have occurred. The answer seems to be due to a phenomenon called “biofilms”: harmful, pathogenic bacteria that can clump together and stick to foreign materials, which become covered in a “film” that protects them from being detected by the immune cells or antibiotics that would normally destroy them. Staphylococcus Aureus biofilm is a common offender. The take-home lesson from this is that needling foreign material into the skin affords “bad bacteria” on the surface and an opportunity to enter and set up home on the building blocks you have laid down for them.
- Contact Dermatitis: Irritant contact dermatitis evolves as a consequence of direct toxic effects from physical or chemical agents on the skin, resulting in keratinocyte damage and local inflammation.
- Post-Inflammatory Hyperpigmentation (PIH): This is perhaps the most commonly-reported serious side effect with micro-needling. There is nothing like a foreign body reaction to amplify the inflammatory cascade, which can be difficult to detect at first; the treatment, by its very design, causes a measured degree of damage resulting in hyperemia – the redness and swelling that commonly follow needling. Our philosophy is to keep inflammation out of the skin, which we believe is at the heart of all premature ageing. However, there is a school of thought that the normal, physiologic response to that damage is what brings the desired aesthetic result. Usually, things calm down within hours or a few days, depending on the needling depth and other treatment parameters including skin characteristics of the patient. If they do not follow the expected course, we suggest that something more insidious and pathological may be at play here and you should seek a second opinion.
- Scarring: Microneedling a patient with keloid scarring has the potential to make things worse. However, the scarring we are referring to here is different – whilst it may not be visible to the naked eye, the fibrous tissue will reduce the pliability of the skin. Scarring is directly proportionate to the inflammatory cascade of any wound-healing process. Thus, where foreign material is implanted, we can expect a chronic, low-grade inflammatory response which would lead to scar-type collagen accumulation over time.
- Cell Damage and Cancer: Particles that are deposited into the body – particularly metals – initiate oxidative stress; inducing redox-sensitive transcription factors associated with inflammation. The skin’s susceptibility to UV radiation is well documented. This is a vast topic that we touch upon in this article.
The Naked Truth
We feel it is necessary to point out that our recommendations are to be used as guidelines only; they are designed for our readers as we try to help them navigate the world of needling and avoid the possibility of adverse reactions or complications.
It is important to keep in mind that there is no such thing as the perfect product – what we mean by this is that it is impossible to formulate a product that does not include an ingredient with the potential to trigger an immune response or affect cell physiology adversely, so it is about weighing the benefits against the risks.
Needling is an invasive treatment that disrupts the acid mantle and breaks down the barrier function, opening channels in your skin which increases the absorption of topical substances. By repeatedly testing your body’s immune system with harsh ingredients, you are triggering an immune response that can lead to long-term complications.
This is why 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 you have no side effects, you can introduce a very gentle moisturiser back into your skincare routine. From there on, once you’re confident your skin has completely calmed down with no inflammation, you can start to add in ingredients such as ceramides, cholesterol, and copper peptides to begin to strengthen your skin and rebuild the barrier function.
It is really important that you avoid Vitamin C and a number of other formulas that can lead to potential allergies or granulose infections.
Finally, be sensible in your approach to your product selection. If you are not confident in what your therapist is recommending, then take a step back and just think, ‘less really is best’. Become your own label detective, read this article before embarking on this 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.
Fabbrocini G, Fardella N, Monfrecola A, Proietti I, Innocenzi D. Acne scarring treatment using skin needling. [PubMed]