Microneedling for the treatment of hair loss

Microneedling, also known as Collagen Induction Therapy (CIT), is a minimally invasive cosmetic procedure that is frequently employed to address multiple dermatologic conditions, especially age-related concerns. This relatively popular therapeutic modality gets its name from the use of microneedles to promote increased collagen production in the skin. The more recent data suggest that along with anti-aging treatment, micro-needling can also provide beneficial results in patients suffering from hair loss. The therapy is proposed to induce neovascularization (blood vessel formation), collagen production, and increased growth factor activity in the treated areas. 

Currently, microneedling is being offered to manage and treat two common hair loss conditions: androgenetic alopecia (AGA) and alopecia areata. It is also believed to enhance the absorption of other hair growth-promoting medications, such as minoxidil, platelet-rich plasma, and topical steroids. The size of the needles can range from less than 1 millimeter to a few millimeters in length.

How does Microneedling help fight hair loss?

Microneedling hair lossThe mechanism of action of the microneedle is through creating sterilized micro-injuries over the skin. Repeated micro-injuries are than associated with the following benefits:

  • Increased collagen production and reorganization are observed in the treated area. This helps in the dissolution of fibrosis, that is disorganized connective tissue, replacing it with a more organized layer.
  • Microneedling also stimulates increased protein production and uptake, especially those essential for the hair growth cycle, such as platelet-derived protein and fibroblast growth factor.
  • It is also linked with improving absorption of topical medications due to the micro-tears created in the dermis and subcutaneous.
  • Similar to its effect on the skin when used to treat acne scars, microneedling also promotes the activity of stem cells to replicate rapidly.
  • Together these changes translate into accelerated hair growth. Today, it is considered as a potential alternative or adjunctive treatment for androgenic alopecia and alopecia areata.

Can it cause scarring?

Microneedling, when carried out by professionals following proper protocols and using correct instrumentation, does not produce any significant scarring. This because the skin penetration is only deep enough to induce healing, however, in cases in which excessive pressure or larger needles are used, it may cause scarring.

Microneedling to treat alopecia areata?

Multiple studies have demonstrated the efficacy of microneedling therapy to treat alopecia areata, a chronic autoimmune disorder that causes excessive patchy hair loss. It is estimated that the condition causes premature hair loss in approximately seven million US citizens alone. Research has proven that the use of corticosteroid (triamcinolone acetonide), the mainstay of treatment in adjunct to microneedling, induces new hair growth in patients suffering from the condition.

Microneedling to treat androgenetic alopecia?

Androgenetic alopecia, or the gendered defined pattern hair loss, is a highly prevalent hair loss condition, that is associated with hormonal dysregulation. The treatment is therefore targeted against the specific hormonal receptors present on the scalp and includes medications such as minoxidil and finasteride, both having an efficacy rate of 60% and 30 % each. Studies demonstrate the use of microneedling may enhance the effectiveness of these topical medications up to 2-3 folds by increasing their absorption. Two separate studies demonstrated the efficacy of microneedling as an adjunct therapy to 5% minoxidil and found a 25% and a 40% increase in hair count when microneedling was performed once every fortnight and once weekly, respectively. 

Another pilot trial carried out in 2013, followed two groups of patients suffering from androgenetic alopecia with one group receiving treatment with minoxidil and microneedling, and the other with 5% minoxidil alone. A seven-point scale was employed to measure the therapy response in both groups. By the end of 12 weeks, it was found that the microneedling group demonstrated a significant increase in mean hair count (+91) in comparison to the Minoxidil-only group (+17).

Microneedling at home?

There are few options commercially available to perform microneedling at home:

Derma roller:

A derma roller is the most popular, widely available, microneedling tool used at home. It consists of a microneedle laden circular tube attached to a handle which easily rolls over the scalp. 

Derma stamp and derma pen:

Unlike the derma roller, derma pen and derma stamp are more sophisticated tools that provide more targeted treatment. These smaller tools are also safer to use as they are less likely to damage the hair follicle by pulling their roots. 

Although microneedling is a minimally invasive procedure, it is frequently advised to get it done by a medical professional rather than doing it at home.

Side effects of microneedling on the scalp?

Although microneedling is considered a relatively safe procedure, it may present with minor complications such as:

  • Bruising,
  • Irritation,
  • Redness,
  • Oozing from the wounds,
  • Swelling,
  • Pain,
  • Infection
  • And, in rare cases, scarring if the skin is deeply penetrated. 

Mild redness and inflammation is the most common aftermath observed with the procedure, although it tends to resolve completely within four to five days. Application of topical medication such as minoxidil with microneedling may also cause patients to experience more burning, irritation, and itching due to increased absorption of the drug. Similarly, individuals with comorbidities affecting the rate of healing, such as diabetes, eczema, acne, or on blood-thinning medications, may experience some delay in symptom resolution.

Patients with active scalp lesions are advised against using a derma roller unsupervised by a medical practitioner. Lastly, the sharing of microneedles or derma rollers is strictly prohibited as it leads to the transmission of infections from one individual to another.

Conclusion

From the above-discussed literature, it can be safely concluded that microneedling is an effective and affordable measure to fight hair loss and stimulate hair growth. Furthermore, when used in combination with other hair loss treatments such as minoxidil or corticosteroids, it may also prevent the severe hair loss seen in androgenic alopecia and alopecia areata.

 

References

Dhurat R, Sukesh MS, Avhad G, Dandale A, Pal A, Pund P. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. International journal of trichology. 2013 Jan;5(1):6.

Chen D, Jarrell A, Guo C, Lang R, Atit R. Dermal β-catenin activity in response to epidermal Wnt ligands is required for fibroblast proliferation and hair follicle initiation. Development. 2012 Apr 15;139(8):1522-33.

Jeong K, Lee YJ, Kim JE, Park YM, Kim BJ, Kang H. Repeated microneedle stimulation induce the enhanced expression of hair-growth-related genes. Int J Trichology. 2012;4(2):117-30.

Tosti A, Duque-Estrada B. Treatment strategies for alopecia. Expert Opinion on Pharmacotherapy. 2009 Apr 1;10(6):1017-26.

Chandrashekar B, Yepuri V, Mysore V. Alopecia areata-successful outcome with microneedling and triamcinolone acetonide. Journal of cutaneous and aesthetic surgery. 2014;7(1):63.

Majid I. Microneedling therapy in atrophic facial scars: an objective assessment. Journal of cutaneous and aesthetic surgery. 2009 Jan;2(1):26.