Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma.To conduct a systematic review and meta-analysis on the efficacy of topical therapy with microneedling in the treatment of melasma.This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded.Twelve eligible studies comprising 459 patients from seven different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (SMD>0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well-tolerated across studies, with no serious adverse events reported.Heterogeneity in study design did not allow for a comparison of the efficacy of various topical therapies with microneedling.Microneedling is a safe and effective adjuvant to topical therapies in melasma.
Adrian Joseph Michel Bailey, Heidi Oi-Yee Li, Marcus G Tan, Wei Cheng, Jeffrey S Dover