Clinical and histopathological evaluation of percutaneous collagen induction (dermaroller) in the treatment of postacne scars

Background Despite appropriate and effective treatment of acne, scarring occurs in patients irrespective of the severity of acne. A single perfect treatment for atrophic acne scars has not yet been developed. Skin microneedling or collagen induction therapy is a new addition to the therapeutic options for such scars. Objective To objectively evaluate the efficacy of the dermaroller, both clinically and histopathologically, in the treatment of atrophic postacne scars. Patients and methods Thirty patients with skin phototypes III and IV with rolling, boxcar, and ice pick acne scars were treated with 1.5mm dermarollers at monthly intervals for five sessions. Assessment was performed at the start and 8 weeks after the end of therapy. Assessment was performed clinically, with histopathological evaluation after staining with hematoxylin and eosin, Masson trichrome stain, and silver stain, together with patient self-assessment. Results After five sessions, rolling and boxcar scars showed excellent and good clinical responses in 20 and 70% of patients, respectively. Ice-pick scars showed only a slight improvement. No side effects, apart from pain during the procedure, and temporary erythema were reported. Hematoxylin and eosin stain indicated a 50% increase in epidermal thickness, markedly increased number and density of dermal collagen fibers, and reduced interfibrillary spaces with a linear orientation of collagen fibers. Masson’s trichrome stain showed a 53.2% mean increase in the collagen fiber content in the papillary dermis in all patients and silver stain showed a mean increase of 65.4% in the number and density of elastic fibers, both with improved arrangement. Conclusion The percutaneous collagen induction therapy offers an effective and safe treatment modality for rolling and boxcar acne scars.