08 Mar Why Hyperpigmentation Caused by Microneedling
The question as to whether hyperpigmentation occurs due to microneedling is brought up repeatedly. The obvious question is that if “post-inflammatory hyperpigmentation” (PIH) is common in darker skin types, why would needling not be considered “high risk” in these patients, given that inflammation results with needling? The answer hinges around the degree and duration of inflammation. This response is typically not prolonged, nor is it as intense after needling when compared to other treatment modalities. Microneedling stimulates production of TGF-B3 which has anti-inflammatory effects. It also stimulates TGF-B1 which restricts pigment formation through downregulation of tyrosinase via decreased gene expression as well as decreasing its intracellular half-life. Also, anti-inflammatory skincare ingredients, such as phosphatidylcholine, typically used in conjunction with needling, limit the inflammatory response. There are other mechanisms due to microneedling that normalize pigment formation as well which I won’t discuss here.
The problem with hyperpigmentation is that there are so many variables and it is almost impossible to determine underlying cause with complete certainty. It usually involves multiple factors. Yes, there are the typical causes which we tend to focus on, such as sun exposure, PIH, smoking, genetics, hormones, photosensitizing meds and skin care products, etc., but the list is too extensive to include here, though some lesser known causes are discussed below.
Microneedling is touted as being colorblind, though it is the microneedling PLUS…..and you can fill in the blanks with chemical peels, photosensitizers, sun exposure, etc. that results in hyperpigmentation. Microneedling is never done in isolation. Life happens. Avoiding sun exposure is virtually impossible in the weeks following treatment. Women have hormones that influence melanogenesis. Many people are on medications which cannot be discontinued that are photosensitizers. Higher Fitz patients are exceptionally capable of producing pigment, and once we have awakened the sleeping giant with rejuvenation treatments, all the traditional treatments for pigmentation, such as IPL, Laser, and Chemical Peels, provoke a perturbed cell even more.
In summary, Microneedling in isolation regulates and normalizes pigment formation, both at a melanocyte and keratinocyte level. It does not cause hyperpigmentation without other influencing factors.
In essence, microneedling is a proven treatment for optimizing skin health that is superior in many ways to other treatment modalities, but, like most things in life, it has its limitations. In our quest for maximizing results beyond these limitations we often try to amplify the positive effects by adding other treatment modalities, forgetting that microneedling may also amplify the negative effects of these treatments through increased absorption or inflammation. Frequently these problems arise when pushing the envelope while trying to compete with practitioners that have greater scope of practice in an attempt to equal their results. A good example of this is when aestheticians use a cosmetic roller and occlusion to enhance penetration of topical anesthetic, thus converting an OTC product into a “drug” that would normally require a prescription to attain those levels of effectiveness. This defeats the purpose of imposing dose level restrictions and removes the very protection it was supposed to afford the practitioner (and client/patient) according to their level of ability and responsibility should an emergency occur, such as cardiac arrest.