Efficacy and safety of microneedling with topical insulin compared with placebo in the treatment of atrophic scars: a prospective study and literature review

Abstract Background Atrophic scars, which affect many individuals and arise from various causes, currently lack a standardized treatment protocol. Recent studies suggest that combining microneedling with topical insulin (TI) may offer a promising new approach to improving the appearance of these scars. Objectives To evaluate the efficacy and safety of microneedling combined with TI for treating atrophic scars caused by acne, cutaneous leishmaniasis, striae alba and postoperative wounds. Additionally, we aimed to assess the impact of treatment on improving quality of life. Methods A total of 158 patients with various types of atrophic scars were divided into two groups: one received microneedling with TI and the other received microneedling with a placebo. Each participant underwent 12 monthly sessions, followed by a 1-year follow-up to assess long-term outcomes. Primary outcomes were measured via the Goodman and Baron qualitative grading system and acne scarring grading system, along with patient satisfaction and Dermatology Life Quality Index scores. Results A statistically significant improvement was observed in the TI group, as reported by patients and clinicians, especially regarding postacne and postleishmaniasis scars (P = 0.001). The improvement in quality of life was most pronounced in the postacne group (P = 0.002). Conclusions This study suggests that microneedling, when combined with TI, is a safe and effective standalone treatment for atrophic scars resulting from various causes. Additionally, this approach may enhance the quality of life for patients with this condition. However, further research with larger sample sizes is needed to validate these findings.