Breaking Down the Research: Dermarolling Considerations for People of Color

First, a definition: for the purposes of this post, when we’re talking about ‘People of Color’ we’re talking about it from a dermatological standpoint. PoC has a social or sociological definition that is not necessarily the same as how we’re talking about it here–for example, an Italian woman with deep skin might be classed as a Fitzpatrick 4 (more on this in a second) even though she wouldn’t consider herself a PoC; likewise, a Black man with light skin might consider himself a PoC but be a Fitzpatrick 3. It is not at all my place or intention to comment on anyone’s identity by using this term in the title–it is just a useful if imprecise catchall term for a variety of deep skin tones.

A more precise way to talk about skin tones is the Fitzpatrick scale, which sorts skin tones into a six-grade scale based on tone and general skin reaction to the sun. 1 is the palest, reflecting those who always burn and never tan; six is the deepest, reflecting those who never burn or freckle and always tan. The Fitzpatrick scale was developed to assess skin cancer risk, but it also divides patients into types one through three, who are likely to develop redness after skin inflammation or trauma (post-inflammatory erythema) and types four through six, who are likely to develop dark spots or hyperpigmentation after that same type of skin inflammation (post-inflammatory hyperpigmentation). If you found your way to this website, you almost certainly already know which of these you are prone to!

microneedling dark skin tones

Why microneedling for skin of color?

Skin of color is under-served in the skincare and skin treatment market, and under-researched in dermatology. Many lasers are not optimized for skin of color, and the deeper the skin tone, the fewer options there are for chemical peels or for laser resurfacing (which, like microneedling, is a means of percutaneous collagen induction). Most treatments are designed with light skin in mind and therefore are often not attentive to the needs of skin of color.

Deeper skin tones are more likely to experience paradoxical hyperpigmentation in response to ablative treatments like a Fraxel laser, meaning that the laser that is supposed to treat discoloration actually causes more because of the trauma to the skin. Hypopigmentation, where the skin loses all its coloration, is also possible, as is scarring and the appearance of milia. All of these are possible reactions to skin resurfacing in all skin tones, but they happen more frequently to people of color (Cohen and Elbuluk, 2016).

All of these reactions are possible in response to microneedling as well, which is why it’s so important to patch test. However, these adverse outcomes are less likely for patients who choose microneedling because it keeps the skin mostly intact. An ablative laser takes off an entire layer or two of skin, creating trauma to the entire face all at once, so if a patient is going to have a negative reaction, it’s going to be all over the entire face. Microneedling creates tiny pinpricks all over the face (or treatment area), causing enough trauma to induce collagen synthesis, but still injuring only a small percentage of the face overall.

What does the research say?

There are no randomized controlled trials attentive to skin of color that compare microneedling against other treatments. One RCT compares microneedling alone to microneedling plus subcision (which you can’t do at home but I plan to write about that soon). Another uses microneedling as a variable and finds that it modestly improves the efficacy of TA injections for melasma.

In a literature review focusing on research and case studies pertaining only to patients of color, the outcomes are pretty good. (A limitation of the literature review: none of the case studies have any patients with type VI skin, the deepest skin tone, and a disproportionately large number of these studies have only patients of Asian descent. There are no papers that study only patients of Hispanic or African descent.) The most-studied condition is acne, and most of the papers describe protocols that are similar to the one I recommend on this site for reducing or removing acne scars with a dermaroller.

The chart below, taken from Cohen and Elbuluk (2016) shows the primary and adverse outcomes in the work on skin of color at that time. A few notes on interpreting it: the primary outcome column can be a little confusing because some of the descriptions note how many patients saw improvement, and some note how much improvement they saw on average.

(Chart)

Primary outcomes are consistent with other, non-skin-type-specific studies on microneedling: that it reduces the appearance of scars and discoloration and that it works even better in conjunction with other treatments like chemical peels and subcision. As far as negative side-effects, three studies report post-inflammatory hyperpigmentation, with 6% of patients, 16% of patients and 17% of patients experiencing PIH in those studies; other studies report no PIH at all. Tram track marks–a shallow scarring pattern that mimics the crosshatched lines of a dermaroller–are noted in two of the studies.  (That word ‘erythema’ here just means inflammation after the treatment, not a permanent skin change.)

Takeaways for home use

People of color are likely to see more potential negative outcomes when dermarolling than their lighter-skinned counterparts; however, people of color are less likely to see potential negative outcomes from dermarolling than from a more intensive skin treatment.

This should also reemphasize the importance of patch testing–a person of any skin tone could have issues with paradoxical hyperpigmentation, and if it’s going to happen to you, you don’t want it to happen on your face!

 

I plan to continue to write about the research on deep skin tones as it comes out; you can check the ‘People of Color’ tag for more on this topic.

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