DOI: 10.1111/exd.

12723

Method Review

www.wileyonlinelibrary.com/journal/EXD

Microneedle applications in improving skin appearance

lez-Va

zquez, Thakur Raghu
Mael
osa T.C. McCrudden, Emma McAlister, Aaron J. Courtenay, Patricia Gonza
Raj Singh and Ryan F. Donnelly
School of Pharmacy, Queens University Belfast, Belfast, UK
Correspondence: Ryan F. Donnelly, Chair in Pharmaceutical Technology, School of Pharmacy, Queens University Belfast, Medical Biology Centre,
97 Lisburn Road, Belfast BT9 7BL, UK. Tel.: +44-(0)-28-90-972-251, Fax: +44 (0)-28-90-247-794, e-mail: r.donnelly@qub.ac.uk
Abstract: Microneedles (MNs) are micron-sized, minimally
invasive devices that breach the outermost layer of the skin, the
stratum corneum (SC), creating transient, aqueous pores in the
skin and facilitating the transport of therapeutic molecules into
the epidermis. Following many years of extensive research in the
area of MN-mediated trans- and intra-dermal drug delivery, MNs
are now being exploited in the cosmeceutical industry as a means
of disrupting skin cell architecture, inducing elastin and collagen
expression and deposition. They are also being used as vehicles to
deliver cosmeceutic molecules across the skin, in addition to their
use in combinatorial treatments with topical agents or light
sources. This review explores the chronology of microneedling
methodologies, which has led to the emergence of MN devices,
now extensively used in cosmeceutical applications. Recent
developments in therapeutic molecule and peptide delivery to the
skin via MN platforms are addressed and some commercially

available MN devices are described. Important safety and

regulatory considerations relating to MN usage are addressed, as
are studies relating to public perception of MN, as these will
undoubtedly influence the acceptance of MN products as they
progress towards commercialisation.

Introduction

are described, and issues surrounding the safety profiles of MN,

together with studies of the publics perception of the same, are
addressed. Finally, ongoing developments and advancements in
the MN-mediated delivery of cosmeceutics are highlighted.

The skin has long been considered an appealing administration

site for the delivery of medications, due to its accessibility and
ability for feasible controlled delivery, in addition to the avoidance
of first pass metabolism in the liver and enzymatic degradation in
the gastrointestinal tract (14). However, the formidable barrier
properties of the outermost layer of the skin, the stratum corneum
(SC), impose significant limitations in the achievement of successful delivery (4). Novel means of disrupting this layer have been
sought and one such innovation is the use of microneedles (MN).
MNs are minimally invasive devices that painlessly bypass the SC
and thus permit enhanced delivery across the skin by increasing
its permeability (5,6). These microprojections, which create temporary channels to the dermal microcirculation, generally range
from 25 to 2000 lm in height, with differing geometries and
shapes and are typically assembled on one side of a supporting
base plate.
A large volume of published studies have charted the facilitated
delivery of low molecular mass and macromolecular products
across the SC using such MN devices (4, 711). More recently,
however, the use of MN in the cosmeceutical industry has been
explored. This review focuses on describing the evolution of skin
needling technologies to combat scarring and wrinkles and the
emergence of MN devices which have been designed and developed with the distinct function of disrupting the barrier properties
of the SC, thus enabling skin rejuvenation and improved skin
appearance via induced collagen synthesis and deposition. Some
commercially available MN devices used in cosmetic applications

2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Experimental Dermatology, 2015, 24, 561566

Abbreviations: SC, stratum corneum; MN, microneedle; PCI,

percutaneous collagen induction; MFR, microneedling fractional
radiofrequency; TGF, transforming growth factor; PDGF, platelet-derived
growth factor; FDA, Food and Drug Administration; API, active
pharmaceutical ingredients; HA, hyaluronic acid; LED, light emitting
diode.
Key words: microneedle microneedling skin rejuvenation

Accepted for publication 8 April 2015

The Skin
Skin health is influenced by numerous factors such as lifestyle,
environment (chronic sun exposure and UV radiation), genetics,
hormones and nutrition (12). Ageing of the skin is a multifactorial
phenomenon which combines the cumulative effects of chronic
exposure to the elements, primarily UV radiation, as well as the
degradation of elastin fibres and marked collagen reduction causing wrinkle development (13). Facial scarring, arising for a number of reasons such as depigmentation, acne or burn-related scars
and the formation of large pores (14,15), is a distressing phenomenon encountered by many people. In addition, intervention treatments for stretch marks undergo continuous review (16). One of
the most common skin diseases which results in scaring is acne
vulgaris, a potentially psychologically distressing condition, the
pathogenesis of which is underpinned by active inflammation
leading to damage to the elastic support structures beneath the
skin surface and resulting in the development of atrophic scars
(15,17). A recently published paper concisely details variability in
acne scarring and documents different treatment approaches,
including needling (18). Ablative methods such as laser resurfacing
or dermabrasion are currently available for the treatment of
scarred and ageing skin but are invariably associated with significant post-operative changes in the skin and require lengthy healing times. In considering this, it was highlighted by Aust et al.

561

McCrudden et al.

(19) that there was a need for less invasive treatment options to
combat these conditions. A thorough 2014 review charts the wide
range of skin resurfacing therapies currently available to clinicians,
in addition to innovative therapies under development (20).
Microneedling and subsequently MN devices are examples of such
innovative therapies.

Disrupting the barrier properties of the SC the

use of MN

The concept of using arrays of miniaturised needles for drug

delivery purposes dates back to 1976 (21) with the exploitation of
high-precision microelectronic industrial tools in the late 1990s
making the fabrication of such devices possible (22). Accordingly,
MN fabrication technology has progressed, garnering much interest from both academia and the pharmaceutical industry. The
conventional mode of action of MN devices is presented in Fig. 1.
There are five main MN designs. These are solid, coated, dissolving, hollow and swellable MN. Figure 2 illustrates various
approaches in the MN-facilitated delivery of medications across
the skin. The means by which each of these approaches achieves
successful delivery has been thoroughly reviewed (4, 9, 23, 24).

Stratum corneum
Microneedle
Viable epidermis

Dermis
Arteriole
Venule
Dermal nerve

Figure 1. Schematic representation of the mode of action of a standard MN

device. The needles on the array puncture through the SC, providing direct access
to the underlying viable epidermis. Dependent on the heights of the needles, the
dermal nerves and capillaries, residing in the dermis, are not contacted.

(a) Hollow

(b) Coated

(c) Solid

(d) Dissolving (e) Swellable

Figure 2. Schematic representation of five different MN modalities. (a) Hollow

MN, for insertion into the skin and infusion of drug through the MN pore created;
(b) coated MN, for deposition of active ingredient into the epidermis, followed by
removal of the MN array; (c) solid MN, for skin pretreatment, followed by the
application of an active-loaded reservoir; (d) dissolving MN, for delivery of active
compound, incorporated into the matrix of the needles, into the skin; (e) swelling
MN, for drug delivery through the hydrogel matrix from a drug-loaded reservoir.

562

Microneedling technologies: An evolutionary step

towards MN usage
A precursor to MN usage in dermatology was skin needling technology. Pioneered in 1995, Orentreich and Orentreich described
subcision or dermal needling for scars (25). This approach
involves pricking or puncturing the skin and then scarifying the
dermis with the needle to build up connective tissue beneath the
scars. This technique could not have been used over large surface
areas, however, due to bleeding and unacceptable bruising. Building upon his work, Camirand and Doucet in 1997 used a tattoo
gun to needle abrade scars (26). This technique has been
accepted, however, to be laboriously slow with the holes created
in the epidermis being too shallow and close together (27). In
work based on these principles, Fernandes developed a new technology, microneedling, to initiate the natural post-traumatic
inflammatory cascade (28). The basis of this technique is to break
collagen strands, which tether the scar to the base of the dermis,
via minute-controlled injuries caused by tiny needles piercing the
skin. This then results in neo-angiogenesis and neo-collagenesis
via induction of the natural wound-healing cascade. It should be
noted that the needles routinely used in microneedling methodologies ranged between 1 and 3 mm in length (27,28), considerably
longer than those commonly found on MN devices. Also referred
to as MN therapy, percutaneous collagen induction (PCI) (27,28),
collagen induction therapy, dry tattooing (no pigment) and intradermabrasion, this innovative microneedling technology has
shown promising results as a simple means of minimising skin
imperfections such as acne scars, surgical scars, fine lines, wrinkles,
stretch marks and cellulite, in addition to improving skin texture,
firmness and hydration (28,29). An example of one such innovative approach involved the use of microneedling fractional radiofrequency (MFR) in acne treatments, which was shown to be
clinically efficient in managing acne scars without causing direct
damage to the epidermis (30). In an extension of these microneedling approaches, the application of PCI in the treatment of
photoageing has also been investigated (31). The basis of microneedling is therefore the controlled mechanical stimulation of the
wound-healing response, which is divided into three phases: (i)
initiation/inflammatory, (ii) proliferation and (iii) remodelling.
Briefly, in phase I, platelets and neutrophils recruited to the injury
site stimulate the release of growth factors including transforming
growth factor-alpha (TGF-a), TGF-beta (b) and platelet-derived
growth factor (PDGF) which all facilitate the production and
propagation of intercellular matrix proteins (31). In phase II,
monocytes, keratinocytes and fibroblasts continue to be influenced
by the release of growth factors (27). As a result, a fibronectin
matrix is formed and fibroblasts ultimately deposit collagen (31).
In phase III, the conversion of collagen, through tissue remodelling and vascular maturation, to collagen I ensues, resulting in
skin tightening (27). Two commercially available MN devices,
namely Dermaroller and Dermapen, were developed based on
these principles and Fernandes PCI innovation.

Approved MN devices
Dermaroller

PCI is achieved via multiple needle application (32). Roller devices

with projecting needles have been designed to achieve this aim.
The Food and Drug Administration (FDA)-approved Dermaroller is described as a hand-held device equipped with medical

2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Experimental Dermatology, 2015, 24, 561566

Microneedle applications in improving skin appearance

grade solid steel MNs, projecting from a cylindrical roller (Fig. 3a)
(3335). The rolling mechanism is applied directly over the skin,
vertically, horizontally and diagonally. There are 24 circular arrays
of eight needles each located on the roller (total 192 needles)
(3436) (Fig. 3a), and the heights of the needles are specific to the
nature of the treatment being employed (7). Home Dermarollers
consist of the Home Roller C 8 (a single needle which is depicted
in Fig. 3b) and the Beauty Mouse. The cosmetic, C 8 model has
needles ranging between 130 and 200 lm in height (Fig. 3b), with
a penetration diameter of 70 lm (34). Another device intended
for home use is the Beauty Mouse, which incorporates 3 Dermarollers with a total of 480 needles and has been developed to
ensure coverage of larger skin surface areas, such as the arms, legs
and buttocks for the treatment of stomach or thigh stretch marks
and cellulite (37). The medical models, CIT 8 and MF 8, are
intended for use by trained professionals only. The CIT 8 has needle heights of 500 lm, and the MF 8, heights of up to 1500 lm
(Fig. 3c and d) (36). A number of other companies, for example,
Hansderma and White Lotus, have marketed products with similar
functions (38,39). Despite the fact that MN devices are often categorised into home and medical use in product literature, they are
available for purchase by any individual online from a multitude
of commercial websites. With no restriction on purchasing of
these products, it is clearly evident that there is potential for abuse
and misuse of these devices.
PCI technology has subsequently evolved with the emergence of
miniature versions of the Dermaroller, termed DermastampsTM
onto the UK market (40). These are sterile medical devices with
(a)

Handle
Roller Disc
MN

(d)

(c)

(b)

needle heights of 200 lm, situated in a 5 mm diameter circular

arrangement (40). They are specifically designed to accommodate
small confined areas where it is difficult for the Dermaroller to
achieve optimal stimulation, for example the upper lip. The device
uses vertical penetration to create infusion channels in the skin
and is considered ideal for use on isolated scars and wrinkles (40).

Dermapen

Designed to overcome the issues of varying pressure application

by physicians/users and the subsequent MN depth penetration
achieved, an advanced microneedling device has been launched,
termed the Dermapen (Fig. 3e). It is described by manufacturers
as a spring-loaded, fractional MN device, with an adjustment ring
allowing for alteration of the heights of the MN, which carries out
the function of fractional mechanical resurfacing (41). It utilises
an electrically powered pen to deliver a vibrating stamp-like
motion to the skin, creating a series of micro-channels in it.
Treatment in acne scarring, burn scars and photoageing is being
investigated by the manufacturers, although no research studies
focusing on this MN device have yet been published. Due to the
substantial interest in these MN devices, more commercial products based on the same principles are currently under development (7,37,42).

Advantages of microneedling
One of the most important advantages of these MN devices is in
overcoming the use of traditional ablative methodologies. Ablative
methods including dermabrasion, chemical peels, collagen injections, cortisone-like injections, cryosurgery and laser resurfacing
are, by their nature, extremely physically disruptive to the targeted
epidermis and superficial dermis (43). In ablative methodologies
such as these, undesired post-operative changes in the skin can
result in significant healing times. As destruction, rather than disruption, of the epidermis initiates an inflammatory response that
stimulates fibroblasts to produce thick branches of scar collagen
(44), skin has been shown to become more sensitive to photodamage and one study has stated that a side effect of such treatment may be the development of dyschromias, a common skin
disorder whereby there is a marked alteration in normal skin pigmentation, resulting in discolouration of the skin, hair and nails
(31). In contrast, microneedling, if limited to breaching the SC
with needles of appropriate heights, would negate the risks and
negative side effects often seen with invasive ablative approaches.

Areas of debate

(e)

(f)

Figure 3. FDA-approved MN devices. (a) Image of a Dermaroller MF 8 (35; (b, c

and d) stereo microscopic images (Leica MZ 8, Switzerland) of the needles from
different Dermaroller models, namely (b) cosmetic Dermaroller C 8 model,
medical models, (c) DermarollerCIT 8 and (d) DermarollerMF 8, scale = 500 lm
(36). (e) Images of the MDerma FDS which will be ready for distribution in early
2015 (Images taken from a marketing PDF received from Dermapen) (41). (f) An
image of LED MicroNeedling Rollers (75).

2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Experimental Dermatology, 2015, 24, 561566

Despite the promising therapeutic benefits of MN devices and

their increasing usage in cosmetic applications, issues of patient
acceptability of MN devices, in addition to queries surrounding
patient safety, have been raised (4547).

Public perception
The future commercial and clinical success of MN devices will
undoubtedly depend not only upon their ability to fulfil a designated function, but also on their acceptability by both patients
and healthcare professionals (48). To this end, the perception of
MN was documented in an informative study carried out by the
Birchall group (49), in addition to a recent pilot study conducted
by the Donnelly research team (50). In both instances, study participants acknowledged the potential benefits of a MN delivery
system with 80% of the participants having a strongly positive
perception of the MN devices used in the study (50). Potentially
detrimental to the impact of such studies however, are reports

563

McCrudden et al.

such as that published in the Daily Mail in 2009 which stated that
the Dermaroller, specifically, resembled a miniature medieval
instrument of torture (45). Despite this poor description of the
device, the article concluded that the use of the Dermaroller
resulted in signs of improved skin appearance: smoother and much
fresher, as the skin takes on a new vitality and looks brighter as well
as firmer (45). Media reports such as this reinforce the importance of clear message dissemination to the general public about
these devices and their uses so that their reputation may not be
unnecessarily harmed.

Potential erythema and irritation

With reference to the potential for local irritation or erythema of
the skin following the use of a MN device, a fundamental concern
based on the potent immune-stimulatory nature of the skin (36),
research has proven that prompt recovery of skin barrier function
is achieved within a matter of hours of device usage (14,51). In
relation to the reddening of the skin, one study proved that erythema normalised within 2448 h in all groups under investigation with no significant difference observed in the erythema index
ratios between the different needle lengths employed in the study
(14).

Patient safety
The potential long-term effects of MN application or indeed
repeated MN application on skin is currently unknown. As with
any novel technology, inappropriate use could cause problems.
With specific reference to cosmetic MN devices, three cases of
allergic granulomatous and systemic hypersensitivity in female
patients, following application of a non-sterile topical product and
subsequent MN treatment, have been reported (46). Worth noting, however, is that, in each case, medical supervision was absent.
In all three cases, the deleterious side effects witnessed were determined to have been due to the inappropriate intra-dermal tattooing of the skin with antigenic topical products. The combined use
of these topical products with MN application is unlicensed, and
so the artificially enhanced delivery of these products to the dermis in this report resulted in the hypersensitivity reactions
observed. In all cases, full or partial recovery was achieved following corticosteroid or tetracycline treatments (46). These cases
highlight the need for caution with regard to inappropriate use of
topical medicines in combination with enhanced transdermal
delivery methods. MN application should only be used in conjunction with fully licensed and tested therapeutics or cosmetics,
designed for this intended purpose.
The question of whether MN devices, for use in cosmetic applications, should be terminally sterilised has also been brought to
the fore. This question must be addressed in line with the recommendations of regulatory bodies, as inappropriate use of microneedling devices could potentially lead to the early, unwarranted
rejection of the devices. An example of one such damaging report,
which involved the inappropriate use of non-adequately sterilised
MN devices between patients, was published in the Daily Mail
in August 2011 (47). Regardless of how MN devices are classified
by the pharmaceutical and cosmeceutical industries, for example
drug delivery systems, consumer products or medical devices, they
are not equivalent to conventional transdermal patches, in that
they do not simply adhere to the skin surface (48). Considered
to be more akin to a conventional hypodermic injection, this
may mean that they will be required to be terminally sterilised.

564

The Dermaroller and the Dermapen are supplied as sterile

products (48) and as they are fabricated from metal, they can be
easily re-sterilised. In particular, the Dermapen explicitly highlights this issue by describing it as a patent pending MN tip (41)
that comes in sterilised individual packages that are easily replaced
and loaded into the spring automated device. It has been shown
by some researchers that MN micro-channels elicit minimal
microbial penetration (13,52,53). To ensure this is the case, particularly in a home environment, appropriate sterilisation of such
devices prior to and following use is essential. With this in mind,
the UK Health Centre does provide guidance for at-home sterilisation of Dermaroller devices, whereby it is suggested that they
be sterilised using those agents routinely used to sterilise babies
bottles (54).

A role for hyaluronic acid in MN delivery systems

Hyaluronic acid (HA), also termed hyaluronan, is a ubiquitous
component of the extracellular matrix, similar to collagen and
elastin. HA is a naturally occurring linear, polyanionic polysaccharide with repeating disaccharide units composed of b-glucuronic
acid and N-acetyl glucosamine (55), see Fig. 4 (56). HA is lost
from the skin upon ageing but has been deemed to play a pivotal
role in tissue rejuvenation (57). It has previously been shown,
when applied topically, to be absorbed from the surface of the
skin, passing through the epidermis (58). It was, at that time, suggested by the authors that HA could act as a carrier for the transport of other drugs into the deeper layers of the dermis. Prior to
this, a HA-based gel was implanted intra-dermally in augmentation therapy studies of facial soft tissues, once again highlighting
the potential of this compound in skin rejuvenation (59). Based
on these previous studies and the unique, versatile properties of
HA, it has been studied as a suitable candidate for MN formulation and subsequent delivery of incorporated active pharmaceutical ingredients (APIs) (57,60,61). One such HA-based MN
product is MicroHyala, which was granted FDA approval in
2004. The salt form of HA, namely sodium hyaluronate, acts as
the base material for these arrays (57). Despite abstract reference
to the use of this product in cosmetic applications (57), there are,
-glucuronic acid

-glucuronic acid

N-acetyl glucosamine

N-acetyl glucosamine

Figure 4. A schematic representation of the structure of hyaluronic acid,

highlighting the b-glucuronic acid and N-acetyl glucosamine residues. This structure
was drawn using Chemspider, the chemical drawing tool (56).

2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Experimental Dermatology, 2015, 24, 561566

Microneedle applications in improving skin appearance

to date, no publications on the use of this, or similar HA-based

patches, in cosmetic applications specifically. The mechanical
properties of MicroHyala, incorporating model drugs, have been
evaluated however and the authors have conceded that the product, although promising, does require further development (57).
With the emergence of HA as a novel cosmetic and MN scaffold
material, it was conceded recently that a fuller understanding of
its inherent biochemical functions and interactions is warranted,
to ensure HA homeostasis (62). Although it is evident that further
research must be conducted on HA-based MN products, the viscoelastic properties of this compound, together with the excellent
biocompatibility and non-immunogenicity of HA, confer it as an
ideal candidate for investigation in MN-based cosmetic, medical
and pharmaceutical products.

MN-mediated peptide delivery

With rare exceptions, protein-based compounds do not readily
permeate across the skin, due to their molecular weights and
hydrophilic nature (63). The delivery of protein- and peptidebased therapeutics across the skin continues to undergo extensive
investigation, with current research focusing on delivery of insulin
and vaccines across the skin (7,9,64,65). In relation to the cosmetic industry, the intra-dermal delivery of peptide cosmeceutics
via MN device is now undergoing investigation. Three such peptides are melanostatin, rigin and pal-KTTKS. Pal-KTTKS is a peptide that, when delivered into the dermis, has been proposed to
stimulate collagen production (66). A recent study has used confocal scanning laser microscopy and fluorescently tagged melanostatin, rigin and pal-KTTKS, to assess the influence of MN usage on
the penetration and distribution of these peptides in the skin,
compared with passive diffusion of the same peptides (66). Pretreatment of the skin with solid, stainless steel MN, followed by
peptide application, resulted in increased penetration and distribution of the lowest molecular mass peptide, namely melanostatin.
This trend was not maintained with the peptides of higher molecular masses, however. The authors, in interpreting these findings,
perhaps could have commented on the MN modality enlisted in
this work. It would be interesting to compare and contrast delivery of the same peptides using various MN approaches, such as
dissolving and swellable MN. These alternate approaches may, in
time, prove more suitable for the delivery of protein-based therapeutics and cosmeceutics than solid MN.

longitudinal, vertical and diagonal directions, and minoxidil was

applied 24 h postprocedure. Using the three primary efficacy measures of hair count and patient/investigator assessment, the Dermaroller and minoxidil-treated group were determined to exhibit
statistically superior hair growth when compared to those treated
with minoxidil only (70). A concluding example of successful cosmeceutical delivery via MN was published recently when two antiwrinkle compounds of different hydrophilicities, namely ascorbic
acid and retinyl retinoate, were incorporated into dissolving
HA-MN platforms for evaluation in combating wrinkles, as determined by Visiometer software (71). These novel patches were
deemed to have efficiently delivered their payload with no evidence of allergies or irritant contact dermatitis having developed
in any of their 24 test subjects. The authors concluded that this
work served as a platform to incorporate other anti-ageing compounds of varying hydrophilicities into dissolving HA-MN.

Light emitting MN devices

Microneedling has previously been used in combination with photodynamic therapy (PDT) to enhance topical delivery of aminolevulinic acid (ALA), in the treatment of actinic keratosis, the dry
scaly patches of skin caused by long-term sun exposure (72). In
this study, skin was pretreated with a MN roller, Roll-CITTM (MN
width: 108 lm, MN length: 300 lm) and ALA was then applied
to the skin for a defined period. Following this, the use of red
light and broadband pulsed light allowed for deeper activation of
ALA, resulting in statistically significant improvements in photoageing scores (72). For a more detailed review of the use of MN
in conjunction with PDT, please refer to Kearney 2014 (73). Other
research teams have also developed microscale optical diffusers, or
fiberoptic MN, for the enhancement of clinical laser procedures
and homogeneous light emission, while minimising photothermal
damage in non-target tissues (74). Evolving from these innovations, new CE-approved devices, termed LED (light emitting
diode) MicroNeedling Rollers (MN length = 1000 lm), have been
launched. These incorporate titanium MNs and LED light to combat wrinkles and scarring and are used in a fashion akin to that
described for the Dermaroller device, see Fig. 3f (75). Worth
noting, however, is that despite the fact that these devices are
readily available for purchase online, there is very limited technical
information available for the same which indicates the benefits of
these over other, non-LED roller devices.

New advancements

Summary

The delivery of cosmeceutic agents

Since the emergence of MN in the scientific literature in 1998

(76), research in this area has intensified and continues to evolve
and develop, with the emergence of superior materials, fabrication
methods and designs. One area of MN research which is undergoing sustained development is in the delivery of cosmeceutical
agents. In this review, the integration and use of MN in cosmetic
procedures has been discussed. A wide range of MN devices have
been described, including the Dermaroller and the Dermapen,
with further commercial products currently in development. Furthermore, the use of MN platforms in the delivery of cosmetic
peptides has also been considered here. As this field progresses
towards further commercialisation of MN devices, however, it is
clear, from the safety and public perception studies outlined
herein, that interaction and engagement with regulatory agencies
is essential to address concerns regarding MN sterile manufacture
and to avoid misuse of these devices.

The exploitation of MN technologies in facilitating efficient delivery of cosmeceutics is actively advancing with many interesting
studies having been published within the past 2 years. For example, a study carried out in mice detailed the in vivo efficacy of eflornithine cream at inhibiting hair growth, following pretreatment
of mouse skin with MN (67). The authors concluded that, with
reference to patients suffering facial hirsutism, this approach represents a potentially viable means of increasing eflornithines ability to inhibit hair growth. Conversely, MNs have also been used
in combination with topical products, such as minoxidil, to stimulate hair regrowth. Following on from pilot studies carried out in
mice (68,69), a 2013 study evaluated the influence of microneedling and minoxidil topical treatment, on human subjects suffering with androgenetic alopecia (AGA) (70). A Dermaroller with
needle heights of 1.5 mm was rolled over the shaven scalp in

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McCrudden et al.

Acknowledgements

Conflict of interest

MMcC and EMcA researched and wrote the paper. AJC and PGV prepared
the figures. TRS and RFD conceived and critiqued the paper.

The authors have declared no conflicting interests.

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