Abstract

2 أغسطس 2026
عبدالله الحربي
Abstract

Atrophic acne scars are frequent and lasting complications of acne vulgaris and may significantly impact both cosmetic results and psychosocial functioning. Microneedling (MN) is a commonly employed technique to stimulate dermal remodeling, and topical insulin has been suggested as a low-cost additive due to its wound repair properties. This systematic review and meta-analysis examined the efficacy of topical insulin in conjunction with MN on outcomes of post-acne atrophic scars versus microneedling plus other adjuncts or controls. We conducted a comprehensive search across PubMed, Scopus, and Web of Science from their inception to January 2026 to identify comparative studies of topical insulin added to MN compared with MN combined with other adjuncts or controls in adult patients with post-acne atrophic scars. We performed random-effect meta-analyses using R (version 4.5.2). Twelve studies involving 566 patients were included. Eight studies contributed to the primary meta-analysis. MN plus topical insulin did not significantly improve scar severity versus controls (SMD = 0.01, 95% CI [− 0.20 to 0.23]; p = 0.907; I² = 25.8%). Subgroup analysis showed no significant comparator interaction (p = 0.467), and leave-one-out analysis did not materially change the estimate. Satisfaction outcomes were also comparable: excellent (RR = 1.01, 95% CI [0.13 to 7.65]; p = 0.995; I² = 85.7%), good (RR = 1.05, 95% CI [0.43 to 2.58]; p = 0.918; I² = 58.8%), fair (RR = 1.31; p = 0.521), and poor (RR = 0.95; p = 0.928). Qualitative evidence generally suggested greater improvement with insulin-assisted MN. These findings were limited by inconsistent outcome reporting. There was no significant additional benefit of using topical insulin in combination with MN for atrophic acne scars and satisfaction was comparable, although some individual studies reported favorable outcomes which should be interpreted with caution. There is a need for larger standardized trials with validated clinician- and patient-reported outcomes to better elucidate any incremental value.



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Funding

The Authors of this study did not receive any grants or funding for conducting this study from any organization or institution.


Author information

Authors and Affiliations

  1. Dermatology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
  2. Ibraheem Altamimi
  3. College of Medicine, King Khalid University, Abha, Saudi Arabia
  4. Abdulelah Alqahtani & Turki Alahmari
  5. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences KSAU-HS, Jeddah, Saudi Arabia
  6. Abdulaziz Saad AlQuhaibi
  7. Riyadh Second Health Cluster, Riyadh, Saudi Arabia
  8. Turki Saeed Alkahtani
  9. College of Medicine, Jouf University, Sakaka, Al Jouf, Saudi Arabia
  10. Lojain Abdulsalam Alkhaldi
  11. College of Medicine, Northern Border University, Arar, Saudi Arabia
  12. Hajar Abdullah Alanazi & Osama Talal S. Alanazi
  13. College of Medicine, Almaarefa University, Riyadh, Saudi Arabia
  14. Fares Fahad Alammari
  15. College of Medicine, Qassim University, Buraydah, Qassim, Saudi Arabia
  16. Atheer G. Almutairi
  17. College of medicine, University College Dublin, Dublin, Ireland
  18. Abdullah M. Alharbi
  19. College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
  20. Renad Ibrahim Alsulaiman
  21. Dermatology Department, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
  22. Khuzama Alfalah

Contributions

Ibraheem Altamimi: conceptualized the study, designed the methodology, analysis and writing. Abdulelah Alqahtani : contributed to methodology development, literature search, statistical analysis and writing. Abdulaziz Saad AlQuhaibi: data curation, and draft writing. Turki Saeed Alkahtani: data curation, study selection, and quality assessment. Lojain Abdulsalam Alkhaldi: Data curation, literature review, and quality assessment. Hajar Abdullah Alanazi: data extraction, preparation of tables and figures, and formatting of the manuscript. Fares Fahad Alammari : literature searches, quality assessment and writing. Atheer G. Almutairi: Data curation, referencing, and draft writing. Turki Alahmari: Data curation, draft writing, quality assessment. Abdullah Alharbi: data analysis, writing, Figure and table preparation. Renad Alsulaiman: data curation, and manuscript language editing. Osama Talal S Alanazi: manuscript writing and finalization. Khuzama Alfala: draft writing and Supervision.

Corresponding author

Correspondence to Ibraheem Altamimi.

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No ethical approval was required for this study, as it is a PRISMA-compliant systematic review and meta-analysis. The protocol of this study was prospectively registered with PROSPERO to maintain transparency.

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