What are the considerations and potential risks for a patient with a history of skin conditions, such as eczema or psoriasis, undergoing aesthetic treatment with Ultraformer MPT (Micro-Needling Platform Technology) for skin tightening and rejuvenation?

Ultraformer MPT Treatment in Patients with Eczema or Psoriasis

Patients with active eczema or psoriasis should not undergo Ultraformer MPT treatment over affected areas, as the micro-trauma from needling can trigger disease flares and compromise skin barrier function. 1

Understanding the Technology and Risks

Ultraformer MPT combines microfocused ultrasound with micro-needling platform technology. The device creates controlled micro-trauma by penetrating 0.25-2.5mm into the dermis at 3,000-5,000 RPMs, triggering neovascularization and collagen remodeling. 2 While this mechanism is beneficial for normal skin, it poses specific risks for inflammatory skin conditions.

Key Contraindications and Precautions

Absolute contraindications for micro-needling include:

• Active inflammatory skin disease in the treatment area 1
• Active eczema or psoriasis lesions 1
• Areas with compromised skin barrier function 1

The primary concerns are:

• Koebner phenomenon: Trauma-induced disease flares are well-documented in psoriasis, where mechanical injury triggers new lesion formation at sites of skin trauma 1
• Barrier disruption: Eczematous skin already has impaired barrier function; micro-needling creates 12 simultaneous penetration points that further compromise this barrier 2
• Infection risk: Inflamed, compromised skin has higher susceptibility to bacterial colonization and infection when barrier is breached 1

Treatment Algorithm for These Patients

Step 1: Disease Activity Assessment

Evaluate current disease status before any consideration:

• Patients with active lesions → defer treatment indefinitely 1
• Patients in complete remission for ≥6 months → may consider treatment with extreme caution 1
• Patients with recent flares (within 3 months) → defer treatment 1

Step 2: Alternative Treatment Selection

For patients requiring skin tightening who have inflammatory conditions:

• Consider microfocused ultrasound without micro-needling component (standard Ultherapy/MFU-V) as it does not breach the epidermis 3, 4
• MFU-V targets the superficial musculoaponeurotic system at 3.0-4.5mm depth without epidermal disruption 5
• This technology heats tissue to >60°C at discrete thermal coagulation points while leaving papillary dermis and epidermis unaffected 5

Step 3: If Proceeding Despite History (Remission Cases Only)

Mandatory precautions include:

• Obtain dermatology clearance documenting disease remission 1
• Avoid any areas with current or recent lesions (within 6 months) 1
• Use lowest depth settings (0.25mm maximum) to minimize trauma 2
• Apply compounded topical anesthesia for minimum 30 minutes, ensuring complete removal before treatment 1
• Ensure skin is well-lubricated with autologous platelet concentrates (APCs) to reduce mechanical trauma 1

Post-treatment monitoring:

• Advise patients to avoid sunlight for 24 hours, as UV exposure can trigger both eczema and psoriasis flares 1
• Avoid heavily scented products for 24 hours post-procedure 1
• Monitor closely for 2 weeks for signs of disease reactivation 1

Evidence-Based Safer Alternatives

For patients with inflammatory skin conditions requiring rejuvenation:

1. Microfocused ultrasound with visualization (MFU-V) alone is the gold standard alternative, as it achieves skin tightening without breaching the epidermis 3, 4

2. Phototherapy protocols may be appropriate for psoriasis patients specifically, though PUVA should only be considered after narrowband UVB has failed 1

3. Intradermal PRF injections (without micro-needling) using 30G 4mm needles create minimal trauma while delivering growth factors 1, 6

Critical Safety Considerations

Common pitfalls to avoid:

• Never microneedle over areas with tattoos, permanent makeup, or any inflammatory skin condition 1
• Do not assume "mild" eczema or psoriasis is safe to treat—even minimal disease activity contraindicates the procedure 1
• Recognize that the 24-48 hour typical downtime may be significantly prolonged in patients with compromised skin barriers 2

Serious complications specific to this population:

• Blistering, erosion/ulceration, and cutaneous necrosis have been reported with ultrasound devices, though rare 7
• Post-inflammatory hyperpigmentation risk is elevated in inflamed skin 1
• Disease flares may be severe and difficult to control once triggered 1

Documentation Requirements

Before proceeding with any patient with skin condition history:

• Document current disease status with photography 1
• Obtain written informed consent specifically addressing flare risk 1
• Consider dermatology co-management for patients with significant disease history 1