Microneedling with Insulin for Dermatological Conditions: Current Evidence
Direct Answer
There is emerging but limited evidence suggesting that microneedling combined with topical insulin may improve atrophic acne scars, though it does not appear superior to microneedling alone or microneedling with other topical agents. The evidence base consists of only small randomized trials with short follow-up periods, and this application represents an off-label use of insulin that is not supported by any dermatology guidelines 1, 2.
Evidence Quality and Limitations
The current evidence for microneedling with topical insulin is restricted to:
A 2025 split-face randomized trial (n=21) found that microneedling with topical insulin produced statistically significant improvement in atrophic acne scars, but showed no statistical difference compared to microneedling with placebo (saline) in terms of clinical improvement or side effects 1.
A 2022 split-face study (n=30) comparing microneedling with insulin versus vitamin C found both achieved comparable improvement in post-acne scars, with vitamin C showing slightly better results 2.
Critical interpretation: When a treatment performs equivalently to placebo (saline), this suggests the benefit derives from the microneedling procedure itself rather than the topical agent 1.
Mechanism and Theoretical Rationale
The proposed mechanism involves insulin's potential wound healing properties, though this remains speculative in dermatological applications 1, 2. However, insulin is designed and FDA-approved exclusively for subcutaneous injection to manage blood glucose in diabetes, not for topical dermatological application 3.
Safety Considerations
Important caveats regarding insulin use:
All available insulin delivery guidelines address subcutaneous injection for diabetes management only, with specific recommendations for 4mm needles at 90-degree angles into subcutaneous tissue 3.
Insulin injection is associated with cutaneous complications including lipohypertrophy, lipoatrophy, local allergic reactions, and erratic absorption when injected into damaged tissue 4.
Patients should never inject into sites of inflammation, edema, ulceration, or infection 3, which raises concerns about applying insulin to actively healing microneedling sites.
The microneedling procedure itself carries expected adverse effects including erythema, pain, edema, and temporary skin irritation 5.
Microneedling Safety Profile
Microneedling as a standalone procedure has established safety and efficacy for:
- Acne scarring
- Skin rejuvenation
- Rhytides
- Surgical scars
- Striae
The procedure is considered relatively safe with minimal adverse effects when performed properly 5, 6.
Clinical Recommendation
Given the lack of demonstrated superiority over placebo and the absence of guideline support, I cannot recommend adding topical insulin to microneedling procedures at this time. The evidence suggests that standard microneedling alone produces the therapeutic benefit 1.
If you wish to enhance microneedling outcomes, consider:
- Optimizing the microneedling technique itself (needle depth, number of passes, treatment intervals) 6
- Using topical vitamin C, which showed comparable or slightly better results than insulin in head-to-head comparison 2
- Ensuring proper patient selection and post-procedure care to maximize the wound healing cascade 6
The 2025 study authors themselves concluded that insulin "may have a value" but requires "further evaluation using different delivery systems, insulin formulations, and assessment modalities" 1, indicating this remains investigational rather than ready for clinical implementation.