Microneedling for Non-cosmetic Dermatologic Conditions: A Systematic Review of Efficacy and Safety.

Microneedling, a minimally invasive dermatologic procedure, has expanded beyond cosmetic use to treat conditions such as vitiligo, hyperhidrosis, melasma, acne vulgaris, and actinic keratoses. This systematic review, conducted in accordance with PRISMA guidelines, included 15 randomized controlled trials involving approximately 1,200 participants identified through searches of PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) up to July 2025. Across multiple conditions, microneedling - particularly when combined with adjunct therapies - demonstrated significant clinical benefits. In vitiligo, microneedling with tacrolimus or 5-fluorouracil (5-FU) achieved repigmentation rates of 40-76.6% compared with 16.9-39.9% for monotherapy. In hyperhidrosis, fractional microneedle radiofrequency (FMR) reduced sweat production, although botulinum toxin A yielded longer-lasting results and greater patient satisfaction. For melasma, combinations with tranexamic acid or cysteamine produced notable modified melasma area and severity index (mMASI) score reductions (29-50%), while in acne vulgaris, microneedle radiofrequency (MRF) outperformed photodynamic therapy (PDT), achieving an 81% reduction in inflammatory lesions versus 73%, with fewer adverse events. Microneedling-assisted PDT also improved actinic keratoses clearance rates by 18% (76% vs 58%). Adverse effects such as transient erythema and mild pain were consistently reported but generally well tolerated. Overall, current evidence supports microneedling as an effective and safe treatment for diverse non-cosmetic dermatologic conditions, particularly when integrated with topical or procedural adjuncts, though standardized protocols and long-term outcome data remain needed.