Frequently practitioners ask us whether we recommend using our Derma FNS© Pen to needle topicals, hyaluronic acid, growth factors, peptides or even exosomes into the skin, after seeing another medical professional perform this treatment on social media. We even have yet to substantiated reports of human derived exosomes being needled into the skin which are unapproved in the UK.

This topic is something that we have been asked many times before, and will probably be asked again, but the short answer is no, we do not recommend this at all, and neither does the MHRA; we know because we asked.

The long answer is that many doctors do apply products to the skin and then needle them in, which can make it confusing for other practitioners to know whether this is the correct thing to do; “if they can do it, and they are a medical professional, why can’t I?”

Also, many companies promote the topical application of hyaluronic acid, growth factors, and more, followed by needling them in. The first issue with this is how deep they are being delivered as a lot of the topical would be left on the surface and significant amounts in the epidermis and dermis, so to us it simply seems like a waste of good products.

When hyaluronic acid is needled into the skin and pushed down the needle channels created, the bulk of it remains in the channel created by the needle and does not spread out into the dermis and therefore has negligible impact. In fact, the jelly slows down the closure of the channels and therefore increases infection risk. New skin cells actually grow around it, which may well slow the recovery process; we also have cross-sectional skin images showing this. The benefit of needled in HA is just cosmetic.

Peter Roberts, Managing Director and Head Trainer at SkinMed©, sought advice from the MHRA, who replied stating that anything applied topically to the skin (even PRP is a topical if applied to the skin) that is then needled into the skin to a depth where microbleeding is caused, runs the risk of introducing a topical product into the systemic circulation.

The MHRA stated that there are clearly defined divisions between what is approved for topical application and what is approved for systemic use.

If a topically applied product is deliberately pushed into the dermis, trying to derive a dermal benefit, and by doing so is introduced to the systemic circulation and the patient were to have an adverse reaction and then took legal action against the clinician, the MHRA stated ‘You would not have a leg to stand on in court and the practitioner could be severely penalised as would the company that has recommended it.’ The practitioner would be forced to sue the supplier, and they would be asked for their systemic safety data. I recommend you ask your supplier before this happens.

We know there has been two cases in which a patient chose to take legal action against their practitioner after having an adverse reaction to one of these treatments, and the matter was settled out of court for more than £40K.

We have a legal duty of care to advise all attending or using our pen and products that this is the advice we have been given and then allow clinicians to make an informed choice. We have since informed all the major players in skin needling but many have ignored this as they have a significant revenue stream in promoting these types of topical treatments in conjunction with needling.

Our recommendation is to use a non-systemically active, beneficial glide medium with anti-erythema properties. This assists in the gliding of the pen over the skin and reduces catching, as well as suppressing epidermal trauma. If one is creating dermal trauma, it means epidermal trauma is unnecessary and in fact, an unwanted side effect, however, by reducing it does not reduce dermal remodelling impact.

The glide medium we recommend has no dermal benefit in that it does not try to enhance collagen, elastin, or hyaluronic acid levels, and so it would be extremely difficult for a lawyer to prove that a practitioner was deliberately needling it in to try and elicit a dermal benefit. Also, it has no systemic activity, so we use it as a glide medium with soothing properties preventing patients from leaving with excessive visible erythema.

This is beneficial to the patient and in no way undermines new collagen fibre production if you are creating microchannels into the dermal layer (defined by micro bleeding observed). Where you are causing trauma to the dermis, allow for MMP1 (collagenase) activation to break down old, bound together, wrinkle-causing collagen and stimulate fibroblast production, initiation and migration, leading to the replacement of the dissolved collagen with a type three collagen elastin matrix.

Auto-needling creates physical holes without introducing additional energy, as opposed to the way peels introduce chemical energy, and lasers and radio frequency introduce light or radiofrequency energy. Therefore, needling does not heat up the skin like other clinical treatments, as this can lead to the production of heat stress proteins, which are produced when cells are under stress as a protective mechanism. By producing heat stress proteins, you are much more likely to stimulate increased pigmentation production resulting in PIH. In short, because auto-needling does not introduce additional energy, and therefore does not heat the skin to anywhere near the level of other energy-based therapies, heat shock protein production is minimal and PIH risk is vastly reduced, making needling safer in high pigmentation-risk clients.

The Alternative Legal Approach

In relation to topicals, needling the skin and putting over a million microchannels into the skin causes changes to the absorption profile across cell membranes. Therefore, if you applied your topical immediately after needling the area and rubbed it in with a gloved hand, the absorption profile is far greater (5 times) in the period immediately post-needling than before. This is not just solution going down into the holes caused by the needles but crossing cell membranes where processes such as facilitated diffusion and other transport mechanisms are altered or accelerated by the needling process, allowing super absorption of ingredients. Some ingredients also go between cells and may offer an additional benefit. Needling changes the absorption profile across cell walls increasing it by 5 to 10 times.

This is purely applying a topical and not needling it into the skin, which is what we recommend.

Immediately after needling a zygomatic zone, we would happily recommend practitioners hand apply and rub in a cream or serum containing growth factors or peptides (EGF), or monosaccharides of acetylglucosamine and glucuronic acid (HYAL SERUM) where the ingredients are used by fibroblasts to increase HA production. Alternatively, we also endorse applying HYAL Cream, which like the HYAL serum has a patented ingredient to activate the Hyaluronan synthetase enzyme in fibroblasts, which makes Hyaluronic Acid. Doing it this way, you are merely applying a topical having increased the absorption profile of the skin.

We do not recommend, as some do, introducing retinoids or ascorbic acid because, although it may be beneficial, it could also add to the short-term irritation, although many clinics do highly recommend this. We would instead consider introducing this once erythema has been controlled and skin is behaving normally and not sensitive.

At SkinMed© the most important aspect of any treatment is the safety of the client. If you have any question on how to achieve outstanding results using the Derma FNS© Pen safely and more effectively than alternative treatments, do not hesitate to get in touch. Simply call 0333 247 2474, or email clinical@skinmed.co.uk to speak to a member of the clinical team