Medical Needling: Effect on Moisture and Transepidermal Water Loss of Mature Hypertrophic Burn Scars

Abstract

Background: Burn scars remain a serious psychological and physiological problem for affected people. Clinical studies and scientific research have already shown that medical needling improves the scar quality in terms of skin elasticity and erythema. At the same time, patients are confronted with a low-risk therapy and face comparatively less postoperative complications.

Objective: The goal of our study was to examine the influence of medical needling on the skin moisture and transepidermal water loss (TEWL) of hypertrophic dry scars. Therefore, 20 patients, of an average age of 34.63 years, with deep second- and third-degree burn scars have been treated.

Methods: Medical needling is performed using a roller covered with needles of 3-mm length. The needling device is rolled over the scar in three directions: vertically, horizontally, and diagonally in order to create as many puncture channels as possible. The puncturing leads to multiple micro-wounds and intradermal bleeding, which evokes the post-needling regeneration cascade. The patients were followed up for 12 months postoperatively. The results have been evaluated by means of objective as well as subjective measurement methods.

Results: The objective measures show that medical needling influences epidermal thickness and improves the epidermal barrier function at a molecular level. Outcomes are marked by a measurable increase in skin moisture and a reduction in TEWL.

Conclusion: Medical needling seems to be a promising approach for the treatment of mature hypertrophic burn scars with a focus on skin moisture and TEWL.

Keywords: barrier function; hydration; low-risk therapy; minimal invasive technique; moisture; transepidermal water loss.

Figure 1. Roller device for medical needling

Figure 2. Patient ratings for "rigidity," "thickness," and "relief" preoperatively and at last follow-up

Patient ratings: 1 = as normal skin, 10 = very different from normal skin

Figure 3. Observer ratings for "surface area," "thickness," and "pliability" preoperatively and at last follow-up

Observer rating: 1 = as normal skin, 10 = very different from normal skin

Figure 4. Patient 1, dorsal left hand, preoperatively (above) and one year postoperatively after needling (below)

Figure 5. Patient 2, face frontal, preoperatively (left) and one year postoperatively after needling (right)

Figure 6. Moisture, pathological scars treated by medical needling and healthy skin preoperatively and one year later

Figure 7. Difference in the moisture index for treated scars and healthy skin preoperatively and one year later

Figure 8. Moisture, untreated scars, and healthy skin preoperatively and one year later

Figure 9. Difference between the pre- and postoperatively measured moisture index depending on the amount of treatment

Figure 10. Increased TEWL, pathological scars treated by medical needling, and healthy skin preoperatively and one year later

TEWL = Transepidermal water loss, increased values in scars treated by medical needling compared to healthy skin

Figure 11. Difference of measured TEWL for pathologically increased scars and healthy skin preoperatively and one year later

TEWL = Transepidermal water loss

Figure 12. Increased TEWL, untreated scars, and healthy skin preoperatively and one year later

TEWL = Transepidermal water loss, increased values of untreated scars compared to healthy skin

Figure 13. Increased TEWL, difference in the pre- and postoperatively measured TEWL index depending on the amount of treatment

TEWL = Transepidermal water loss, improvements depending on the amount of treatment

Figure 14. Decreased TEWL, pathological scars treated by medical needling, and healthy skin preoperatively and one year later

TEWL = Transepidermal water loss, decreased values of scars treated by medical needling compared to healthy skin

Figure 15. Decreased TEWL, untreated scars, and healthy skin preoperatively and one year later

TEWL = Transepidermal water loss, decreased values of untreated scars compared to healthy skin

Figure 16. Difference between the pre- and postoperative measured TEWL index in Tewameter units depending on the amount of treatment

TEWL = Transepidermal water loss, improvements depending on the amount of treatment