Chemical peeling in combination with microneedling versus chemical peeling or microneedling monotherapy in the treatment of acne scars: a systematic review and meta-analysis

Abstract

Introduction: Acne scars are a common and often distressing consequence of acne vulgaris, leading many patients to pursue aesthetic treatments. While microneedling and chemical peels are effective on their own, combining them may yield better results. Aim: To systematically evaluate the efficacy and safety of combining microneedling with chemical peeling versus either treatment alone in the management of atrophic acne scars. Material and methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251082268). A comprehensive search of PubMed, Embase, and Cochrane databases identified randomised and non-randomised trials comparing combined microneedling and chemical peeling to monotherapies. Outcomes included clinical improvement, patient satisfaction, adverse events, and quality-of-life measures. Results: Nine studies (n = 566) met inclusion criteria; six were eligible for meta-analysis. The combination therapy significantly outperformed microneedling (OR = 5.72, 95% CI: 2.82–11.61) and chemical peeling (OR = 8.94, 95% CI: 4.72–16.95) alone. Responder rates ≥ 75% reached 40–50% with combination therapy versus ≤ 13% with monotherapy. ECCA scores improved more with dual therapy. Patient-reported satisfaction and DLQI (Dermatology Life Quality Index) scores also favoured combination protocols. Adverse events were mild and transient, with no serious complications. Conclusions: Combined microneedling and chemical peeling is superior to either treatment alone for atrophic acne scars, with favourable safety and patient-reported outcomes.