The Acne Microneedling Myth: Why I Don't Always Follow the Rules

By Alice Hemmingsen, RN, RM, & Dermal Therapist | Through the Looking Glass Clinic, Tweed Heads

If you've ever Googled microneedling and acne, you've probably seen it listed as a firm contraindication. "Do not microneedle over active acne." It appears in training manuals, beauty therapy courses, and skincare blogs across the internet.

Here's the thing - that advice exists for a reason. But it's not the whole story. And as a Registered Nurse and Dermal Therapist, I think you deserve the nuanced version.

Where the microneedling for acne

"Rule" Comes From

The standard contraindication is written to protect patients from practitioners who are running a device over skin without the clinical knowledge to do it safely. In that context, it makes complete sense. A beauty therapist without a clinical background probably shouldn't be microneedling over active acne lesions - not because it's always harmful, but because without understanding the mechanism, the skin type, the lesion type, and the right products to pair it with, the risk of getting it wrong is real.

But clinical guidelines written for the least experienced practitioner aren't always the right guidelines for every practitioner.

The Clinical Argument for Treating Active Acne

Let me walk you through my reasoning - and then show you the research that backs it up.

Cutibacterium acnes is anaerobic. The bacteria responsible for acne thrives in low-oxygen environments - deep within the sebaceous follicle, away from air. This is actually why benzoyl peroxide works: it releases oxygen into the follicle, killing the bacteria. When microneedling creates micro-channels in the skin, it exposes those anaerobic environments to oxygen. The bacteria don't love that.

The micro-channels allow therapeutic actives to penetrate far deeper than topical application alone. 

As a dermal therapist, I can pair microneedling with anti-inflammatory serums, antibacterial actives, and skin-restoring ingredients that, under normal circumstances, would sit on the surface of the skin. Through open micro-channels, those same ingredients reach the dermis - where the inflammation is actually happening.

The result is a genuine treatment of active acne - not just management of it.

What the Research Actually Says

A 2023 pilot study published in the National Institutes of Health found that microneedling:

• Reduced the severity of active acne lesions - both inflammatory and non-inflammatory

• Did not cause post-treatment complications - contradicting the assumption that treating active acne with microneedling is inherently dangerous

• Was safe for darker skin types (Fitzpatrick III-V) - which is significant, because darker skin tones are often considered higher risk for post-inflammatory hyperpigmentation

• Stimulated collagen types I, III, and VII - meaning it simultaneously treated active acne AND began addressing the scarring underneath

The study concluded that microneedling "may be considered a safe and effective treatment for active acne."

That's not fringe science. That's a peer-reviewed, NIH-published pilot study from 2023.

So Who Should and Shouldn't Have This Treatment?

I want to be clear: I don't microneedle over every active acne presentation. Clinical judgement is the whole point.

I'm comfortable treating active acne with microneedling when:

• The lesions are primarily inflammatory (papules, pustules) rather than nodulocystic

• The client has been thoroughly assessed and appropriate products selected

• There are no other contraindications present (isotretinoin, compromised barrier, active infection etc.)

• The client understands what to expect and has given informed consent

I would not proceed if:

• The acne is severe, nodulocystic, or cystic

• The client is on or recently ceased isotretinoin (Roaccutane)

• There is any active infection, open wounds, or compromised skin integrity beyond the acne itself

• Clinical assessment suggests the risk outweighs the benefit for that individual

• 
  

Why This Matters for Teens with Acne

This is an area I'm particularly passionate about - partly because my daughter Ella, who works alongside me at the clinic, has a special clinical interest in teenage acne. We know how devastating acne can be for a young person's confidence. We also know that teens are often told to just "wait it out" or handed a prescription and sent on their way.

A properly delivered microneedling treatment with the right serums can make a meaningful difference to active acne AND prevent the scarring that so often follows - addressing both problems simultaneously. That's a conversation worth having.

The Bottom Line

Rules in aesthetics exist for good reasons. But understanding WHY a rule exists allows a skilled clinician to know when a different approach is more appropriate for their patient.

Microneedling over active acne isn't reckless if you know what you're doing. It can be genuinely therapeutic - backed by clinical reasoning and, now, peer-reviewed evidence.

If you or your teenager are struggling with acne and want an honest conversation about your options, we're here for it.

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Through the Looking Glass Clinic | 46A Wharf St, Tweed Heads NSW 2485

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