Fractional Radiofrequency Microneedling Combined With Low-Dose Isotretinoin versus Standard-Dose Isotretinoin in Moderate-to-Severe Acne: A Randomized Controlled Pilot Study
DOI:
https://doi.org/10.66344/jpad.v36i3.3484Keywords:
Fractional radiofrequency,, low-dose isotretinoin, obesity, acne, combination therapyAbstract
Background Oral isotretinoin is highly effective for moderate-to-severe acne but is limited by adverse effects and delayed onset of action. Fractional radiofrequency (RF) microneedling may enhance outcomes through targeted sebaceous gland destruction and dermal collagen remodeling.
Objective To compare the efficacy of fractional RF microneedling combined with low-dose isotretinoin versus standard-dose isotretinoin monotherapy in moderate to severe acne and assess the impact of body mass index (BMI) on treatment response.
Methods In this randomized controlled pilot study, 40 patients with moderate-to-severe acne (Investigator Global Assessment (IGA 3–4)) were assigned to combination therapy (RF microneedling plus isotretinoin 20 mg/day) or standard isotretinoin (0.5 mg/kg/day). The primary endpoint was IGA at Week 8.
Results At Week 8, the combination group showed greater improvement (mean IGA 1.55 vs. 2.90; P<.0001) and higher responder rates (90% vs. 30%). Lesion reduction was significantly greater with combination therapy. Six-month success rates were similar by intention-to-treat but favored combination therapy per-protocol (100% vs. 75%). All treatment failures occurred in obese patients (BMI ≥30 kg/m²), with lower failure rates in the combination group. No serious adverse events or wound healing complications were observed.
Conclusion Combination therapy with fractional radiofrequency microneedling and low-dose isotretinoin resulted in faster and greater clinical improvement than standard-dose isotretinoin monotherapy, with a favorable safety profile. Higher BMI was associated with treatment failure.
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