A study comparing the effect of dermaroller versus dermaroller with copper peptide in the management of acne scars

INTRODUCTION

Acne vulgaris, a chronic inflammatory condition of the pilosebaceous unit, is a common dermatological disorder affecting adolescents, which can produce mental health consequences, including that of low self-esteem and depression, which is influenced by its subsequent effect of scarring. At present, there is no single treatment modality that guarantees absolute success. Consequently, a combination of procedures or frequent technique changes is often recommended.

Dermaroller therapy has shown to be an effective treatment, significantly improving acne scars. Copper peptides, a more recent treatment, have also been assessed and found to yield excellent results in reducing scars.

Five types of dermaroller, all Food and Drug Administration approved, have been utilized in Konstantinos dermaroller series, namely C-8 (cosmetic type), C-8 HE (cosmetic type for hair-bearing areas like the scalp), collagen induction therapy-8 (medical type), MF-8, and MS-4.¹ In addition, commercially available dermarollers with slight variations on the market include the home care dermaroller, beauty mouse, and Dermapen.

While the typical dermaroller used for treating acne scars is a drum-shaped device equipped with 192 fine microneedles arranged in eight rows and 36 columns ranging from 0.5 to 1.5 mm in length and diameter of 0.1 mm, the dermaroller used in this study had 540 needles with 1.5 mm length titanium needles.² Research has shown that rolling a dermaroller (with 192 needles, 200 µm in length, and 70 µm in diameter) over an area 15 times results in approximately 250 holes per cm², thus the dermaroller used in this study possibly produced 703 holes approximately per cm². The value of approximately 703 holes/cm² produced by a 540-needle dermaroller is not derived from direct empirical measurement but rather extrapolated from existing data associated with a standard 192-needle dermaroller.³ The microneedles are manufactured using reactive ion etching on materials such as silicon or medical-grade stainless steel. The device is pre-sterilized through gamma irradiation and is designed for single use only.

During treatment, these needles penetrate the stratum corneum, creating micro-conduits (small holes) without causing harm to the epidermis. Five days after the injury, a fibronectin matrix forms, which regulates collagen deposition and contributes to skin tightening that can last 5–7 years, primarily due to collagen III. Neocollagenesis depth has been observed to be between 500 and 600 µm with a 1.5 mm needle.⁴ Microneedling stimulates the release of growth factors that promote the production of new collagen (natural collagen) and elastin in the papillary dermis. In addition, new capillaries are formed, and this neovascularization and neocollagenesis following treatment help reduce scars.⁵ The procedure is, therefore,SS aptly called “percutaneous collagen induction therapy” and has also been used in the treatment of photo-aging.⁵

The human copper-binding peptide glycyl-L-histidyl-Llysine (GHK)-Cu is a small, naturally occurring tripeptide present in human plasma. It can also be released from tissues in response to injury. GHK as such functions as a complex with Cu²⁺, stimulating both production and destruction of collagen and glycosaminoglycans and also influences metalloproteinases and its inhibitors, promoting skin repair and healing.^6,7 Since its discovery in 1973, GHK-Cu has established itself as a potent protective and regenerative agent, currently utilized in skin and hair products.

These peptides are crucial in the synthesis of the extracellular matrix and play key roles in innate immunity, pigmentation, and inflammation. In addition, they exhibit antioxidative and antimicrobial properties.⁸

When used in conjunction with dermaroller microneedling, transdermal delivery of copper peptides like GHK is significantly enhanced, offering a synergistic benefit that further aids in wound remodeling and tissue regeneration.

MATERIAL AND METHODS

This study assesses the effects of microneedling as a standalone treatment compared to its combination with copper peptide for acne scar treatment.

RESULTS

A total of 40 patients were included in this study, who were distributed equally among the two groups.

Participants were categorized into two age groups: Those under 25 years of age and those over 25 years of age. In group A (dermaroller monotherapy), 6 participants (30%) were under 25 years of age, and 14 participants (70%) were over 25 years. In group B (dermaroller with copper peptide), 7 participants (35%) were under 25, and 13 participants (65%) were over 25.

The majority of patients were male, including 11 males (55%) and 9 females (45%) in group A (dermaroller monotherapy) and 17 males (85%) and 3 females (15%) in group B (dermaroller with copper peptide). The P-value revealed a statistically significant difference in the gender distribution between the two groups, suggesting a potential gender-related variation in treatment allocation or response.

Participants were categorized based on the duration of acne scars, as those with scars under 5 years, 6–10 years, and scars for more than 10 years and constituted 10 (50%), 7 (35%), and 3 (15%) in group A (dermaroller monotherapy), respectively, and 7 (35%), 11 (55%), 10 (15%) in group B (dermaroller with copper peptide), respectively.

Both groups had a balanced distribution of Fitzpatrick skin types 4 and 5, where type 4 was observed among 15 (75%), and type 5 was observed among the remaining 5 (25%) in each group.

In dermaroller with copper peptide group, 15 (75%) patients had ice pick scars, and 19 (95%) patients had boxcar scars. In dermaroller monotherapy, 12 (60%) patients had ice pick scars and 18 (90%) patients had boxcar scars. All 20 patients in each group had rolling scars, making it the most common type of acne scar.

Participants under dermaroller monotherapy exhibited a mean baseline Goodman and Baron’s quantitative score of 20.7 (Standard deviation [SD] = 6.6), while those in copper peptide group had a mean baseline score of 22.7 (SD = 5.5). By the final follow-up, participants in the copper peptide group achieved the most significant reduction, with a mean score of 16.7 indicating a drop of 6 points from baseline, whereas group A showed a mean score of 16.2, indicating a drop of 4.5 points from baseline. Both groups showed a decrease in the mean over time, indicating an improvement in the acne scars based on Goodman and Baron’s quantitative score [Table 1].

Goodman and Baron’s qualitative scores were compared among the two treatment groups. At the final follow-up, 8 out of 20 in group A (40%) showed a drop in one grade whereas remaining 12 (60%) did not show any change in the grade. With respect to Group B, 14 out of 20 (70%) showed a drop in one grade whereas remaining 6 (30%) did not show any change in the grade.

In the dermaroller monotherapy group, female participants experienced a more significant reduction in the GB index, decreasing from a baseline mean of 19 (SD = 5) to 15 (SD = 5) at the final visit. In contrast, male participants showed a decrease from a baseline mean of 22 (SD = 7) to 17 (SD = 7) at the final visit. In the dermaroller with copper peptide group, female participants showed a notable decline, dropping from a baseline mean of 20 (SD = 5) to 12 (SD = 2) at the final visit, while male participants experienced a reduction from a baseline mean of 23 (SD = 6) to 18 (SD = 6) at the final visit.

In the group with dermaroller monotherapy, patients under 25 years of age had a mean baseline Goodman and Baron’s quantitative score of 16, decreasing to 12 at the final follow-up. Those under age group of more than 25 years had a mean baseline score of 23, decreasing to 18 at the final follow-up. In dermaroller with copper peptide group, those under 25 years of age had a mean baseline score of 20, decreasing to 14 at the final follow-up, whereas those above 25 years had a mean baseline score of 23, decreasing to 18 at the final follow-up.

In the dermaroller group, participants with scar durations of <5 years, 6–10 years, and over 10 years had mean baseline Goodman and Baron’s quantitative scores of 19, 23, and 21, respectively. At the final follow-up, these scores were reduced to 15, 18, and 16, in the same order. In the copper peptide group, participants with scar durations of <5 years, 6–10 years, and over 10 years had mean baseline scores of 21, 24, and 19, respectively. By the final follow-up, these scores decreased to 15, 18, and 16, in the same sequence.

In Group A (dermaroller monotherapy), baseline mean for boxcar scars and rolling scars was 7.1 and 8.9, respectively, which decreased to 5 and 6.5 by the final visit. However, the mean baseline of 4.2 for ice pick scars remained unaffected throughout the treatment period. Under copper peptide, baseline mean value was 8.2, 7.6, and 9.5 in terms of boxcar scars, rolling scars, and ice pick scars, respectively. There had been a significant reduction in the mean values accounting for a mean value of 4.6, 4.1, and 8.5, respectively, for boxcar scars at their final visits.

In dermaroller group, none of the patients had hyperpigmentation, whereas in the case of copper peptide group, 8 (40%) had hyperpigmentation and 12 (60%) reported no side effects.

DISCUSSION

In this study, investigators have endeavored to compare the therapeutic efficacy of dermaroller as monotherapy and dermaroller with copper peptide.

The study participants included males and females in the ratio of 7:3, suggesting a male preponderance which was in contrast to the study by Pandey et al., and Momin et al.^4,12 The P-values in the current study indicate significant differences in Goodman and Baron’s quantitative Index reduction across genders. Although the influence of gender is not elaborated in similar studies, females in Group B (dermaroller with copper peptide) showed a more significant reduction compared to Group A (dermaroller monotherapy), indicating a faster improvement in females using copper peptide.

In the current study, patients <25 years of age in Group B (derma roller with copper peptide) showed a faster decline in Goodman and Baron’s quantitative index compared to Group A (dermaroller monotherapy), suggesting copper peptide may accelerate improvement in younger individuals. In those with more than 25 years, both groups showed a steady decline in GB index, but Group B (derma roller with copper peptide) maintained slightly better improvement. These findings indicate that copper peptide may lead to faster results in younger patients but still benefits older individuals over time. Based on our understanding, no studies are available to compare the outcome with age, while Hassan et al., in the study of microneedling in acne scars documented 25.07% as the mean age of acne scars.¹³

In the current study, in Group B (derma roller with copper peptide) patients with Fitzpatrick skin type 5 had a greater decline compared to those patients with Fitzpatrick skin type 5 in Group A (dermaroller monotherapy), suggesting faster response in darker skin tones. Patients in Group B (derma roller with copper peptide) with Fitzpatrick skin type 4 showed moderate improvement, while patients in Group A (dermaroller monotherapy) had overall slower response. These results indicate that copper peptide may be more effective for patients with Fitzpatrick skin type 5, while both treatments are beneficial for type 4 skin. All patients in a study by Dogra et al., (2014) belonged to skin types IV and V but yet, but the possible outcomes have not been discussed in this or other similar studies.¹⁴

This study reveals significant differences in GB index reduction based on the duration of scars. In individuals with scars <5 years of duration in Group B (dermaroller with copper peptide), a greater improvement was observed compared to Group A (dermaroller monotherapy), indicating a quicker response in early-stage scars. For those with scars lasting 6–10 years, both groups showed improvement, but Group B (dermaroller with copper peptide) demonstrated a more pronounced decline. In cases of scars older than 10 years, the results suggest that longer treatment is needed for noticeable improvement. These findings emphasize that early intervention leads to better outcomes, while older scars require more extended treatment for significant improvement.

In the present study, the reduction in the mean value at the final visit in Group B (dermaroller with copper peptide) was similar to the decrease observed in a comparable study by Kumar and Srinivasan,¹⁵ involving participants treated with a dermaroller and copper peptide. Although Kumar and Srinivasan’s 15study reported a greater percentage of decline in the mean value for the copper peptide group, the current study found a consistent, though smaller, decrease in the mean value for the copper peptide group compared to the patients in group A (dermaroller monotherapy).

In the current study, boxcar scars in Group B showed a decrease from the mean baseline value, which was comparable to the reduction observed in a study by Kumar and Srinivasan, in the group where Boxcar scars were treated with dermaroller and copper peptide.¹⁵ In the study, Kumar and Srinivasan 15 reported that the mean value of rolling scars had a significant reduction in the copper peptide group which corresponds with the findings of the current study, where the copper peptide group showed an overall decline of rolling scars which was higher compared to the dermaroller group.

In the same study by Kumar and Srinivasan,¹⁵ the mean score of ice-pick scars was found to have no significant reduction in the ice-pick scars on copper peptide group compared to the reduction observed with the dermaroller group. This was in contrast with the current study where minimal response was attained in the copper peptide group whereas no change in the baseline mean was observed in the group with dermaroller monotherapy.

A 16-week treatment duration was found to be optimal for achieving maximum results in rolling and ice pick scars. Rolling scars showed significant improvement in the combination group (Group B), with scores decreasing from 7.6 ± 2.9 to 4.1 ± 1.7 (P = 0.001), indicating enhanced efficacy with copper peptide. Ice pick scars, though more resistant, showed a significant reduction in Group B from 9.5 ± 3.4 to 8.5 ± 3.5 (P = 0.00), while no change was observed in Group A. These findings support 16 weeks as the minimum required period to attain peak improvement in rolling scars and initiate a response in ice pick scars.

In the study by Kumar and Srinivasan,¹⁵ the P-value for the dermaroller group was statistically significant, but the p-value for the dermaroller with copper peptide group was even more significant. This finding corresponds with the current study, where both groups showed significant P-values, but the dermaroller with copper peptide group had a more substantial P = 0.001 as mentioned in Table 1.

The P-values at Baseline (0.05) and Week 3 (0.04) indicate significant differences, suggesting that copper peptide may contribute to an early improvement in GB index. However, from Week 6 onward, P-values indicated no significant difference between groups in the later weeks. This suggests that while copper peptide may accelerate early improvements, both treatments show similar outcomes in the long term [Figure 1].

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Figure 1:

Graph showing weekly distribution of Goodman and Baron’s quantitative score.

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In the present study, both groups showed a reduction in mean baseline values, with the dermaroller combined with copper peptide demonstrating a slightly better reduction according to Goodman and Baron’s qualitative scoring. This, however, is subjective and therefore cannot be precisely recorded.

In the study by Kumar and Srinivasan,¹⁵ post-inflammatory hyperpigmentation was more commonly observed in the dermaroller group compared to the group treated with both dermaroller and copper peptide. This finding was in contrast with the current study, where a higher percentage of hyperpigmentation as an adverse effect was seen in patients treated with dermaroller and copper peptide. Consistent with the results for the dermaroller group in the current study, no significant adverse effects were reported in the study by Majid, where microneedling was used for acne scars.¹⁶

Clinical image showing response to dermaroller monotherapy, dermaroller with copper peptide, and side effects noted in dermaroller with copper peptide group has been shown in Figures 2-7.

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Figure 2:

Clinical image of patient in Group A (dermaroller monotherapy). (a) Baseline presentation – Week 0. (b) Response at the end of final week – Week 16.

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Figure 3:

Dermaroller monotherapy group. (a) Clinical image at baseline -Week 0 and (b) response to treatment at final follow-up-Week 16.

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Figure 4:

Clinical image of patient in Group B (dermaroller with copper peptide). (a) Baseline presentation – Week 0. (b) Response at the end of final week – Week 16.

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Figure 5:

Dermaroller with copper peptide group. (a) Clinical image at baseline -Week 0 and (b) response to treatment at final follow-up-Week 16.

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Figure 6:

Dermaroller with copper peptide group. (a) Clinical image showing no hyperpigmentation at baseline - Week 0 and (b) hyperpigmentation noted over areas treated with copper peptide at final follow-up-Week 16.

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Figure 7:

Clinical image of patient in Group B (dermaroller with copper peptide) with side effect (hyperpigmentation). (a) Baseline presentation – Week 0. (b) Final follow-up – Week 16 (hyperpigmentation noted over the areas treated with copper peptide).

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Acne scars remain a formidable challenge for dermatologists, owing to their resistance to various treatment modalities.

However, scientific advancements and medical expertise continue to yield innovative approaches to addressing these scars.

Each acne treatment possesses its own advantages and disadvantages. By strategically combining these treatments, optimal outcomes can be achieved. Based on the findings, copper peptide can be considered a useful adjunct for accelerating early improvement in Goodman and Baron’s quantitative score. However, since P-values from Week 6 onward show no statistically significant difference between the groups, its long-term benefits appear comparable to derma-roller monotherapy. Therefore, copper peptide may be recommended for patients seeking faster initial results, but it may not offer additional long-term advantages. None of the groups were associated with long-term complications, except for the dermaroller with copper peptide group, where hyperpigmentation was observed. However, this was found to diminish in subsequent follow-ups after the study period had concluded.

This study highlights the effectiveness of dermaroller monotherapy in improving acne scars over a 16-week period, with both treatment groups, derma-roller alone and derma-roller combined with copper peptide showing consistent improvement in quantitative scores. Although Group B (with copper peptide) began with slightly worse baseline scores, both groups achieved comparable outcomes by Week 16, indicating that the addition of copper peptide offers only minimal long-term benefit.

Notably, the study suggests that copper peptide may provide greater early improvement, particularly in individuals with Fitzpatrick skin type 5, implying enhanced efficacy in the skin of color. These findings point to the potential for more tailored treatment strategies and support the need for further research comparing responses in fair skin versus skin of color to optimize acne scar management across diverse populations.

CONCLUSION

The study evaluated the effectiveness of two modalities of treatment for acne scars across various parameters. While both groups demonstrated statistically significant improvement, the analysis revealed a faster decline in mean value till week 6 for those treated with dermaroller with copper peptide, suggesting that copper peptide may contribute to an early improvement in Goodman and Baron’s quantitative score. However, from Week 6 onward, P-values indicated no statistically significant difference between groups. This suggests that while copper peptide may accelerate early improvements, both treatments show similar outcomes in the long term. In addition, demographic factors such as age, gender, duration of scars, type of acne scar, and Fitzpatrick skin type were found to influence treatment outcomes, highlighting the importance of patient-based approach in managing acne scars. The current study suggests that dermaroller therapy alone is effective and can be confidently recommended as a standalone treatment. Adding copper peptide offers only limited additional benefit and could be considered for patients with more severe baseline symptoms, as they showed some early improvement. Further research with larger, better-matched groups is needed to confirm any long-term or early-stage advantages of combining copper peptide with dermarolling. Considering the minimal added benefit, its cost-effectiveness should also be carefully evaluated before routine use. Keeping in mind the hyperpigmentation associated with copper peptide, dermaroller as a standalone can be considered a cost-effective treatment option in the management of acne scars.