Topical Ideal Sized Chitosan Dressing to Reduce Folliculitis After Microneedling, RF Microneedling, and Fractional CO ₂ Laser Resurfacing

Background and Objectives Folliculitis, pustules, and acneiform eruptions are recognized early adverse events after microneedling, RF microneedling, and fractional laser resurfacing procedures that create microchannels or microthermal columns in the skin. Chitosan is a cationic biopolymer with film‐forming and antimicrobial properties and has been used as a wound dressing material. Study Design/Materials and Methods We performed a single‐center retrospective cohort review of 324 consecutive patients undergoing microneedling ( n = 140), RF microneedling ( n = 121), or ablative fractional CO 2 laser resurfacing ( n = 63). Immediately after each procedure, 3 mL of a topical 2% chitosan formulation was applied as a postprocedure dressing. The primary outcome was clinician‐documented folliculitis/pustular eruption within 7 days following the procedure. Patient age and sex were not available in a complete analyzable format in the retrospective extract and therefore could not be summarized for the full cohort. Results Two folliculitis/pustular events occurred among 324 patients (0.62%; 95% CI 0.17%–2.22%). After microneedling including injector, 1/140 patients (0.71%) developed a diffuse full‐face follicular papulopustular eruption. After RF microneedling, 1/121 patients (0.83%) developed a localized follicular eruption with only a few lesions. No folliculitis/pustules were recorded after ablative fractional CO 2 laser resurfacing (0/63; 0%). Conclusions In this retrospective cohort, standardized immediate postprocedure application of topical 2% chitosan was associated with a low observed frequency of folliculitis/pustular eruptions across microneedling, RF microneedling (Sylfirm X, Viol Medical, Korea), and fractional CO 2 laser resurfacing (Beladona, Wontech, Korea), with variability observed between modalities. Controlled comparative studies with standardized demographic and device‐level data are needed to determine whether chitosan reduces risk relative to standard postprocedure dressings.