Comparative study between the efficacy of microneedling combined with topical insulin versus microneedling combined with topical ascorbic acid 20% in the treatment of striae alba

Introduction Striae alba (SA) are a prevalent cosmetic dermatologic condition characterized by dermal collagen and elastin disruption due to mechanical stretching. Clinically, they appear as atrophic, hypopigmented linear bands that commonly affect the abdomen and are therapeutically challenging due to their refractory nature. Objective: To compare the efficacy and safety of microneedling with topical insulin versus microneedling with 20% ascorbic acid in treating SA. Patients and methods This prospective comparative study included 40 female participants with abdominal SA, divided into two equal groups: group A received microneedling with topical insulin, while group B received microneedling with topical 20% ascorbic acid. Treatments were administered monthly for four consecutive months. Clinical effectiveness was evaluated 1 month after the last session using the Manchester Scar Scale, striae width measurements, and patient satisfaction. Results Both treatments showed significant improvement ( P <0.001). Mean Manchester Scar Scale improvement was 63.74±20.21 in group A and 63.04±13.23 in group B ( P =0.898). Both groups demonstrated significant reductions in striae width after 1 month ( P <0.001). In group A, median width decreased from 1.0 mm [interquartile range (IQR) 0.65–2.0] to 0.5 mm (IQR 0.45–1.0); in group B, from 0.75 mm (IQR 0.5–1.0) to 0.3 mm (IQR 0.3–0.5). Intergroup comparisons showed no significant differences in percentage of improvement ( P =0.956), degree of improvement ( P =0.469), or patient satisfaction ( P =0.710). Conclusion Microneedling combined with either topical insulin or ascorbic acid shows comparable efficacy and favorable tolerability in treating SA, providing clinicians with two effective treatment options.