Microneedling Combined With Biomimetic Peptides for Burn Scar Improvement: A Prospective Study

Abstract

Background:

Hypertrophic scarring commonly follows burn injury, resulting from persistent inflammation, abnormal fibroblast activity, and excessive extracellular matrix deposition, leading to functional limitation and aesthetic impairment. Despite multimodal management, outcomes remain variable. Biomimetic peptides can modulate cellular pathways involved in tissue repair, whereas microneedling enhances transdermal delivery and stimulates dermal remodeling.

Methods:

This prospective, single-arm, interventional, before-and-after clinical study evaluated patients with hypertrophic burn scars treated with microneedling-assisted delivery of biomimetic peptides. Participants underwent 5 treatment sessions at 12-week intervals, followed by a final follow-up assessment 12 weeks after the last session (week 60). Scar characteristics were assessed at baseline and during follow-up using validated instruments, including the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. Scar-related symptoms and functional limitation were also recorded. Safety was monitored through prospective reporting of adverse events. Pre- and posttreatment outcomes were compared within subjects.

Results:

Following therapy, improvement was observed across multiple scar domains, including pigmentation, pliability, thickness, and vascularity, reflected by reductions in Vancouver Scar Scale and Patient and Observer Scar Assessment Scale observer scores. Patient-reported outcomes showed parallel improvements in discomfort, pruritus, and perceived stiffness, accompanied by gains in functional mobility. No serious adverse events or treatment discontinuations occurred.

Conclusions:

Microneedling-assisted biomimetic peptide therapy was associated with meaningful improvements in scar appearance and patient-reported function in hypertrophic burn scars. This minimally invasive approach may complement comprehensive scar rehabilitation. Controlled studies are needed to confirm efficacy and refine protocols.

Takeaways.

Question: Can microneedling combined with biomimetic peptides and growth factors improve the clinical characteristics and functional limitations of hypertrophyc burn scars?

Findings: In this study repeated microneedling combined with biomimetic peptides and growth factors was associated with the improvement of the hypertrophic burn scar characteristics and functional outcome, and improvement of the range motion.

Meaning: Microneedling-assisted delivery of biomimetic peptides and growth factors may represent a minimally invasive regenerative approach for improving the appearance and functional impact of burn scars.

INTRODUCTION

Burn injuries frequently result in hypertrophic scarring, a pathological process marked by excessive fibroblast proliferation, disorganized collagen deposition, persistent inflammation, and abnormal vascularization.^1–3 These scars can cause pain, pruritus, restricted mobility, and substantial aesthetic concerns, significantly affecting patients’ quality of life and long-term rehabilitation outcomes.^3,4 Management of hypertrophic scars remains a clinical challenge, as conventional therapies often yield variable results, require prolonged treatment, and may fail to prevent recurrence.^5,6

Current strategies for scar management include compression therapy,⁷ silicone sheeting,⁸ corticosteroid injections,⁹ physiotherapy,¹⁰ and laser-based interventions.¹¹ Although these approaches can improve scar appearance and function, they primarily address surface features rather than targeting the underlying molecular and cellular mechanisms driving abnormal scar formation.^12,13 Consequently, there is growing interest in regenerative and biologically targeted therapies capable of modifying scar tissue at the cellular and extracellular matrix level.^14,15

Biomimetic peptides encompass several classes of synthetic signaling molecules designed to reproduce the biological activity of endogenous growth factors, cytokines, extracellular matrix fragments, and regulatory peptides. Depending on their structure and target pathway, these peptides may promote fibroblast proliferation, collagen synthesis, angiogenesis, extracellular matrix remodeling, or epidermal regeneration. The formulation used in the present study contains synthetic peptides developed through recombinant and peptide engineering technologies and does not contain human-derived biological material.^16,17 Experimental studies have shown that these peptides can stimulate fibroblast and keratinocyte proliferation,^16,18 enhance collagen and elastin synthesis,^17,18 and modulate extracellular matrix remodeling,¹⁹ suggesting a potential role in controlling the pathological wound-healing environment of hypertrophic scars.^19,20

Microneedling, a minimally invasive technique that creates controlled microinjuries in the dermis, not only facilitates transdermal delivery of active compounds^16,18 but also independently triggers growth factor release and dermal remodeling, further enhancing regenerative outcomes.^18,19 Despite encouraging preclinical data and preliminary clinical observations, robust evidence assessing the combined application of biomimetic peptides and microneedling in burn-related hypertrophic scars is limited.^20,21 This study therefore aims to systematically evaluate the safety, objective scar improvements, and patient-reported functional outcomes associated with this intervention using validated assessment tools.^21,22

MATERIALS AND METHODS

Study Design

This is a prospective, interventional, before-and-after clinical study evaluating the safety, objective scar outcomes, and patient-reported functional improvements following microneedling-assisted delivery of biomimetic peptides in patients with hypertrophic burn scars. The study did not include a control group; future randomized controlled trials comparing this intervention with standard therapies such as compression, silicone, or massage are warranted. This study was conducted at the outpatient burn and regenerative dermatology clinic of the University of Kirei, Monterrey, Mexico.

Ethical Considerations

The study protocol (protocol no. K20261) was reviewed and approved by the ethics committee of the College of Specialists in Facial and Body Aesthetics, Mexico. Ethical approval was granted for research involving human subjects and remained valid until December 4, 2026. All participants provided written informed consent for participation, treatment, and publication of clinical images.

Sample Size and Statistical Power

The sample size was calculated to detect meaningful changes in Vancouver Scar Scale (VSS) scores. Based on previous studies, a moderate effect size (Cohen d = 0.6) was assumed. With a paired design, a significance level of 0.05, and 80% power, at least 24 patients were required. To allow for possible dropouts, the study included 30 patients. Patients with bilateral scar involvement were counted as a single participant for all analyses. Patients were recruited consecutively to reduce selection bias and better reflect routine clinical practice. This approach provided sufficient power to assess within-subject changes in scar severity.

Patient Selection

Participants were consecutively recruited from the outpatient burn and aesthetic clinic population to minimize selection bias and ensure representativeness of typical clinical cases.

Inclusion Criteria

• Adults aged 18–50 years.

• Only scars treated 6 months or more after injury were included to avoid the acute wound-healing phase and to evaluate established hypertrophic scars. However, hypertrophic scar remodeling may continue beyond this period, and spontaneous maturation remains a potential confounding factor when interpreting treatment outcomes.

• Total body surface area involvement of 40% or less.

• Ability to provide informed consent.

Exclusion Criteria

• Active infection or ulceration in scarred areas.

• History of keloid formation or systemic connective tissue disorders.

• Pregnancy or breastfeeding.

• Prior regenerative therapy (peptides, fat grafting, or laser therapy) within 3 months.

Screening included detailed medical history, physical examination, and verification of eligibility criteria. Patients meeting all inclusion and no exclusion criteria were enrolled and scheduled for baseline evaluation.

Intervention Protocol

The biomimetic peptide solution used (Dermaheal HSR/SR, Caregen Co., Korea) contains SH-oligopeptide-1, acetyl hexapeptide-8, and other regulatory peptides known to enhance collagen and elastin synthesis. Treatment was directed toward selected scar regions based on scar size, scar thickness, and clinical characteristics, including areas demonstrating increased thickness, irregular texture, erythema, or ongoing scar activity. Sessions were performed at 12-week intervals to align with the physiological timeline of collagen remodeling and dermal matrix reorganization, which typically occurs during the several weeks following controlled dermal injury. A 12-week interval was selected to allow sufficient time for collagen remodeling and tissue maturation between treatment sessions based on clinical experience and the expected timeline of dermal repair following controlled injury. No concurrent scar therapies, such as compression garments, silicone-based products, corticosteroid injections, laser therapy, or massage therapy, were administered during the study period to isolate the effect of the intervention.

The selection of this peptide formulation was based on its established regenerative profile in dermatologic and wound-healing applications. SH-oligopeptide-1, an epidermal growth factor–mimetic peptide, has been shown to stimulate keratinocyte and fibroblast proliferation and promote extracellular matrix remodeling. Acetyl hexapeptide-8 acts as a regulatory peptide that modulates cellular signaling involved in collagen organization and dermal elasticity. Additional biomimetic peptides in the formulation contribute to enhanced synthesis of collagen, elastin, and glycosaminoglycans, all of which are essential for restoring dermal architecture in scarred tissue. These effects restore dermal architecture, targeting dysregulated fibroblasts and abnormal extracellular matrix in hypertrophic burn scars. Prior use in regenerative dermatology supports its safety and scar remodeling potential.

All enrolled patients received microneedling-assisted delivery of biomimetic peptides (Dermaheal HSR/SR) according to a standardized treatment protocol. Before each session, the scarred areas were thoroughly cleansed and disinfected using standard antiseptic procedures to minimize the risk of infection. Microneedling was then performed using a 36-needle Dermapen cartridge, applied uniformly across the affected regions. A needle depth of 0.5 mm was maintained for all patients to ensure consistent dermal penetration while avoiding unnecessary tissue trauma.

Immediately following microneedling, the volume of biomimetic peptide solution was individualized according to scar size, scar thickness, and clinical characteristics, with total volumes ranging from 0.5 to 3 mL per session, allowing for optimal absorption through the microchannels created by the procedure. Treatment was focused on selected clinically relevant portions of the scar and not necessarily the entire visible burn area. Therefore, the clinical photographs depict the overall burn scar region and its evolution over time but should not be interpreted as representing the exact surface area treated during each session. The combination of controlled mechanical injury and peptide delivery was designed to stimulate dermal remodeling, enhance fibroblast activity, and promote the synthesis of collagen, elastin, and glycosaminoglycans within the scar tissue.

Patients underwent 5 treatment sessions at 12-week intervals. The same trained clinician performed all procedures to ensure procedural consistency and reproducibility. After each session, patients received standardized postprocedure instructions, including gentle cleansing of treated areas, avoidance of direct sun exposure, and monitoring for signs of irritation or infection.

Throughout the study, all adverse events, including erythema, edema, pain, or delayed healing, were documented prospectively. The intervention was well tolerated, with no serious adverse events reported, supporting both the safety and feasibility of this combined microneedling and peptide protocol for the management of hypertrophic burn scars.

Outcome Measures

Primary Outcomes (Objective)

The primary outcomes focused on the morphological characteristics of hypertrophic burn scars, assessed using 2 validated observer-based instruments. The VSS evaluates 4 key parameters of scar tissue: pigmentation, vascularity, pliability, and scar height. Pigmentation is scored based on color deviation from surrounding skin; vascularity assesses redness or erythema; pliability reflects tissue elasticity, ranging from normal to contracture; and scar height measures thickness relative to surrounding skin. Each domain is scored individually, and the sum provides an overall scar severity index, allowing standardized, reproducible assessment across time points.

Complementing the VSS, the Patient and Observer Scar Assessment Scale (POSAS) observer component provides a comprehensive evaluation of scar morphology, including surface texture, thickness, relief, and irregularity. POSAS observer scores are rated on a 10-point scale for each item, where higher scores indicate more severe scarring. Together, VSS and POSAS observer scores allow detailed, standardized tracking of structural changes in scars over time.

Secondary Outcomes (Patient-reported/Functional)

Patient-reported outcomes were captured using the POSAS patient component, which assesses subjective symptoms, including pain, pruritus, stiffness, and overall scar appearance. Scores are recorded on a 10-point scale, with higher values indicating greater severity or discomfort.

Functional outcomes were evaluated through range of motion (ROM) measurements using a goniometer for joints affected by burn scars, particularly in the extremities. ROM quantification provides objective insight into functional limitations caused by scar contractures. Additionally, pain and pruritus were measured using a visual analog scale (0–10), where 0 represents no symptoms and 10 represents the worst imaginable symptoms. For patients with torso scars, ROM assessment included trunk flexion, extension, and rotation. The combination of these observer-based, patient-reported, and functional measurements was selected to provide a comprehensive, standardized, and clinically meaningful assessment of both the structural and functional impact of hypertrophic burn scars, ensuring objective tracking of treatment efficacy throughout the entire study period.

All observer-based assessments (VSS and POSAS) were conducted by a blinded, independent clinician. Functional assessment included goniometric measurement of joints affected by burn scar contracture or restricted mobility. Because different anatomical regions were involved across participants, ROM values were normalized and expressed as a percentage of the expected physiological ROM for the affected joint. ROM outcomes were analyzed at the patient level. For patients with involvement of more than 1 joint, normalized ROM values were averaged to generate a single patient-level ROM score for statistical analysis. Patients with bilateral scars were counted as a single participant, and ROM measurements from all affected joints were incorporated into the patient-level score. VSS was selected as the primary endpoint because it provides a widely validated and objective clinical assessment of key morphological scar characteristics, including pigmentation, vascularity, pliability, and scar height. These structural parameters are particularly relevant in hypertrophic burn scars and allow standardized comparison across time points. The POSAS scale was additionally included to capture patient-reported symptoms and subjective scar perception, thereby complementing the objective VSS evaluation.

Safety Outcomes

All participants were monitored for adverse events throughout the study. Safety assessments included erythema, edema, infection, delayed healing, and other procedure-related complications. Events were documented prospectively and categorized by severity and relationship to the intervention.

Follow-up Schedule

Patients were assessed at baseline and before each of 5 sessions spaced 12 weeks apart (weeks 0, 12, 24, 36, 48). A final follow-up at week 60 evaluated sustained scar improvements, functional outcomes, and safety. At each visit, VSS, POSAS, ROM, and adverse events were recorded to monitor scar progression and treatment response.

Statistical Analysis

Data were analyzed using SPSS v28.0 (IBM, Armonk, NY). Continuous variables were reported as mean ± SD or median (interquartile range), and categorical variables as counts and percentages. Normality was tested with the Shapiro–Wilk test. Within-subject comparisons used paired t tests for normal data and Wilcoxon tests for nonparametric data. Effect sizes were calculated to assess clinical relevance. A two-tailed P value less than 0.05 was considered significant. This approach ensures a robust evaluation of morphological and functional improvements, integrating objective scales, patient-reported outcomes, and safety for a comprehensive assessment of efficacy and tolerability.

RESULTS

A total of 30 patients completed the study (mean age 28.6 ± 6.4 y; 56.67% female, 43.33% male). The mean time since burn was 18 ± 6 months. Scars were located on the hands (40.00%, n = 12), legs (33.33%, n = 10), and torso (26.67%, n = 8), all hypertrophic at baseline (mean VSS, 11.2 ± 2.8) (Table 1, Figs. 1–12).

Table 1.

Baseline Demographic and Clinical Characteristics of Study Participants

Variable	Value
No. patients	30
Age, y, mean ± SD	28.6 ± 6.4
Sex, n (%)
Female	17 (56.67)
Male	13 (43.33)
Time since burn injury, mo, mean ± SD	18 ± 6
Scar location, n (%)
Hands	12 (40.00)
Legs	10 (33.33)
Torso	8 (26.67)
Mean baseline VSS score	11.2 ± 2.8

Fig. 1.

Baseline appearance of the right leg before treatment.

Fig. 12.

Left leg scar viewed from a different angle, 12 weeks after the fifth treatment session, showing an overall normalized scar appearance and improved pigmentation.

Fig. 2.

Baseline appearance of the right leg before treatment, shown from a different view, upon discharge from the hospital after the burn.

Fig. 3.

Right leg burn scar at week 12, after the first treatment session, showing a mild reduction in erythema and thickness compared with baseline.

Fig. 4.

Right leg scar at week 24, after the second treatment session, showing reduced scar thickness, improved pliability, and early vascular normalization.

Fig. 5.

Right leg scar at week 48, after the fourth treatment session, showing decreased scar thickness, reduced erythema, and increased pliability.

Fig. 6.

Right leg scar at week 60, 12 weeks after the fifth treatment session, showing improved morphology, reduced elevation, increased elasticity, and very good resolution of vascular redness.

Fig. 7.

Baseline appearance of the left leg before treatment.

Fig. 8.

Left leg scar at week 12, after the first treatment session, showing slight softening of the scar tissue and a mild reduction in erythema.

Fig. 9.

Left leg scar at week 24, after the second treatment session, showing early normalization of pigmentation, modest reduction in scar elevation, improved pliability, and reduced scar redness.

Fig. 10.

Left leg scar at week 48, after the fourth treatment session, showing scar softening, decreased thickness, and more uniform pigmentation.

Fig. 11.

Left leg scar at week 60, 12 weeks after the fifth treatment session, showing sustained improvement in elevation, pliability, and vascularity, with an overall normalized scar appearance and improved pigmentation on the overall skin.

Patients were evaluated at baseline, before each of 5 treatment sessions (weeks 0, 12, 24, 36, 48), and at a final follow-up at week 60. Early improvements after the first session included pigmentation changes in 20.00% (n = 6), slight pliability gains in 16.67% (n = 5), and minor elevation reductions. By week 24, 43.33% (n = 13) showed mixed pigmentation, and 33.33% (n = 10) demonstrated improved pliability. At week 36, 60.00% (n = 18) exhibited improved vascularity and pliability, with VSS declining to 8.3 ± 2.2 (P < 0.001).

At week 48, favorable changes were observed across individual scar domains: mixed pigmentation in 73.33% (n = 22), firm pliability in 70.00% (n = 21), elevation of less than 2 mm in 66.67% (n = 20), and improved vascularity in 76.67% (n = 23). At week 60, improvements were sustained: mean VSS, 6.5 ± 2.1 (P < 0.001); mixed pigmentation, 83.33% (n = 25); firm pliability, 76.67% (n = 23); elevation of less than 2 mm, 70.00% (n = 21); and improved vascularity, 80.00% (n = 24). POSAS observer scores decreased from 18.4 ± 3.2 to 11.6 ± 2.9, and patient scores from 21.0 ± 4.1 to 13.2 ± 3.5 (P < 0.001).

Pruritus decreased from 6.2 ± 1.8 to 2.4 ± 1.3, and patients reported reduced stiffness and improved comfort. ROM improved from 62.3% ± 8.1% to 80.5% ± 6.7% of normal physiological ROM (P < 0.001), indicating progressive functional recovery across affected anatomical sites.

Minor transient erythema and mild edema occurred in 20.00% (n = 6), resolving spontaneously within 24–48 hours. No infections, delayed healing, or discontinuations were reported, confirming the safety and feasibility of microneedling-assisted biomimetic peptide therapy (Tables 2–4, Figs. 13, 14).

Table 2.

VSS Scores Over Time

Follow-up	N	Pigmentation (Mean ± SD)	Vascularity (Mean ± SD)	Pliability (Mean ± SD)	Height (Mean ± SD)	Total VSS (Mean ± SD)	P Value Versus Baseline	Significance
Baseline	30	3.2 ± 0.8	3.1 ± 0.7	2.9 ± 0.6	2.0 ± 0.5	11.2 ± 2.8	—	—
Week 12	30	3.0 ± 0.7	2.9 ± 0.6	2.7 ± 0.5	1.8 ± 0.4	10.4 ± 2.6	0.03	*
Week 24	30	2.7 ± 0.6	2.6 ± 0.5	2.4 ± 0.5	1.6 ± 0.4	9.3 ± 2.4	<0.01	†
Week 36	30	2.4 ± 0.5	2.4 ± 0.4	2.1 ± 0.4	1.4 ± 0.3	8.3 ± 2.2	<0.001	‡
Week 48	30	2.2 ± 0.5	2.1 ± 0.4	1.9 ± 0.3	1.2 ± 0.3	7.2 ± 2.2	<0.001	‡
Week 60	30	2.0 ± 0.4	1.9 ± 0.3	1.8 ± 0.3	1.1 ± 0.2	6.5 ± 2.1	<0.001	‡

VSS scores at baseline and during follow-up are presented as mean ± SD. P values indicate comparisons with baseline values.

^*P < 0.05.

^†P < 0.01.

^‡P < 0.001.

Table 4.

Functional ROM During Follow-up

Follow-up	N	ROM (% of Normal ± SD)	P Value Versus Baseline	Significance
Baseline	30	62.3 ± 8.1	—	—
Week 12	30	67.4 ± 7.5	0.04	*
Week 24	30	71.0 ± 7.0	<0.01	†
Week 36	30	74.0 ± 6.5	<0.001	‡
Week 48	30	77.0 ± 6.2	<0.001	‡
Week 60	30	80.5 ± 6.7	<0.001	‡

ROM is expressed as the percentage of normal physiological motion and presented as mean ± SD. P values indicate comparisons with baseline values.

^*P < 0.05.

^†P < 0.01.

^‡P < 0.001.

Fig. 13.

Progression of scar morphology over time. Line chart showing the VSS total score and the POSAS observer score at baseline and follow-ups (weeks 12, 24, 36, 48, 60). Data are presented as mean ± SD, with error bars representing variability. Both scores decreased over time.

Fig. 14.

Patient-reported symptoms and functional recovery over time. Line chart showing the POSAS patient score, visual analog scale pruritus (left y axis), and joint ROM (right y axis) at baseline and follow-ups. Data are presented as mean ± SD. Symptom severity decreased, and joint mobility increased over time.

Table 3.

POSAS and VAS Scores Over Time

Follow-up	N	POSAS Observer (Mean ± SD)	POSAS Patient (Mean ± SD)	VAS Pruritus (Mean ± SD)	VAS Pain (Mean ± SD)	P Value Versus Baseline	Significance
Baseline	30	18.4 ± 3.2	21.0 ± 4.1	6.2 ± 1.8	5.8 ± 1.7	—	—
Week 12	30	16.9 ± 3.0	18.7 ± 3.9	5.2 ± 1.6	5.0 ± 1.5	0.02	*
Week 24	30	14.8 ± 2.7	16.2 ± 3.5	4.1 ± 1.4	4.2 ± 1.3	<0.01	†
Week 36	30	13.1 ± 2.5	14.6 ± 3.2	3.2 ± 1.2	3.4 ± 1.1	<0.001	‡
Week 48	30	12.0 ± 2.3	13.5 ± 3.0	2.5 ± 1.0	2.8 ± 1.0	<0.001	‡
Week 60	30	11.6 ± 2.9	13.2 ± 3.5	2.4 ± 1.3	2.5 ± 0.9	<0.001	‡

POSAS observer and patient scores, together with VAS scores for pruritus and pain, are presented as mean ± SD. P values indicate comparisons with baseline values.

^*P < 0.05.

^†P < 0.01.

^‡P < 0.001.

VAS, visual analog scale.

DISCUSSION

Hypertrophic scars arise from dysregulated wound healing with excessive fibroblast activity, abnormal collagen deposition, and persistent inflammation, leading to contracture, thickening, erythema, and reduced pliability. These changes can limit mobility, cause discomfort, and reduce quality of life. Effective management requires a multifaceted approach addressing both structural and functional aspects of scar tissue.^21,22 Although hypertrophic changes may appear earlier, treatment was initiated only after 6 months to avoid the acute wound-healing phase and focus on established scars. Nevertheless, hypertrophic scar maturation may continue for several years after burn injury, and spontaneous improvement cannot be excluded as a contributor to the observed changes.

In this study, we evaluated the effects of serial microneedling-assisted biomimetic peptide therapy on hypertrophic burn scars. Microneedling was used not only as a delivery system but also as an independent regenerative stimulus. Controlled microinjuries induced by the procedure activate dermal remodeling pathways, including upregulation of growth factors, stimulation of fibroblasts, and increased collagen and elastin synthesis. Microneedling has been shown to induce neocollagenesis, improve collagen organization, and promote dermal remodeling in both experimental and clinical studies of scar treatment.^23,24 By combining this mechanical stimulus with topical biomimetic peptides, which mimic endogenous signaling molecules involved in extracellular matrix regulation, a synergistic mechanism may be achieved, as suggested in the regenerative dermatology literature.^24,25 Each treatment session was spaced at 12-week intervals to allow sufficient time for collagen remodeling and tissue regeneration, consistent with the natural kinetics of dermal repair. Follow-up assessments tracked scar progression at baseline, before each session, and 12 weeks after the final session. Early pigmentation and pliability improved rapidly, whereas later sessions enhanced vascularity and thickness. By week 60, most patients had better VSS/POSAS scores, less pruritus, and improved mobility. Safety was excellent, with minor erythema/edema. Microneedling-assisted peptide therapy is a safe and effective adjunct.

Comparing our findings with the current literature, previous studies evaluating microneedling and regenerative treatments in hypertrophic scars, typically involving 10–30 patients, have reported improvements in scar thickness, pliability, and pigmentation after 3–6 treatment sessions, although most studies are limited by small sample sizes and short follow-up durations.^23–25 However, most reports have been limited to small case series or single-session interventions. Our study, with a structured, multisession protocol and systematic follow-up, provides stronger longitudinal evidence of both functional and morphological improvement. The integration of objective scar scales, patient-reported outcomes, and functional measures further strengthens the evidence, ensuring that the observed benefits are clinically meaningful and not limited to aesthetic parameters. Recent studies highlight the potential of regenerative peptides to modulate fibroblast activity and enhance scar remodeling.^21–23 Microneedling has been shown to synergistically improve the transdermal delivery of bioactive molecules.^24,25 The peptide formulation used in the present study was selected because it combines multiple biomimetic signaling molecules that target complementary pathways involved in tissue repair. Epidermal growth factor-like peptides stimulate cellular proliferation and reepithelialization, whereas regulatory peptides enhance collagen organization and dermal matrix stability. When delivered through microneedling-generated microchannels, these peptides may achieve deeper dermal penetration and localized biological activity within scar tissue, thereby supporting structural remodeling and functional recovery.

This study lacked a randomized control group, and the small, single–center sample limits generalizability. Scar characteristics varied, and assessments (VSS, POSAS, ROM) could be enhanced with advanced imaging. Outcomes may be affected by adherence, lifestyle, and scar age. Only hypertrophic burn scars were studied, so applicability to other scar types is uncertain. The combined microneedling and peptide intervention prevents determination of the independent effect of each component. Future controlled studies comparing microneedling alone, peptide therapy alone, and standard conservative treatments are needed to clarify relative efficacy and mechanisms of action. Because the study duration extended to 60 weeks, some degree of natural scar maturation cannot be completely excluded. However, all scars were older than 6 months at enrollment, a stage at which hypertrophic scars typically show slower spontaneous remodeling. The consistent and progressive improvements observed across sequential treatment sessions suggest that the intervention likely contributed to the observed changes.

Future multicenter, randomized trials are needed to confirm efficacy and safety across diverse populations. Comparative studies with standard therapies and longer follow-up are required to assess clinical value, durability, and late effects. Advanced imaging and molecular analyses may further clarify mechanisms and optimize protocols.

CONCLUSIONS

Serial microneedling-assisted biomimetic peptide therapy was associated with meaningful improvements in hypertrophic burn scar morphology, patient comfort, and functional outcomes. The intervention was safe and well tolerated and effectively addressed both structural and functional impairments, supporting its use as a minimally invasive strategy for postburn scar management.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.