Evaluation of Combined Chemical Peeling and Microneedling Protocols in the Treatment of Acne-Prone Skin: A Pilot Study

Abstract

Acne vulgaris is a prevalent dermatological disorder characterized by excessive sebum production, impaired skin hydration, enlarged pores, and persistent lesions. Chemical peeling is a well-established procedure in cosmetic dermatology, while microneedling has emerged as a promising minimally invasive procedure; however, evidence on their combined use remains limited. This pilot study aimed to compare the efficacy of chemical peeling, combined chemical peeling with microneedling, and a classic cosmetic protocol in patients with mild to moderate acne. Fifteen participants aged 18–45 years were divided into three groups according to the treatment protocol. Groups 1 (chemical peeling) and 3 (classic cosmetic care) each received four sessions at two-week intervals, whereas Group 2 (combined peeling with microneedling) completed seven sessions. Sebum levels, hydration, pore counts, and acne lesions were assessed using digital skin analysis and evaluated statistically by one-way ANOVA followed by Tukey’s HSD test (p < 0.05). Chemical peeling reduced sebum secretion (−17–18%) and acne lesions (−14%) and increased hydration (+22%), although pore counts increased (+8–18%). The combined protocol achieved the most pronounced seboregulation (−23–25%) and lesion reduction (−22%) with pore reduction (−7%), but hydration decreased (−14–19%). The classic treatment produced only modest effects, mainly a slight decrease in sebum (−10%) and lesions (−8%), accompanied by dehydration (−23–26%) and increased pore counts (+14–16%). These findings indicate the efficacy of chemical peeling and its enhancement through combination with microneedling, emphasizing the need for individualized cosmetic strategies and further validation in larger controlled trials.

1. Introduction

Chemical peeling has established itself as an effective and reliable procedure in aesthetic dermatology, while techniques such as microneedling and mesotherapy have gained popularity lately. Despite their growing use, the combined use of chemical peeling and microneedling remains unsupported by standardized formulations or well-defined treatment protocols. Furthermore, significant gaps remain in documenting clinical outcomes and ensuring long-term patient follow-up [1].

When applied together, chemical peeling and microneedling provide practitioners with a versatile set of options for managing facial skin ageing and treating a range of dermatological conditions. To achieve safe and effective results, a comprehensive patient evaluation and a solid understanding of procedure’s indications, contraindications, and limitations are essential [2].

1.1. Overview of Acne Vulgaris

Acne vulgaris is one of the most prevalent dermatological disorders, affecting individuals of all ages and genders, though it is most common during adolescence and early adulthood. It is the most frequently treated condition in clinical dermatology. Acne primarily involves pilosebaceous units and is clinically manifested by excessive sebum production (seborrhea), comedone formation (open and closed), and inflammatory lesions such as papules and pustules. In more severe cases, nodules and cysts may also occur. If inadequately managed, acne can lead to persistent scaring and have a significant psychological impact on patients [3,4].

The pathogenesis of acne is multifactorial, with numerous interrelated factors contributing to lesion development. These include genetic predisposition, hormonal fluctuations (elevated androgens), dietary influences (high-glycemic foods and dairy products), improper skin hygiene, psychological stress, the use of comedogenic cosmetic products, and certain medications [5,6].

Modern acne management strategies emphasize comprehensive care, including appropriate therapeutic interventions, maintenance skincare, and long-term follow-up. Treatment success often depends on patient adherence and the clinician’s ability to tailor interventions to the individual’s specific needs and severity [4,7].

1.2. Pathophysiology of Acne

Acne arises due to abnormal keratinization within the pilosebaceous follicle, which leads to the buildup and blockage of sebum. This environment favors the proliferation of Cutibacterium acnes (formerly known as Propionibacterium acnes), a bacterium that contributes to the inflammatory response. The resulting follicular obstruction marks the initial stage of comedone formation, which can progress to inflammatory lesions such as papules, pustules, and, in more severe cases, nodules or cysts [8].

Clinically, acne presents with a range of visible lesions, including enlarged pores, whiteheads (closed comedones), blackheads (open comedones), papules, pustules, and microcysts, also referred to as retention lesions. These are typically distributed in seborrheic areas of the face, most notably the T-zone (forehead, nose, and chin), as well as the lower facial region, including the jawline and chin; the forehead may also be involved in certain cases [4,9].

1.3. Acne Treatment Strategies

A wide range of therapeutic options is available for acne management, including topical treatments, systemic medications, chemical peeling, dermabrasion, and light-based therapies. These modalities can be used either as standalone interventions or in combination, depending on the individual patient’s needs. The primary objectives of treatment are to reduce the number and severity of lesions, prevent scar formation, and improve the overall appearance and texture of the skin. Treatment strategies are tailored to individual factors, including the type and severity of acne, patient age, skin type, and medical history. It is important to note that clinical improvement may take several weeks to months to become evident [4,5,10].

Post-acne scarring is a frequent complication, affecting up to 95% of individuals with acne. These scars are generally categorized into two main types: hypertrophic (raised) and atrophic (depressed). Various treatment options are available to address acne scars, including dermabrasion, laser resurfacing, dermal fillers, radiofrequency, microneedling, chemical peeling, cryotherapy, intralesional corticosteroid injections, and subcision techniques [4,5,11].

Acne management strategies can be divided into:

• Topical treatments: typically, first-line therapy for mild to moderate acne includes retinoids (adapalene, tretinoin, isotretinoin, and tazarotene), antibiotics (erythromycin, clindamycin), and other agents with anti-inflammatory or antimicrobial properties (benzoyl peroxide, sulfur, dapsone, corticosteroids) [12].
• Systemic treatments: for moderate to severe or treatment-resistant acne, systemic options may be necessary; these include oral retinoids (isotretinoin), antibiotics (erythromycin, azithromycin, clindamycin and doxycycline), hormonal therapies (combined oral contraceptives), and other agents such as corticosteroids and clofazimine [13].
• Complementary and alternative therapies: include the use of antimicrobial peptides, herbal and plant extracts, and other natural compounds that may possess anti-inflammatory or antibacterial activity [14].
• Physical treatments: a variety of procedures may be employed, including comedone extraction, electrocautery, cryotherapy, intralesional corticosteroid injections, and various laser-based therapies [15].
• Chemical peeling: superficial and medium-depth chemical peeling, utilizing agents like alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), polyhydroxy acids (PHAs) with keratolytic, comedolytic, anti-inflammatory, and antibacterial properties, are commonly employed as adjunctive or maintenance therapies in acne to reduce sebum production and enhance skin texture [16,17,18].
• Microneedling: minimally invasive, simple, cost-effective, and well-tolerated technique with minimal downtime and a favorable safety profile, making it suitable for acne-prone skin due to its preservation of the stratum corneum and basement membrane and its reduced risk of post-inflammatory hyperpigmentation, infection, or photosensitivity [2,19].

1.4. Combining Chemical Peeling with Microneedling

Combining chemical peeling with microneedling represents a synergistic strategy that integrates the distinct therapeutic mechanisms of both procedures to optimize clinical outcomes in the management of acne, post-inflammatory hyperpigmentation, photoaging, and residual scarring. Chemical peels primarily act on the epidermis, promoting controlled exfoliation and accelerating cellular turnover, resulting in improved skin tone, texture, and clarity. Microneedling, on the other hand, targets deeper dermal layers by inducing microinjuries that stimulate the skin’s natural repair mechanisms, such as collagen and elastin synthesis [20,21].

When performed sequentially, microneedling not only enhances regenerative responses but also increases cutaneous permeability, enabling more effective transdermal delivery of active compounds. This dual-action approach can potentially amplify therapeutic efficacy while reducing the need for high concentrations of peeling agents or more invasive procedures. This combination has shown promise in treating pigmentation disorders, with outcomes comparable to those achieved through deep peels or non-ablative fractional lasers [22].

This study aims to provide a preliminary evaluation of the effects of combining chemical peeling with microneedling in acne-prone skin. In the absence of standardized protocols, the research explores different treatment schedules and strategies to compare their relative clinical performance. The objective is to generate reproducible, hypothesis-driven insights related to acne severity and skin characteristics, with a particular focus on changes in acne lesions and skin texture.

Given the lack of standardized protocols and the small sample size, the study qualifies as a pilot study, aimed at generating hypotheses and directions for future research on larger samples.

2. Materials and Methods

This prospective pilot study was conducted in collaboration with the aesthetics skin care facility “Șoimița Science of Skin” from Târgu Mureș, where the practical component of the research was implemented. The study enrolled volunteers seeking aesthetic treatment for acne-prone skin. All study procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki and were approved by the Ethics Committee of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania (approval no. 1929; date 16 November 2022).

A total of 15 participants aged 18 to 45 years with Fitzpatrick skin types II to IV were included. All presented with mild to moderate facial acne, including comedones, papules, pustules, and post-acne scarring.

Inclusion criteria required the absence of systemic acne treatments or recent cosmetic procedures in the six months preceding enrollment. Exclusion criteria included severe forms of acne (e.g., nodulocystic or conglobate), use of corticosteroids or isotretinoin within the previous six months, active infections, pregnancy, breastfeeding, and hypersensitivity to any of the treatment ingredients.

Patient selection was carried out in collaboration with the cosmetic salon. The initial evaluation involved a standardized questionnaire, supplemented with specific diagnostic tools, including a cosmetic record, a skin sensitivity test, a skin phototype questionnaire, digital photography, and skin analysis using a professional scanner. Evaluations were repeated at each stage of the study and concluded with a comprehensive final assessment.

All cosmetic solutions used in the study were approved for use on both the Romanian and European cosmetic markets and complied with current regulatory safety standards. Each product had clearly defined indications, contraindications, and usage protocols to ensure safe and practical application.

Participants were assigned to one of the following three treatment groups:

• Group 1 received four chemical peeling sessions at 14-day intervals. The peeling solution was a standardized mixture of azelaic acid and salicylic acid.
• Group 2 underwent seven treatment sessions, consisting of four chemical peeling (with the same standardized mixture of azelaic acid and salicylic acid) followed by three microneedling sessions, administered every 14 days. Microneedling was performed using a Dermapen equipped with sterile single-use cartridges (depth range: 0.25–1.25 mm), along with active ampoules tailored for acne-prone skin.
• Group 3 followed a classic cosmetic treatment protocol consisting of four sessions at 14-day intervals. These included manual comedone extraction, soothing masks, and supportive skincare, with no chemical peeling or microneedling.

Each treatment session began with skin cleansing and toning, followed by enzymatic exfoliation where appropriate. Before each session, skin parameters were evaluated using a digital scanner that measured sebum levels, moisture, pore size, pigmentation, elasticity, and the count of acne lesions. All collected data were documented and subjected to statistical analysis to determine the comparative efficacy of each treatment protocol.

The skin analyzer system employed two specialized illumination sources (RGB and UV) and intelligent image-processing software to compare images captured before and after treatment, thereby revealing distinct visual and structural changes. When the skin is exposed to visible RGB and safe UV light, different chromophores within the cutaneous tissue selectively absorb and reflect these wavelengths. The integrated digital camera records the reflected signals, which are subsequently interpreted by the software based on spectral absorption characteristics. The resulting images provide a detailed representation of the skin’s current condition and enable predictive assessment of its future evolution.

To assess treatment efficacy, the following tools and methods were employed:

• Global Acne Grading System (GAGS): quantitative scale which evaluates acne severity by scoring six facial regions, each assigned a multiplication factor (nose and chin = 1, cheeks and forehead = 2, chest and back = 3), based on the most severe lesion present (comedone = 1, papule = 2, pustule = 3, nodule = 4). Final scores range from 0 to 44. Only patients with mild facial acne (GAGS scores between 1 and 18) were included in the study.
• Lesion Count: acne lesions, including comedones, papules, pustules, nodules, and cysts, were counted individually in the following facial zones: forehead, cheeks, nose, chin, and perioral area.
• Skin Parameter Analysis: sebum levels, hydration, pore count, and pigmentation were measured using a professional digital skin analysis system. The system utilizes RGB and UV light, along with intelligent software, to compare images taken before and after treatment, highlighting both visual and structural changes in the skin. Additionally, a separate determination was made to assess the skin’s elasticity and moisture content at each visit.
• Patient Feedback Questionnaire: at the end of the treatment period, patients completed a structured questionnaire designed to capture their experience regarding the procedure, perceived results, side effects, and communication with the cosmetic specialist.

The chemical peeling procedure consisted of four treatment sessions, conducted at two-week intervals. Each session followed a standardized cosmetic protocol specifically adapted for acne-prone skin and was performed with a peeling solution containing azelaic acid and salicylic acid.

The protocol included the following steps and products:

• Initial Cleansing: Purifying Gel Cleanser—Dr. Belter Linie A (anti-acne)—containing allantoin and chlorhexidine gluconate, to thoroughly cleanse the skin.
• Toning: Purifying Lotion—Dr. Belter Linie A (anti-acne), enriched with witch hazel extract, chlorhexidine gluconate, and an organic sulfur complex, to help tone and purify the skin.
• Exfoliation (sessions 1 and 3): Enzymatic Peel—Dr. Belter Enzyme Crème Peeling—containing shea butter, witch hazel, squalane, and vitamin E, applied to promote gentle exfoliation and skin renewal.
• Degreasing and Pre-Peel Preparation: HD Therapeel PRE—degreasing solution based on glycolic acid and a detoxifying complex (pH 4.5–5.5), used to remove residual oils and makeup, ensuring optimal penetration of the active peeling agents.
• Peeling Application: Purifying Peel—a combination of azelaic acid and salicylic acid, applied in three layers and allowed to act for 10 min. Protective measures were taken to shield the eye and lip areas.
• Neutralization: HD Therapeel POST—a neutralizing solution (pH 8–9), based on sodium bicarbonate, used to counteract the peel’s acidity and soothe the skin. This solution does not require rinsing.
• Post-Peel Care: Cliniccare EGF Pure Mask—a calming, hydrating, anti-inflammatory, and rejuvenating mask, formulated with hyaluronic acid, niacinamide, and oligopeptides. Total Recovery Gel—a post-procedure regenerating gel based on Aloe vera, applied to accelerate healing and reduce inflammation.

The combined therapeutic approach included four sessions of chemical peeling and three sessions of microneedling, at two-week intervals over a 12-week treatment period. The microneedling treatment was performed in three sessions, following the chemical peeling sessions, at two-week intervals, using a Dermapen device equipped with sterile, single-use cartridges. Needle depth was adjusted between 0.25 mm and 1.25 mm, depending on the treated facial area and individual skin sensitivity.

The protocol included the following steps and products:

• Initial Cleansing: Purifying Gel Cleanser—Dr. Belter Linie A (anti-acne)—containing allantoin and chlorhexidine gluconate, to thoroughly cleanse the skin.
• Toning: Purifying Lotion—Dr. Belter Linie A (anti-acne), enriched with witch hazel extract, chlorhexidine gluconate, and an organic sulfur complex, to help tone and purify the skin.
• Exfoliation (Sessions 1 and 3): Enzymatic Peel—Dr. Belter Enzyme Crème Peeling, containing shea butter, witch hazel, squalane, and vitamin E, applied to promote gentle exfoliation and skin renewal.
• Microneedling Procedure: the procedure was performed using physiological serum as a base to facilitate smooth of the device movement across the skin; each facial zone (forehead, cheekbones, nose, upper lip, and chin) was treated individually, and microneedling ampoules were applied directly over each zone after needling.
• Treatment Vial Application: Sessions 1 and 2—Purifying Cocktail Vial (5 mL), formulated with burdock root extract, sage, white nettle flower, panthenol, methionine, and hydrolyzed glycosaminoglycans. This cocktail supports sebum regulation, minimizes pores, and promotes the healing of inflamed lesions.
• Treatment Vial Application: Session 3—RCPR Vial (5 mL), a revitalizing blend of oligopeptides 1–2, polypeptides 1–2, vitamins A, C, E, hyaluronic acid, amino acids, B-complex vitamins, and glutathione, aimed at reducing pore size, fading scars and post-acne pigmentation, hydrating, and rejuvenating the skin.
• Post-Treatment Care: Cliniccare EGF Pure Mask was applied to calm, hydrate, and reduce inflammation. Its active ingredients include hyaluronic acid, niacinamide, and oligopeptides. Total Recovery Gel, formulated with Aloe vera, was used to accelerate skin healing and restore the skin’s barrier function.

Because the number of treatment sessions differed between groups four for the chemical peeling and classic cosmetic protocols, and seven for the combined chemical peeling with microneedling protocol, all results were standardized to the end of each group’s final session. The values obtained after every treatment were normalized to baseline (100%) to reduce inter-individual variability and enable comparison of relative percentage changes. Although Group 2 had a longer duration, normalization to baseline allowed detection of relative trends; however, the longer timeline remains a confounding factor.

All statistical analyses were performed using Design-Expert^® software v. 13 (Stat-Ease Inc., Minneapolis, MN, USA). One-way ANOVA was used to evaluate the effect of different treatment protocols (chemical peeling, combined peeling and microneedling, and classic cosmetic treatment) on each measured skin parameter (sebum levels, hydration, pore counts, and acne lesions). For each response, the software calculated the F-statistics and corresponding p-values to assess overall group differences. To further identify which groups differed significantly, post hoc multiple comparison tests were conducted, including Tukey’s Honest Significant Difference (HSD) with statistical significance set at p < 0.05.

3. Results and Discussion

3.1. Results

Treatment efficacy was assessed by changes in GAGS scores measured at baseline and after completion of the respective treatment protocols: 6 weeks for Groups 1 and 3 (four sessions each) and 12 weeks for Group 2 (seven sessions). Comparative analysis was performed using one-way ANOVA to test group differences, followed by Tukey’s HSD for pairwise comparisons. Significance was set at p < 0.05. ANOVA and Tukey’s HSD post hoc tests were conducted using Design-Expert^® v.13, which includes validated modules for comparative statistical analysis within designed experiments.

The values obtained before the first session (baseline) were used as a reference and normalized to baseline (100%). Subsequently, all determinations were expressed relative to this value, being mathematically correlated with the initial result. Such an approach enabled percentage reporting to more clearly highlight evolutionary trends and differences between therapeutic protocols, regardless of the initial absolute values, which exhibit significant interindividual variability.

The detailed individual results for the chemical peeling group are summarized in

Table 1. Individual and normalized results for Group 1 (chemical peeling) (n = 6).

Subject	Meeting	Age	Sex	Sebum U/ 100	Sebum T/ 100	Moisture U/ 100	Moisture T/ 100	Small Pores/100	Big Pores/ 100	Acne Count/ 100
1	1	36	F	7212/ 100	19,169/ 100	47/ 100	68/ 100	11,890/ 100	5342/ 100	33,360/ 100
	2			7177/ 99.51	18,873/ 98.45	55/ 117.02	64/ 94.12	11,952/ 100.52	6230/ 116.62	32,151/ 96.38
	3			6893/ 95.58	16,829/ 87.79	63/ 134.04	69/ 101.47	12,245/ 102.99	6665/ 124.76	30,178/ 90.46
	4			6458/ 89.54	16,270/ 84.87	65/ 138.29	72/ 105.88	13,358/ 112.35	6318/ 118.27	29,229/ 87.62
2	1	26	F	9108/ 100	19,262/ 100	32/ 100	47/ 100	11,258/ 100	5279/ 100	34,229/ 100
	2			7832/ 85.99	18,163/ 94.29	39/ 121.88	57/ 121.28	12,405/ 110.19	5746/ 108.85	33,940/ 99.16
	3			7402/ 81.27	16,959/ 88.04	42/ 131.25	59/ 125.53	12,251/ 108.82	5430/ 102.86	32,485/ 94.90
	4			7207/ 79.13	15,093/ 78.36	44/ 137.50	55/ 117.02	12,997/ 115.45	5840/ 110.63	26,309/ 76.87
3	1	25	F	8600/ 100	15,916/ 100	45/ 100	38/ 100	12,292/ 100	4080/ 100	30,248/ 100
	2			8269/ 96.15	15,003/ 94.26	48/ 106.66	47/ 123.68	12,015/ 97.74	4938/ 121.03	29,449/ 97.36
	3			7861/ 91.41	14,489/ 91.03	49/ 108.88	49/ 128.95	12,237/ 99.55	5048/ 123.73	29,069/ 96.10
	4			7639/ 88.83	13,298/ 83.55	52/ 115.55	55/ 144.74	12,657/ 102.97	5195/ 127.33	27,060/ 89.46
4	1	27	F	8900/ 100	19,360/ 100	53/ 100	35/ 100	12,569/ 100	6446/ 100	34,160/ 100
	2			8642/ 97.10	18,166/ 93.83	62/ 116.98	40/ 114.29	12,995/ 102.67	6349/ 98.50	32,453/ 95
	3			7984/ 89.71	17,674/ 91.29	64/ 120.75	49/ 140	12,462/ 98.46	6480/ 100.53	30,159/ 88.29
	4			7175/ 80.62	16,500/ 85.23	60/ 113.21	50/ 142.86	13,744/ 109.35	7531/ 116.83	28,969/ 84.80
5	1	21	F	8991/ 100	22,622/ 100	46/ 100	56/ 100	13,537/ 100	5168/ 100	37,496/ 100
	2			8321/ 92.55	21,581/ 95.39	48/ 104.34	60/ 107.14	12,157/ 89.81	4636/ 89.71	37,120/ 99
	3			7482/ 83.22	20,252/ 89.52	50 108.70	62/ 110.71	12,189/ 90.04	5635/ 109.04	35,597/ 95.90
	4			7078/ 78.72	19,249/ 85.09	54/ 117.39	61/ 108.93	12,431/ 91.83	5304/ 102.63	33,239/ 88.65
6	1	29	F	8575/ 100	15,685/ 100	34/ 100	58/ 100	12,848/ 100	3719/ 100	29,970/ 100
	2			8276/ 96.51	15,065/ 96.05	36/ 105.88	59/ 101.72	13,082/ 101.83	4511/ 121.29	28,209/ 94.12
	3			7525/ 87.76	14,317/ 91.28	40/ 117.64	61/ 105.17	14,879/ 115.81	4348/ 116.91	27,361/ 91.29
	4			6971/ 81.30	13,367/ 85.22	38/ 111.76	65/ 112.07	15,072/ 117.31	4912/ 132.08	26,131/ 87.19

Normalized values are expressed as percentages relative to baseline (100%). Parameters: sebum levels (U- and T-zones), hydration (U- and T-zones), small and large pores, and acne lesion count across four evaluation sessions.

.

For U-zone sebum levels (Sebum U), the mean value decreased to 83.0 at the final measurement, corresponding to a 17.0% reduction (SD = 7.7). A comparable decrease was noted for T-zone sebum (Sebum T), which decreased to 83.7 (−16.3%, SD = 6.4), confirming a consistent seboregulatory effect in both facial regions.

In terms of hydration, U-zone moisture (Moisture U) increased to 122.3 at the final evaluation, reflecting a 22.3% improvement (SD = 12.2). A similar effect was observed for T-zone moisture (Moisture T), which reached 121.9 (+21.9%, SD = 14.8). Both regions demonstrated enhanced hydration, with slightly higher variability in the T-zone.

Pore analysis revealed a moderate increase in small pores, with a final mean of 108.2 (+8.2%, SD = 7.6), and a more pronounced rise in large pores, reaching 118.0 (+18.0%, SD = 11.4). There was a tendency toward apparent pore enlargement, although variability was high.

For acne count, the mean value decreased to 85.8 at the final measurement, corresponding to a 14.2% reduction (SD = 6.1). The reduction confirms a modest but consistent decline in acne lesions across participants.

Overall, the updated descriptive statistics indicate a reduction in sebum secretion, a moderate improvement in acne lesion count, and an improvement in hydration in both U- and T-zones. However, pore counts increased, particularly for large pores, underscoring the need for additional strategies to address pore-related changes.

The summarized data for the combined chemical peeling and microneedling group are presented in

Table 2. Individual and normalized results for Group 2 (combined chemical peeling with microneedling) (n = 5).

Subject	Meeting	Age	Sex	Sebum U/ 100	Sebum T/ 100	Moisture U/100	Moisture T/ 100	Small Pores/100	Big Pores/100	Acne Count/100
7	1CP	29	F	7526/ 100	13,512/ 100	54/ 100	61/ 100	13,185/ 100	5662/ 100	43,130/ 100
	2CP			7282/ 96.76	12,736/ 94.26	51/ 94.44	65/ 106.55	13,660/ 103.60	5661/ 99.98	41,962/ 97.29
	3CP			6873/ 91.32	11,689/ 86.51	59/ 109.25	67/ 109.84	13,156/ 99.78	5756/ 101.66	38,523/ 89.32
	4CP			6370/ 84.64	10,771/ 79.71	56/ 103.70	72/ 118.04	13,615/ 103.26	5835/ 103.06	37,876/ 87.82
	1MN			6443/ 85.61	11,016/ 81.53	51/ 94.44	64/ 104.91	13,002/ 98.61	5486/ 96.89	35,313/ 81.88
	2MN			6068/ 80.63	10,024/ 74.19	47/ 87.04	53/ 86.88	12,879/ 97.68	5268/ 93.04	32,450/ 75.24
	3MN			5985/ 79.52	10,012/ 74.10	43/ 79.63	50/ 81.97	12,649/ 95.93	5360/ 94.67	30,575/ 70.89
8	1CP	20	F	8257/ 100	20,140/ 100	47/ 100	51/ 100	14,197/ 100	7101/ 100	32,662/ 100
	2CP			7814/ 94.63	19,035/ 94.51	45/ 95.74	53/ 103.92	13,619/ 95.93	6443/ 90.73	31,789/ 97.33
	3CP			7240/ 87.68	16,984/ 84.33	50/ 106.38	59/ 115.69	13,444/ 94.70	7094/ 99.90	30,421/ 93.14
	4CP			7038/ 85.23	15,624/ 77.58	55/ 117.02	58/ 113.73	13,067/ 92.04	7625/ 107.38	29,590/ 90.59
	1MN			6664/ 80.42	15,319/ 76.06	53/ 112.77	49/ 96.08	13,134/ 92.51	7013/ 98.76	28,687/ 87.83
	2MN			6125/ 74.18	14,199/ 70.50	45/ 95.74	42/ 82.35	13,080/ 92.13	7056/ 99.46	27,317/ 83.64
	3MN			5923/ 71.73	14,420/ 71.60	40/ 85.10	45/ 88.24	12,685/ 89.35	6880/ 96.89	26,116/ 79.96
9	1CP	41	F	9465/ 100	22,003/ 100	60/ 100	60/ 100	13,798/ 100	6281/ 100	37,666/ 100
	2CP			8499/ 89.79	20,912/ 95.04	54/ 90	60/ 100	14,194/ 102.87	6402/ 101.93	34,810/ 92.42
	3CP			8009/ 84.62	19,274/ 87.60	62/ 103.33	64/ 106.66	14,271/ 103.47	6559/ 104.43	32,889/ 87.32
	4CP			7862/ 83.06	18,547/ 84.29	66/ 110	66/ 110	14,757/ 106.95	6770/ 107.79	31,422/ 83.42
	1MN			7741/ 81.79	18,112/ 82.32	59/ 98.33	67/ 111.66	13,249/ 96.02	6456/ 102.83	30,073/ 79.94
	2MN			7026/ 74.23	17,891/ 81.31	55/ 91.66	62/ 103.33	13,041/ 94.51	5731/ 91.24	30,874/ 81.97
	3MN			7137/ 75.40	16,747/ 76.11	48/ 80	54/ 90	12,490/ 90.52	5593/ 89.25	29,672/ 79.02
10	1CP	19	F	8346/ 100	17,627/ 100	65/ 100	53/ 100	12,783/ 100	3878/ 100	31,487/ 100
	2CP			8176/ 97.96	16,027/ 90.92	60/ 92.31	55/ 103.77	12,739/ 96.66	3592/ 92.63	26,474/ 84.08
	3CP			7522/ 90.13	16,272/ 92.31	61/ 93.85	56/ 105.66	12,993/ 101.64	3850/ 99.8	25,390/ 80.64
	4CP			6801/ 81.49	15,286/ 86.72	66/ 101.53	62/ 116.98	13,103/ 102.50	4001/ 103.17	24,989/ 79.36
	1MN			6584/ 78.89	15,403/ 87.38	60/ 92.31	51/ 96.23	12,407/ 97.06	3931/ 101.37	25,847/ 82.09
	2MN			6620/ 79.32	15,042/ 85.33	56/ 86.15	48/ 90.57	12,161/ 95.13	3759/ 96.93	24,635/ 78.24
	3MN			6506/ 77.95	14,860/ 84.30	52/ 80	43/ 81.13	11,947/ 93.46	3512/ 90.56	24,012/ 76.26
11	1CP	28	F	8923/ 100	22,237/ 100	63/ 100	58/ 100	13,526/ 100	4617/ 100	33,880/ 100
	2CP			8025/ 89.94	21,655/ 97.38	64/ 101.58	59/ 101.73	14,608/ 108	4702/ 101.84	32,570/ 96.13
	3CP			7594/ 85.11	19,097/ 85.88	66/ 103.13	60/ 103.44	15,192/ 112.32	4790/ 103.75	30,025/ 88.62
	4CP			7028/ 78.76	18,064/ 81.23	72/ 114.29	63/ 108.62	14,881/ 110.02	5488/ 118.87	29,327/ 86.56
	1MN			6808/ 76.30	18,561/ 83.47	65/ 103.17	61/ 105.17	14,351/ 106.10	4372/ 94.69	29,786/ 87.92
	2MN			6517/ 73.04	17,798/ 80.04	53/ 84.13	52/ 89.66	13,953/ 103.16	4137/ 89.60	28,232/ 83.32
	3MN			6227/ 69.79	17,220/ 77.44	51/ 80.95	50/ 86.20	13,117/ 96.98	4231/ 91.63	28,798/ 85

Normalized values are expressed as percentages relative to baseline (100%). Parameters: sebum levels (U- and T-zones), hydration (U- and T-zones), small and large pores, and acne lesion count across seven evaluation sessions.

.

For Sebum U, the mean value decreased to 82.6 after chemical peeling, reflecting a 17.4% reduction (SD = 7.1). A further decline was observed following microneedling, reaching 74.9, corresponding to a 25.1% reduction from baseline (SD = 4.2). A similar trend was seen for Sebum T, which decreased to 81.8 during peeling (−18.2%, SD = 7.5) and to 76.7 after microneedling (−23.3%, SD = 5.2).

In terms of hydration, Moisture U increased during peeling to 109.3, representing a 9.3% improvement (SD = 7.0). However, after microneedling, it declined to 81.1, corresponding to an 18.9% reduction (SD = 9.6). Similarly, Moisture T improved during peeling to 113.5 (+13.5%, SD = 6.1) but dropped to 85.5 following microneedling (−14.5%, SD = 9.5).

Analysis of pores revealed a modest increase after peeling, with small pores reaching 103.0 (+3.0, SD = 5.0) and large pores rising to 108.1 (+8.1%, SD = 5.6). In contrast, microneedling reduced pore counts, with small pores decreasing to 93.2 (−6.8%, SD = 4.4) and large pores to 92.6 (−7.4%, SD = 4.3).

For acne count, a consistent reduction was observed across both phases: 85.6 after peeling (−14.5%, SD = 6.9) and further improvement to 78.2 after microneedling (−21.8%, SD = 4.6).

The combined treatment indicated a progressive reduction in sebum secretion and acne lesions, with peeling initially improving hydration; however, microneedling temporarily reduced hydration, likely due to transient barrier disruption in hydration. Pore characteristics exhibited opposite trends between treatments, with apparent pore enlargement after peeling but a reduction following microneedling.

However, these results must be interpreted with caution, as the combined group received more treatment sessions over a longer intervention period. Therefore, the superior outcomes observed may reflect cumulative treatment exposure rather than a specific effect of the microneedling component, which cannot be isolated within the present study design.

The individual results obtained for the classic cosmetic treatment group are summarized in

Table 3. Individual and normalized results for Group 3 (classic cosmetic treatment) (n = 4).

Subject	Meeting	Age	Sex	Sebum U/100	Sebum T/100	Moisture U/100	Moisture T/100	Small Pores/100	Big Pores/100	Acne Count/100
12	1	18	M	9259/ 100	22,923/ 100	62/ 100	67/ 100	12,393/ 100	3680/ 100	38,305/ 100
	2			8641/ 93.33	21,608/ 94.26	54/ 87.10	56/ 83.58	13,201/ 106.52	3745/ 101.77	37,251/ 97.25
	3			8442/ 91.18	20,755/ 90.54	55/ 88.71	52/ 77.61	14,104/ 113.81	3935/ 106.93	36,570/ 95.47
	4			8025/ 86.67	20,125/ 87.79	54/ 87.10	48/ 71.64	14,954/ 120.66	4254/ 115.6	35,782/ 93.41
13	1	32	F	8587/ 100	17,962/ 100	64/ 100	74/ 100	13,566/ 100	7241/ 100	32,163/ 100
	2			7959/ 92.69	17,792/ 99.05	55/ 85.94	67/ 90.54	14,692/ 108.30	7330/ 101.23	30,848/ 95.91
	3			7644/ 89.02	16,968/ 94.47	49/ 76.56	59/ 79.73	14,823/ 109.27	7994/ 110.40	30,719/ 95.51
	4			7404/ 86.22	15,538/ 86.50	45/ 70.31	52/ 70.27	14,995/ 110.53	7404/ 102.25	28,658/ 89.10
14	1	23	F	8551/ 100	20,280/ 100	62/ 100	64/ 100	11,284/ 100	5958/ 100	34,438/ 100
	2			8152/ 95.33	19,472/ 96.02	51/ 82.26	53/ 82.81	12,956/ 114.82	6014/ 100.94	32,938/ 95.64
	3			8154/ 95.36	19,316/ 95.25	50/ 80.65	50/ 78.13	13,116/ 116.24	6707/ 112.57	31,115/ 90.38
	4			7933/ 92.77	18,786/ 92.63	47/ 75.81	48/ 75	13,886/ 123.06	7201/ 120.86	31,778/ 92.28
15	1	44	F	8584/ 100	19,599/ 100	53/ 100	55/ 100	13,643/ 100	6204/ 100	33,609/ 100
	2			8496/ 98.97	19,508/ 99.54	50/ 94.34	53/ 96.36	14,253/ 104.47	6914/ 111.44	33,239/ 98.90
	3			8073/ 94.05	19,082/ 97.36	42/ 79.25	46/ 83.64	14,681/ 107.61	7106/ 114.54	31,652/ 94.18
	4			7882/ 92.99	18,756/ 91.82	40/ 75.47	44/ 80	14,887/ 109.12	7252/ 116.89	31,286/ 93.09

Normalized values are expressed as percentages relative to baseline (100%). Parameters: sebum levels (U- and T-zones), hydration (U- and T-zones), small and large pores, and acne lesion count across four evaluation sessions.

.

For Sebum U, the mean value decreased to 89.7 at the final measurement, corresponding to a 10.3% reduction (SD = 4.7). A nearly identical decrease was observed for Sebum T, which declined to 89.7 (−10.3%, SD = 4.5).

In contrast, hydration parameters showed a marked reduction. Moisture U decreased to 77.2, representing a 22.8% decrease (SD = 10.0), while Moisture T declined further to 74.2, corresponding to a 25.8% decrease (SD = 10.7).

Pore analysis revealed increases in both categories. Small pores rose to 115.8 (+15.8%, SD = 7.3), while large pores increased to 113.9 (+13.9%, SD = 7.3).

For acne count, the mean value declined modestly to 92.0, corresponding to an 8.0% reduction (SD = 3.5).

Overall, the descriptive statistics for the classic treatment demonstrate a moderate reduction in sebum secretion and a slight decrease in acne lesion count, accompanied by a decline in hydration and a tendency toward increased pore visibility.

3.2. Statistical Analysis

In the ANOVA analysis, the F-statistic was used to assess whether the differences in mean values among the treatment groups were statistically significant. It was calculated as the ratio of the variance between groups to the variance within groups. Higher F-values indicate that intergroup differences are large relative to intragroup variability, while values close to 1 suggest similar group means.

The corresponding p-value expresses the probability that the observed differences occurred by chance; values below 0.05 were considered statistically significant, indicating that at least one treatment group differed from the others. Given the small and uneven sample size, the statistical analysis should be regarded as exploratory. Findings approaching the conventional threshold for significance (p ≈ 0.03–0.05) must be interpreted cautiously, as limited statistical power may increase the risk of errors.

The overall results of the one-way ANOVA performed for each evaluated parameter are presented in

Table 4. One-way ANOVA results comparing the three treatment groups.

Parameter	F-Statistic	p-Value	Interpretation
Sebum_U	4.38	0.0374	Significant intergroup difference
Sebum_T	68.92	0.0000002638	Significant intergroup difference
Moisture_U	44.82	0.000002708	Significant intergroup difference
Moisture_T	19.31	0.0001775	Significant intergroup difference
Small pores	5.64	0.01872	Significant intergroup difference
Big pores	23.1	0.0000768	Significant intergroup difference
Acne count	16.03	0.0004083	Significant intergroup difference

F-statistics and corresponding p-values indicate overall significance levels for differences among chemical-peeling, combined, and classic treatment protocols for each evaluated parameter.

.

For Sebum U values, ANOVA analysis indicated significant differences between the three groups (F = 4.38, p = 0.037). The differences suggest that the treatments had distinct effects on sebaceous secretion in the U-zone. Both chemical peeling and the combined approach produced more substantial seboregulatory effects than the classic treatment, highlighting the higher efficacy of procedures that involve active interventions.

For Sebum T values, significant differences were found (F = 68.92, p < 0.0001). The T-zone, being more sebaceous, responded particularly well to chemical interventions. The magnitude of change was higher in the peeling and combined groups than in the classic group, confirming that advanced procedures are more effective at regulating sebum in this region.

For Moisture U values, ANOVA analysis revealed high differences (F = 44.82, p < 0.0001). Hydration improved in the peeling group but decreased in the classic and combined groups (after microneedling). The analysis results indicate that while peeling supports stratum corneum hydration, microneedling temporarily disrupts barrier function, thereby reducing water retention.

For Moisture T, significant differences were also observed (F = 19.31, p < 0.001). The peeling group showed improvements in hydration, while the classic and combined groups tended toward decreases. The results reinforce that peeling enhances hydration, whereas mechanical disruption may reduce it.

Differences were significant for small pore count (F = 5.64, p = 0.019). Peeling was associated with a slight increase in small pore counts, whereas microneedling (in the combined group) reduced them. The results indicate divergent effects: exfoliation may accentuate visible pores, while microneedling appears to support pore refinement.

Highly significant intergroup differences were found for big pore count (F = 23.10, p < 0.0001). Peeling led to pore enlargement, whereas microneedling reduced the number of large pores, and the classic group showed moderate increases. The outcome highlights that the treatment modality plays a central role in pore morphology.

Group differences were significant for acne count (F = 16.03, p < 0.001). Both peeling and combined treatments reduced acne lesions more effectively than the classic approach. Notably, microneedling enhanced lesion reduction beyond that achieved with peeling alone, reflecting synergistic benefits when procedures are combined.

The high F-values observed for some parameters may overestimate statistical significance, as they can result from low within-group variance in the small pilot sample, thereby limiting the robustness of intergroup comparisons. A comparison of the percentage changes observed in parameters across the three treatment groups is provided in

Table 5. Comparative summary of percentage changes between treatment groups.

Parameter	Group 1—Chemical Peeling	Group 2—Chemical Peeling + Microneedling	Group 3—Lassic Treatment
Sebum U	~−17% (strong reduction)	~−25% (strong reduction)	~−10% (moderate reduction)
Sebum T	~−18% (strong reduction)	~−23% (strong reduction)	~−10% (moderate reduction)
Moisture U	~+22% (improved hydration)	~−19% (hydration decrease)	~−23% (strong reduction)
Moisture T	~+22% (improved hydration)	~−14% (hydration decrease)	~−26% (strong reduction)
Small pores	~+8% (slight increase)	~−7% (slight decrease)	~+16% (increase)
Big pores	~+18% (increase)	~−7% (slight decrease)	~+14% (increase)
Acne count	~−14% (moderate reduction)	~−22% (strong reduction)	~−8% (slight reduction)

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Following ANOVA analysis, Tukey’s Honest Significant Difference (HSD) test was applied as a post hoc analysis to perform pairwise comparisons between the treatment groups (Peeling, Combined, Classic), allowing for the identification of specific intergroup differences while controlling for type I error. The detailed pairwise comparisons between groups obtained through Tukey’s HSD post hoc analysis are summarized in

Table 6. Tukey’s HSD post hoc pairwise comparisons between treatment groups.

Parameter	Comparison	Mean Difference	p-Value	Results
Sebum U	Classic vs. Combined	−7.03	0.0515	Not significant
Sebum U	Classic vs. Peeling	−6.64	0.0561	Not significant
Sebum U	Combined vs. Peeling	0.39	0.9857	Not significant
Sebum T	Classic vs. Combined	10.31	0.0001	Significant
Sebum T	Classic vs. Peeling	−5.96	0.0045	Significant
Sebum T	Combined vs. Peeling	−16.28	<0.0001	Significant
Moisture U	Classic vs. Combined	−0.46	0.9968	Not significant
Moisture U	Classic vs. Peeling	45.11	<0.0001	Significant
Moisture U	Combined vs. Peeling	45.57	<0.0001	Significant
Moisture T	Classic vs. Combined	35.08	0.0025	Significant
Moisture T	Classic vs. Peeling	47.69	0.0001	Significant
Moisture T	Combined vs. Peeling	12.61	0.2346	Not significant
Small pores	Classic vs. Combined	−15.84	0.0149	Significant
Small pores	Classic vs. Peeling	−7.63	0.2543	Not significant
Small pores	Combined vs. Peeling	8.21	0.1753	Not significant
Big pores	Classic vs. Combined	−28.39	0.0007	Significant
Big pores	Classic vs. Peeling	4.06	0.7363	Not significant
Big pores	Combined vs. Peeling	32.45	0.0001	Significant
Acne count	Classic vs. Combined	10.98	0.0177	Significant
Acne count	Classic vs. Peeling	−6.21	0.1787	Not significant
Acne count	Combined vs. Peeling	−17.19	0.0003	Significant

.

As all groups received active interventions, the reported effects should be interpreted as relative differences between treatment protocols rather than absolute treatment efficacy.

Sebum and acne outcomes demonstrated the most substantial improvements in both the peeling and combined treatment groups, with only limited effects observed under the classic approach.

Hydration parameters responded positively to peeling, reflecting enhanced skin barrier function, but declined following microneedling sessions and in the classic treatment group, indicating treatment-dependent differences in water retention.

Pore analysis revealed that chemical peeling tended to increase both small and large pore counts, whereas microneedling contributed to pore refinement and reduction.

The statistical and comparative analyses presented in Table 4, Table 5 and Table 6 confirm that the type of treatment protocol influenced sebum regulation, hydration, pore morphology, and acne lesion count.

3.3. Clinical Interpretation of Statistical Results

Sebum (U and T-zone): The reduction in sebum secretion in the groups subjected to chemical peeling and the combined protocol indicates efficacy in regulating sebaceous gland activity. From a clinical perspective, this effect is essential in preventing the formation of comedones and inflammatory lesions. The classic group showed a modest reduction, which suggests that non-invasive treatments have a limited impact on seboregulation.

Hydration (U and T-zone): Chemical peeling led to an increase in hydration levels, suggesting improved skin barrier function. In contrast, microneedling was associated with a decrease in skin hydration, likely due to transient stratum corneum disruption and increased transepidermal water loss. This finding is clinically relevant, as acne-prone skin often exhibits baseline barrier impairment. Consequently, microneedling requires careful risk-benefit assessment and appropriate post-procedural barrier-supportive care, particularly in patients with dry or sensitive skin. This hydration decrease is considered temporary and typically resolves during normal skin recovery.

Pores (small and large): Chemical peeling increased the number of visible pores, including large ones, which can be perceived as a negative aesthetic effect. The observed increase in pore count following chemical peeling is most likely attributable to enhanced pore visibility after exfoliation and removal of follicular debris, rather than to true structural pore enlargement, as superficial peeling can transiently accentuate pore appearance in digital skin analyses. On the other hand, microneedling significantly reduced pore size and number, indicating a beneficial effect on skin texture. Complementarity between the procedures can be exploited in personalized protocols, depending on the patient’s aesthetic goals. From a clinical and aesthetic perspective, this increase in visible pores may be perceived negatively by patients and should be anticipated, discussed during counseling, and managed through appropriate protocol selection or adjunctive pore-refining strategies.

Number of acne lesions: The greater reduction in acne lesions observed in the combined group likely reflects the intensified treatment regimen, as the higher number of sessions and longer duration preclude attributing this effect specifically to microneedling. Peeling alone had a moderate effect, and classic treatment produced a minimal reduction. From a clinical perspective, these results support the use of combination therapies in cases of persistent or recurrent acne, potentially reducing the need for systemic treatments.

To facilitate clinical interpretation,

Table 7. Comparative overview of chemical peeling and microneedling in acne-prone skin.

Aspect	Chemical Peeling	Microneedling
Mechanism	Controlled chemical exfoliation, keratolytic and comedolytic effects	Mechanical micro-injury inducing dermal remodeling
Sebum regulation	Effective reduction in sebum secretion	Enhanced seboregulation when combined with peeling
Effect on hydration	Improves skin hydration by enhancing stratum corneum turnover	Temporary reduction in hydration due to transient barrier disruption
Effect on pores	Increased pore visibility following exfoliation	Reduction in pore size and number
Effect on acne lesions	Moderate reduction in lesion count	Higher lesion reduction when used in combination
Advantages	Non-invasive, improves hydration, well tolerated, suitable for maintenance therapy	Promotes collagen synthesis, improves texture and pore refinement
Disadvantages	May transiently accentuate pore appearance	Requires post-procedural care; may cause short-term dryness

summarizes the main advantages and limitations of chemical peeling and microneedling in acne-prone skin.

3.4. Study Limitations

Although the results provide valuable insights into the efficacy of combination therapies for acne, the study has several methodological limitations that must be considered. The small sample size (n = 15) limits the statistical power and generalizability of the conclusions. Group sizes were unequal, which may have affected within-group variance estimates and reduced statistical power. Participants were recruited from a single center, which may have introduced selection bias and limited the generalizability of the results to broader, more diverse populations. The short duration of the intervention (12 weeks) and the lack of long-term follow-up prevent assessment of the sustainability of therapeutic effects and the potential for delayed adverse reactions.

Another methodological limitation of this pilot study is the unequal number of treatment sessions across the investigated groups. The combined chemical peeling and microneedling group received a higher number of sessions over a longer intervention period, introducing a fundamental confounding factor. As a result, the superior outcomes observed in this group may be driven, at least in part, by increased treatment frequency and cumulative exposure rather than by the microneedling procedure itself.

External variables (such as diet, stress, personal skin care routine, or use of other cosmetic products) were not systematically controlled, which may have influenced the results.

Additionally, the limited demographic distribution (primarily women with skin phototypes II–IV) restricts the relevance of the conclusions to other patient categories.

The absence of a no-treatment or sham control group limits the ability to attribute the observed effects exclusively to the investigated interventions; although a classic cosmetic protocol was included as a comparator, it does not represent a true placebo. However, in the context of a pilot study conducted in a cosmetic setting, the inclusion of a placebo group was considered impractical for both ethical and practical reasons, due to the difficulty of maintaining participant blinding.

Accordingly, all statistically significant findings, particularly those near the significance threshold, should be regarded as hypothesis-generating rather than conclusive.

Because sebaceous gland activity decreases with age, the inclusion of a wide age range (18–45 years) may have influenced baseline sebum values. This aspect should be addressed in future studies by narrowing the age range or applying age-based stratification.

These limitations emphasize the need for future multicenter studies, with larger samples and rigorous methodology to validate and extend the current observations.

3.5. Future Perspectives and Research Directions

Based on the preliminary results of this pilot study, future research should address current methodological limitations and explore broader clinical applications through more rigorous investigation.

Including a placebo or sham-treatment arm, along with proper randomization and blinding, would ensure a more accurate evaluation of treatment efficacy and reduce bias.

Further studies should also establish standardized protocols for combining chemical peeling and microneedling, optimizing session frequency, peeling agent concentration, microneedling depth, and post-treatment care. Longer follow-up periods (6–12 months) are recommended to assess long-term efficacy, delayed adverse effects, and patient satisfaction.

Finally, investigating biological mechanisms such as inflammatory response, collagen synthesis, and modulation of skin barrier integrity could clarify the cellular interactions driving therapeutic outcomes.

4. Conclusions

This pilot study provides preliminary, exploratory insights into the effects of chemical peeling and its combination with microneedling in acne-prone skin. Chemical peeling was associated with reductions in sebum secretion and acne lesion count, along with improvements in skin hydration, although it was accompanied by a transient increase in visible pores. The combined protocol showed trends toward greater seboregulation, lesion reduction, and pore refinement but was also associated with a temporary decrease in hydration, likely reflecting transient barrier disruption.

These findings should be interpreted with caution. The small and uneven sample size, the absence of a no-treatment control group, and differences in treatment intensity across protocols preclude causal inference. In particular, the more pronounced effects observed in the combined group cannot be attributed solely to microneedling, as they may reflect cumulative treatment exposure and a more intensive intervention schedule. Accordingly, the results should be regarded as hypothesis-generating rather than confirmatory.

Despite these limitations, the study highlights the potential value of individualized cosmetic strategies that balance efficacy, hydration preservation, and patient tolerability in acne-prone skin. Future research should focus on rigorously designed, multicenter randomized controlled trials with balanced treatment protocols, adequate sample sizes, and extended follow-up periods to confirm these preliminary observations and to establish standardized, evidence-based approaches for combined cosmetic therapies in acne management.