Clinical Evaluation of Fractional Microneedling with Radiofrequency for Inflammatory Acne Vulgaris: Report of 5 Cases

Background: Conventional therapies for moderate-to-severe inflammatory acne include topical agents, systemic antibiotics, hormonal treatments, and oral isotretinoin. However, increasing resistance of Cutibacterium acnes to antibiotics and the potential adverse effects of systemic agents have prompted growing interest in non-pharmacological alternatives such as fractional microneedling radiofrequency (RF-MN), recently introduced in the clinical practice. Objective: This report of five cases aims to document the clinical benefits and safety of RF-MN using the Focus Dual® device in the treatment of moderate-to-severe inflammatory acne vulgaris. Methods: Five patients (2 male, 3 female; aged 19–28 years; Fitzpatrick skin types II–III) with moderate-to-severe acne were treated with two RF-MN sessions at 4-week intervals using the Focus Dual® device (Med & Tech, Occhiobello (RO), Italy). Acne severity was assessed using the Face Global Acne Grading System (F-GAGS) and the 5-point Global Improvement Score (GIS), with evaluations performed by two independent blinded raters (G.P and O.R). Standardized photographic documentation and lesion counting were conducted at baseline (T0) and 4 weeks after the second session (T2). All individual F-GAGS scores for each of the five patients showed a reduction from baseline to T2, as consistently assessed by both evaluators. Two patients improved from moderate to mild acne, one improved from severe to moderate, and one remained mild. GISs indicated clinical improvement ranging from Grade 1 to Grade 2 in all cases, with individual improvements between 8.33% and 37.93%. No adverse events were reported during treatment or follow-up. Conclusions: RF-MN appears to be a promising therapeutic option for moderate-to-severe inflammatory acne, providing clinical improvement and reduction in acne severity without adverse effects. Prospective studies with a larger sample are needed to confirm these preliminary results and support the potential role of RF-MN as an adjunctive or standalone treatment in patients with limited tolerance or response to conventional therapies.