Wrinkles may worsen with microneedling in patients prone to glycation, but this is not an absolute contraindication to treatment. Glycation is due to abnormal cross-linking of collagen. Therefore, the more new collagen that is produced via needling, (be that cosmetic or medical), the more cross-linking, the worse the appearance, if it was truly due to glycation. Patients should be aware of this and sign informed consent.
Glycation looks like ‘cobblestone’ which is quite different from the loss of structural integrity due to sun damage. In the latter, we typically also see hyperpigmentation. Other things to consider that may ‘appear’ similar to glycation, or complicate the appearance of glycation, would be scarring (due to electrolysis or chemical peels, done repeatedly over a lengthy time), or sebaceous hyperplasia. Solar elastosis may also have a similar appearance.
Glycation is more pronounced in diabetics and influenced by diet, so any positive changes associated with needling may also be due to dietary advice given at the time of consultation. Products that contain ingredients that combat glycation, such as L-Carnosine, or Supplamine, should always be used in conjunction with microneedling. These can be applied topically or taken as a supplement. I would recommend both oral and topical in severe cases.
Remember that a normal fasting blood sugar and HgbA1c does not rule out glycation. In the early stages of metabolic disorders, the body may compensate to maintain normal readings, so the pathological process is occurring without evidence of the endpoint (abnormal blood test). In other words, the body is “working” much harder to be “normal”. Another point to consider is that readings may be set high at the lab for the benchmark for pathology so as not to have too many of the population labeled as diabetics. If one believes in prevention rather than cure, we should not be waiting for full-blown endpoint pathology, such as nerve and skin damage via glycation, to establish itself. Diet and exercise are considered a good place to start.