Microneedles

The concept of microneedles was first derived from the use of large hypodermic needles in the 1970s, but it only became prominent in the 1990s as microfabrication manufacturing technology developed. The investigation on MNs' potential to improve transdermal drug delivery gradually raised public awareness of MNs. In the 2000s, clinical trials on MNs' use in drug delivery began. Subsequent research into microneedle drug delivery has explored the medical and cosmetic applications of this technology through its design. This early paper sought to explore the possibility of using microneedles in the future for vaccination. Since then researchers have studied microneedle delivery of insulin, vaccines, anti-inflammatories, and other pharmaceuticals. In dermatology, microneedles are used for scarring treatment with skin rollers. As mentioned before, microneedles have also been explored for local targeted drug delivery at other drug delivery sites, such as the gastrointestinal, ocular, vascular etc., of which, ocular, vaginal and gastrointestinal have shown increasingnly convincing outcomes where they serve as a more efficient, localised drug delivery system, without the drawbacks of systemic exposure/toxicity. The major goal of any microneedle design is to penetrate the skin's outermost layer, the stratum corneum (10-15μm). can penetrate the skin. Compounds that weigh more than 500 Da cannot penetrate the skin. == Materials ==

Microneedles (MNs) consist of micro-sized needles arrays that are made of various materials exhibiting different characteristics and are suitable in the synthesis of different types of MNs. The selection of materials for formation of MNs greatly depends on the strength of skin penetration, manufacturing method, and rate of drug release. On the contrary, MNs made of metals like stainless steel, titanium, and aluminum, are non-toxic and possess strong mechanical properties to penetrate the skin without breakage. Polymer is also regarded as a promising material for MNs due to its good biocompatibility and low toxicity. Water-soluble polymers are more commonly used within the big polymer group and MNs tip breaking is more likely compared to MNs made of silicon and metal. Therefore, polymer is a more suitable material for dissolving MNs or hydrogel-forming MNs. == Types ==

Since their conceptualization in 1998, several advances have been made in terms of the variety of types of microneedles that can be fabricated. The 5 main types of microneedles are solid, hollow, coated, dissolvable/dissolving, and hydrogel-forming. The distinct characteristic of each type of MNs allow a variety of clinical applications, including diagnosis and treatment. Hard solid MNs have sharp tips that pierce through and form pores on the stratum corneum. Solid MNs help increase the permeability and absorption of drugs. A benefit of coated MNs is that less of the drug is needed as compared to other drug administration routes. Hydrogel-forming microneedles The primary material for the fabrication of hydrogel-forming microneedles (HFMs) is hydrophilic polymer that encloses drugs. This material draws water from interstitial fluid in the stratum corneum and results in polymer swelling and release of drug. Besides, the hydrophilic features of HFMs allow readily uptake of interstitial fluid that could be used for disease diagnosis. == Application and principle ==

Transdermal drug delivery The most abundant transdermal drug administration route currently is via hypodermic needles, transdermal patches, and topical creams. Compared to hypodermic needles, MNs provide a pain-free administration. Compared to transdermal patches, MNs are proven to be effective in producing micropores on the epidermis. The micropores facilitate the absorption of large molecules, like calcein and insulin, by 4 times via in-vitro skin models. Disease diagnosis and monitoring Disease diagnosis and monitoring of therapeutic efficacy is possible by detecting several biomarkers in body fluid. However, current tissue fluid extraction methods are pain-inducing, and it may take up to hours or days for samples to be analyzed in medical laboratories. These fluids provide more clinically significant and accurate values than those extracted from the systemic circulation, subsequently lowering the chances of underestimation of disease severity, especially for localized diseases. Thus, MNs are potential candidates for Point-of-care (PoC) testing which could be conducted bedside. The repetitive penetration through the stratum corneum forms micropores, and these physical traumas to the skin sequentially stimulate the wound-healing cascade and expression of collagen and elastin in the dermis. MNs have been diverged into different forms, including Dermapen and Dermarollers. Dermarollers are hand-held rollers equipped with a total of 192 solid steel micro-sized needles arranged into 24 arrays, lengths ranging from 0.5-1.5mm. With the growing popularity of microneedling, MNs have also been commodified into home care Dermarollers, which are similar to medical dermarollers, except that the needles are shorter (0.15mm). This is a more budget-friendly device that allows individuals to perform microneedling at home. == Advantages ==

There are many advantages to the use of microneedles, the most prominent being the improved comfort of patients. Needle phobia can affect both adults and children, and sometimes can lead to fainting. The benefit of microneedle arrays is that they reduce anxiety that patients have when confronted with a hypodermic needle. In addition to improving psychological and emotional comfort, microneedles have been shown to be substantially less painful than conventional injections. Some studies recorded children's views on blood sampling with microneedles and found patients were more willing when prompted with a less painful procedure than traditional sampling with needles. Microneedles are beneficial to physicians as well, since they produce less hazardous waste than needles and are generally easier to use. Microneedles are also less expensive than needles as they require less material and the material used is cheaper than the materials in hypodermic needles. Microneedles present a new opportunity for home and community-based healthcare. One of the biggest drawbacks of traditional needles is the hazardous waste that they produce, making disposal a serious concern for doctors and hospitals. For patients who require regular administration of medication at home, disposal can become an environmental concern is needles are placed in the trash. Dissolvable or swelling microneedles would provide those who are limited in their ability to seek hospital care with the ability to safely administer drugs in the comfort of their homes, although disposal of solid or hollow microneedles could still pose a needle-stick or blood borne pathogen infection risk. Another benefit of microneedles is their lower rates of microbial invasion into delivery sites. Traditional injection methods can leave puncture wounds for up to 48 hours post-treatment. This leaves a large window of opportunity for harmful bacteria to enter into the skin. Microneedles only damage the skin to a depth of 10-15μm, making it difficult for bacteria to enter the bloodstream and giving the body a smaller wound to repair. Further research is required to determine the types of bacteria able to breach the shallow puncture site of microneedles. == Disadvantages ==

There are some concerns about how physicians can be sure that all of the drug or vaccine has entered the skin when microneedles are applied. Hollow and coated microneedles both possess the risk that the drug will not properly enter the skin and will not be effective. Both of these types of microneedles can leak == Safety profile ==

Apart from procedural pain, some common post-treatment adverse events (AEs) of MNs include temporary discomfort, erythema (skin redness), and edema. Pinpoint bleeding, itching, irritation, and bruising are also possible in some cases. Photoprotection and minimal exposure to chemicals irritants are often advised for an effective recovery and lowered chance of skin inflammation. Severe risks may be possible if there are technical errors during the procedure. For example, the usage of non-sterile tools might result in post-inflammatory hyperpigmentation, systemic hypersensitivity, local infections, etc. Moreover, if excess pressure is used over a bony prominence, it could lead to "Tram-track scarring". But this could be avoided by using smaller needles and prevent over-pressurizing on top of these areas. In addition, if the patient is allergic to the either the drug used or the material of MNs, contact dermatitis is possible. Therefore, clinicians should be cautious towards patients with high risks of allergy. == References ==