Microneedling Contraindications

Microneedling is often sold as low-risk, but it deliberately injures the skin to start a wound-healing response. That means the most important decision is sometimes not which depth to use — it is whether treatment should happen at all. This screening information is relevant whether you are booking a salon treatment or planning home sessions.

A contraindication does not always lead to the same decision. Some findings mean decline, some mean defer, some mean refer for assessment, and some mean proceed with proper records. A checklist supports that decision; it never replaces professional judgement.

Screen consistently and keep clear records. Get the editable Microneedling Intake, Consent & Disclaimer Forms.

Decline, defer, refer or proceed

What to screen — and how to read it

• Active skin conditions: infection, cold sore, open wound or inflamed acne in the area mean do not needle that area now — treat or refer first.
• Keloid tendency: a history of keloid or hypertrophic scarring needs careful risk assessment; refer or decline depending on your scope.
• HIV or hepatitis: do not exclude anyone by diagnosis alone. Assess immune status, active illness and healing, and apply standard infection control to every client.
• Epilepsy: assess control, triggers and medication, and refer where needed — not a blanket ban.
• Diabetes: uncontrolled diabetes is the higher-risk finding; controlled diabetes is not an automatic exclusion.
• Cancer: suspicious or undiagnosed lesions, current malignancy in the area, active treatment or impaired immunity are the decision points — a remote past history is not a lifetime ban.
• Recent surgery: assess the site, healing and the surgeon’s advice; there is no automatic six-month rule.
• Isotretinoin: current or recent use needs assessment against the exact device guidance and, where appropriate, the prescriber — not a fixed universal rule.
• Blood thinners: never advise a client to stop prescribed medication for a cosmetic procedure; assess bleeding risk and refer to the prescriber.
• Steroids or immunosuppressants: individual assessment, with medical input where relevant.
• Pregnancy or breastfeeding: elective microneedling is commonly deferred because evidence is limited — not because hormones make it universally dangerous.
• Hormone therapy: record it and assess pigment risk; it is not a blanket contraindication.
• Allergies: ask and document sensitivities (nickel, latex, anaesthetic) where relevant — you cannot force disclosure, so make asking routine.
• Melanin-rich skin: darker skin is not a contraindication, but it can carry a higher risk of pigment change after inflammation. Assess previous PIH, melasma and current inflammation. Read the pigmentation-risk guide. Fitzpatrick type alone is not a full assessment.

What your records can — and cannot — do

Documentation evidences the process; it does not make an unsuitable treatment suitable, remove your duty of care, or guarantee that an insurer will pay. Valid informed consent is a real discussion — the procedure, material risks, benefits, alternatives and the option not to proceed — that the client understands and can withdraw at any time. For insurance, check your own policy wording, exclusions and scope with your insurer or broker; a signed form is not automatic cover.

South African compliance

Health history is special personal information under POPIA: collect only what you need, explain why, keep it secure and accurate, and follow a lawful retention and disposal process. Build the workflow around the National Health Act (information and informed consent), the rules for your professional registration and scope, and POPIA — and have your documents reviewed for the services you actually provide.

The documentation system

The Microneedling Intake, Consent & Disclaimer Forms give you a structured starting point for intake, screening, consent and records. The Professional Microneedling Training Manual covers the reasoning and protocol (an educational reference, not a certification). Adapt both to your scope, insurer and local law.

The bottom line

The most important microneedling decision is not how deep to go — it is who you treat. Screen consistently, decide clearly, and document the decision.