<p>Due to the natural barrier of skin structure, traditional topical drug utilization for skin disease management has been severely constrained by low bioavailability. While current microneedle (MN)-based systems confront challenges related to therapeutic efficacy, penetration depth, and delivery precision, they offer considerable promise as minimally invasive platforms. To address these limitations, electric stimulus (ES) has been strategically integrated as a programmable external trigger within microneedle patches, enabling spatiotemporal control over drug release kinetics. This review systematically delineates recent advancements in ES-assisted microneedle systems for managing dermatological conditions, highlighting their dual capacity to enhance transdermal permeability while minimizing systemic toxicity through localized delivery, in alignment with emerging trends in functional integration and device miniaturization. This encompasses a comprehensive analysis of the regulatory role of ES, strategic selection of power supply modules, and the rational design of microneedles in conjunction with their corresponding drug-loading strategies. Guided by the Three I Principles (Integrated-Intelligent-Individualized), future developments should focus on creating closed-loop systems with embedded biosensors for real-time biomarker monitoring, implementing AI-driven adaptive dosing algorithms, and developing modular microneedle arrays. This paradigm shift towards patient-centered care will require cross-disciplinary convergence of flexible electronics, biocompatible energy harvesters, and precision medicine approaches to accommodate personalized treatment regimens.</p> Graphical abstract <p></p>