As a new treatment technology for local skin diseases, microneedles (MNs) can penetrate the skin barrier and deliver encapsulated drugs to skin lesions minimally and invasively. Compared with the traditional treatment forms, it has the advantages of more substantial drug permeability, fewer side effects, and good patient compliance. Metal-organic frameworks (MOFs) have attracted the attention of researchers owing to their high catalytic activity, large specific surface area, and substantial drug-loading capacity, establishing them as an emerging class of nanomaterials. However, MOF materials have some limitations, such as poor dispersion and limited drug delivery forms. Some MNs have the problem of insufficient mechanical strength, and the combination of MOF materials and MN technology can overcome these limitations and combine their advantages, which is promising in treating skin diseases. Therefore, this paper firstly outlines the synthesis and design of MOFs and their derived materials, secondly outlines the therapeutic strategies and current status of research on MOFs, then briefly describes the types of MNs, summarizes the recent advances in the treatment of skin disorders with MOF-MNs, explores the safety of their application, and finally presents the challenges and looks forward to the future, based on our understanding of the field.