Acne Scar Management


An unfortunate consequence of acne is residual scarring. Most of the people after long periods of dealing with deep and painful inflammations of acne lesions are moving to another phase which assumes the management of residual scars after acne. Just like the acne, the scars can negatively affect the quality of life and lead to feelings of embarrassment and low self-esteem.

Acne is a very common inflammatory disorder of the pilosebaceous unit that consists of comedones, inflammatory papules, pustules, and nodules involving the face, chest, and back.

Most of the time a bad management of acne lesions, maintaining a prolonged state of inflammation, a no proper protection, choosing of not suitable products, picking, scabbing, or even using some very aggressive treatments which are not allowing enough time for the skin to develop a natural complete process of healing and scaring, can lead to not only very common PIH (post inflammatory hyper pigmentations) but also to atrophic acne scars.

Each of these scar types has been classified based on the underlying scar pathology. Treatment options can be better tailored with very good results, by classifying acne scars into distinct types.

The classification of this atrophic acne scars describes them as:

Ice pick scars are smaller, narrower indentations that point down into the skin’s surface. These scars are common on the cheeks.

Boxcar scars are broad, usually box-like depressions with sharply defined edges, most often form on areas like the lower cheeks and jaw, where skin is relatively thick.

Rolling scars have a varying depth, with sloping edges that make skin appear wavy and uneven.

Unlike atrophic scars, hypertrophic and keloid scars are formed as raised lumps of scar tissue where the acne once was. This happens when scar tissue builds up, sometimes from previous acne spots. People with a darker skin color are more likely to develop this type of scarring. Because of the risk of complications and unpredictable way of action in skin tissues healing, is better this kind of scars to be address by a dermatologist.

What’s the best treatment for acne scars?

Acne scars are abnormal healed tissues, and no single treatment is best for everyone. Is taking time, perseverance, a very good home regime to protect and sustain the “re-healing “process.

The goal in every acne scar treatment is reducing of any discoloration of the skin, reducing the depth of the scars, and resurfacing of the skin for a fresh, new, healthy appearance. The good news is there are effective solutions for healing.

The best options include:

A chemical peel is a quick procedure that can be used to treat mild acne lesions and shallow atrophic acne scars.  At the same time, these chemical peels are limited use for deeper atrophic scars and are not a solution for darker-skinned persons because of the potential for pigmentary alterations.

Dermabrasion is useful for superficial atrophic acne scars, such as rolling or shallow boxcar scars, but is less effective for icepick scars.  Advantages of dermabrasion include improvement of skin resurfacing and PIH (post inflammatory hyperpigmentation)

Microneedling is one of the best options for acne scars. It consists of a sterile device with several fine sharp needles applied to acne scars to create multiple small micro punctures in the papillary to mid-dermis. By creating these small wounds in the dermis, a cascade of growth factors is initiated which results in collagen stimulation and production. As micro-needling penetrates only to the depth of the upper dermis, it is most useful for shallow boxcar and rolling scars. A usual treatment course with micro-needling consists of 3 to 5 sessions spaced 4 weeks apart, and results are seen in 3 months.

Radiofrequency (RF) is evolving a device which uses electromagnetic radiation to generate an electric current that heats the dermis causing neocollagenesis and skin contraction. This generates and accelerates collagen production, and contraction of collagen fibers to restructure and tighten the skin and improve the texture of the skin. Radiofrequency has decreased downtime and risk of scarring and infection compared with ablative lasers, and it can be safe to use in all skin types.

A different number and combination of these modalities might improve the appearance of your skin, depending on your scar type, your skin type, and the severity of the scarring.

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