A Discussion About Acne Scars

By Jerry K. L. Tan, MD, FRCPC

We all aspire to a smooth, clear complexion. When pimples arise, the need to flatten them out and squeeze is understandable. Unfortunately though, this may lead to short and long-term problems such as persistent redness, large brown stains (hyperpigmentation) and scarring (loss of skin substructure). Stains and scars are often confused by patients - stains are pale or brown flat marks whereas scars can be seen as indentations or pock marks in the skin. It's now recognized that scars can also develop from small as well as large lumpy pimples.

For both scars and stains, the best treatment is avoidance - that is, preventing the acne in the first place or at least treating it early and avoiding picking or squeezing the spots.

To treat acne and prevent new scars from forming, you should remember:

  • You should get help for your acne as soon as you notice it as early treatment minimizes the severity of acne and the risk of scarring
  • Effective acne treatments are available
  • You can control and cover the visible lesions and avoid embarrassment

Types of Acne Scars

It is common to have stains and mild scars from acne. Stains will generally improve with time and can be helped to improve more quickly with skin care treatments such as topical retinoids, alpha-hydroxy acids and therapeutic exfoliating facials. For many of those with mild scars, they may not even be aware of it - some of these may improve over time. However, severe scarring may be more difficult to treat.

There are a number of types of scars caused by acne. (Pictures can be found at Types of Acne Scars)

  • Ice pick scars - Deep pits, that are the most common and a classic sign of acne scarring.
  • Box car scars - Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
  • Rolling scars - Scars that give the skin a wave-like appearance.
  • Hypertrophic scars - Thickened, or keloid scars.

Acne Scar Treatment Facts:

  • Ideally, acne should be quiescent or controlled before treating scars
  • Treatments for scars depend on the specific scar type
  • Treatment also depends on your skin type.
  • Embarrassment from is most often due to facial scars - effective treatment can lead to an improvement in self-image and confidence
  • Scars on the chest and back will also respond to treatment

Non-surgical Treatment For Acne Scars

There are several non-surgical treatment options that may be appropriate for your acne scars:

Skin Camouflage/Cover-up:

For patients with active acne, acne staining, and scars - effective camouflage foundation can improve the appearance of the skin rapidly. Choose products that are non-comedogenic and non-acnegenic and have your tones matched by a skin-care expert to achieve that matte, flawless appearance.

Topical Creams: (Tretinoin):

Can improve your acne, reduce staining and improve fine scars by causing gentle exfoliation and by encouraging collagen production.

Chemical Peels (AHA peels):

Can improve overall skin tone and luster, but do little for scars, it works best if you get a series of at least six peels, having one every 1-2 weeks.

Skin Fillers/injectables:

Materials are injected into the depressed area of the scar to elevate it to the level of the normal surrounding skin. This treatment is best for scars with smooth shoulders such as thumbprint or rolling scars. Evaluating whether individual scars will respond to fillers is easily done by placing slight tension at the scar edge - if this improves the appearance of the scars, fillers will help. There are temporary and permanent fillers - examples are: Artecoll®, Zyplast®, Restylane®, and HylaForm®.

Non-ablative collagenosis:

New laser and radiofrequency devices are being evaluated for enhancing collagen formation in deeper skin layers without damaging the skin surface. It is possible that these treatments may also prove useful in acne scarring.

Surgical Treatment Options For Acne Scars

1. Microdermabrasion:

It uses very fine aluminum crystals to achieve light exfoliation of the skin. This is helpful for staining and very fine scars. It also works best if you get a series of at least 6, having one every 1-2 weeks.

2. Photorejuvenation:

Using laser or broadband visible light, 5-6 treatments that are performed every 3-4 weeks. This treatment improves mild acne scarring by causing new collagen formation.

3. Scar Revision:

Surgical removal (excision) of acne scars is especially effective for ice pick and boxcar scars. The excision may be in the form of a punch that is closed with sutures that are removed about 7 days later. The end result is replacement of a circular scar with a linear suture scar.

Another technique called subcision uses a sharp instrument to undercut the tethered bases of scars. In this case, the overlying skin is not cut so there is no need for sutures. Further improvement can then be achieved by injecting filler substances into the subcised regions.

4. Resurfacing:

a) Ablative Laser Treatments: - Laser resurfacing (CO2 laser, Erbium Yag laser): These resurfacing lasers remove the surface layer of skin and cause a zone of heat injury. The healing process allows for reformation with younger less scarred skin and deeper layer of new collagen formation.

b) Dermabrasion: - This is a mechanical procedure in which a rapidly rotating wire or brush is used to strip off the surface irregularities of skin. Felt by most experts to be the most effective primary treatment for extensive scarring, it can be used in conjunction with fillers and excision.


About the author:
Dr. Jerry K. L. Tan, MD, FRCPC: Adjunct Professor, Faculty of Medicine, University of Western Ontario, Windsor, Canada. Director, Acne Research and Treatment Centre, Windsor, Canada. Area of specialty: acne and rosacea.


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