Acne therapy involves physical
treatment to obtain therapeutic results, which is the leading concern for
many acne patients. Acne scar treatment plays an important part in this.
Types of Scars
Acne scars are defined by their shape, number, depth, localization, and
duration, as well as the patient’s skin type.
Macules, or “pseudoscars,” are the most inflamed lesions receding
into flat reddish spots in their final stages. People with darker skin
tend to suffer more of these scars.
Keloids are hypertrophied scar tissues that results from increased tissue
formation and excessive collagen during healing.
Other acne scar types are caused by loss of tissue, such as the following:
Ice pick scars are named as such because of their appearance. The lesions
have jagged edges and it may be superficial or deep.
Box-car scars are depressed fibrotic scars with sharp edges and steep
sides. They are very similar to chicken pox (varicella) scars. Broader
than ice-pick scars, they are round, polygonal, or linear at the skin surface.
Rolling scars are deep and soft and have gently rolling edges that merge
with the skin.
Atrophic scars are small and soft. These white scars are slightly raised
above the surrounding skin.
All patients need to know the risks and benefits involved in every procedure.
There is also a need to explain that results vary and that complete erasure
of the scar may not be possible, and multiple treatments may be required
for best results. The patient’s medical background must also be examined
for any history of oral therapy, keloids, or persistent facial acne—acne
scar treatment is usually discouraged in the presence of any of these.
Types of treatments
Collagen injections: Collagen, a natural substance in the body, is injected
under the skin to fill deep soft scars. The cosmetic and aesthetic effect
lasts for three to six months and may be extended with further injections.
It is not effective for ice pick scars and keloids.
Autologous fat transfer: A sample of fat is taken from another site of
the patient’s body. The fat is injected into the dermis (surface)
of the skin with the purpose of pushing and elevating the depressed scar.
Frequent sessions are expected as the skin absorbs fat in 6–18 months.
Dermabrasion: The affected area is injected with local anesthetic, and
a high-speed brush or a fraise removes the surface skin and changes the
contours of the scars. Superficial scars can be completely removed and
the depth of deep scars can be reduced. The procedure is best for light
skinned patients, as darker-skinned patients may suffer coloration and
require further treatment.
Microdermabrasion removed surface cells by using aluminium oxide crystals
passing through a vacuum. Microdermabrasion is only suitable to treat fainter
Chemical peels may either be superficial, intermediate, or deep.
Superficial peeling removes macular scars and any accompanying pigmentation,
reducing skin pore size and giving the skin a healthier complexion. Ice
pick and U-shaped scars may be given this treatment. For 15 to 30 days
prior to this treatment, the skin must be prepared with keratolytic products
and depigmenting creams. This type of chemical peel has the highest risk-benefit
ratio, owing to side effects such as erythema folliculitis, flare of acne
lesions, and hypo- or hyper-pigmentation.
Intermediate and deep peeling on the other hands have lower risk-benefit
ratios than superficial peeling. The effect on atrophic scars are mild
and short-lived, and keloids are not affected.
Varieties of laser treatment are possible depending on the intensity and
wavelength of the lasers. Using a wand-like laser handle, scars literally
disappear and are replaced by fresh skin cells. One of the laser's most
significant advantages over traditional techniques for skin resurfacing
is that treatment is relatively bloodless and non-invasive. The procedure
also offers more control in the depth of penetration of the skin's surface,
allowing an increased degree of precision and safety in treating delicate
While laser surfacing is known to be a good acne scar treatment, erythema
is an almost certain side effect, lasting for more than three months in
more than half of all patients. Hyperpigmentation, although lasting less
than three months, also occurred in 29% of all patients. Lesion flare-ups
and other problems requiring medical intervention were common.
Depressed and hypertrophic facial scars can be raised by pulse-dye and
intense pulse light laser, and atrophic and shallow U-shaped scars can
be treated by high-energy pulsed CO2 lasers.
Punch excision can treat ice picks and deep scars. This procedure utilizes
a tool that is usually round and sharp resembling a cookie-cutter that
comes with a diameter ranging from 1.5 mm to 3.5 mm. The size of the tool
is matched to the relative sized of the area of the scar. Under a local
anesthetic, the area is punched and the scar is excised with the skin edges
Punch elevation combines punch excision and grafting without causing irregularities
in skin color or texture. This treatment can only treat scars with sharp
edges and normal bases, making treatment of box car scars by this method
Skin grafting, otherwise known as skin replacement, is especially needed
to close the defect of unroofed sinus tracts. This is especially effective
for deep scars especially on the face.
Latest research shows that combination treatments have tremendous effect
on the recovery of the skin’s elasticity and removal of scars. An
example would be that of combination of dermabrasion and punch excision
of scar tissue make many ice-pick scars treatable and less evidence of
the scar is seen.