Acne Scar Treatment - Types and Treatment

Introduction:

Acne is an active state and is in itself a source of concern; once the acne goes down, one has to deal with the scars it leaves behind. Acne needs to be treated, and the scars separately. Depending on the type of scars, the treatment and longevity of the treatment vary.

Who Needs Scar Treatment?

• Skin is a protective barrier. In the event of an acne breakout, this barrier gets disrupted and penetrates the skin, damaging the tissue layers beneath it. This is the cause of scars post-active acne breakout.

• Skin tone and race can also be a factor. Darker skin type groups have more chances of hyperpigmentation and scarring.

What Are the Different Types of Acne Scars?

Acne scars can be broadly classified as atrophic scars or hypertrophic scars.

Depressed or Atrophic Scars: These scars are at a lower level than the surrounding skin.

• Depressed Scars:

  • Icepick Scars: Chickenpox-like scars or V-shaped scars that are deeper into the skin and difficult to treat.

  • Boxcar Scars: These are u-shaped scars with sharp edges. They can be shallow or deep; shallow scars are easier to treat. Dermabrasion is effective; in the skin of color, 4 % Hydroquinone pretreatment may be necessary to prevent hyperpigmentation.

  • Rolling: Wide depressions with rounded edges with a rolling appearance.

Raised Scars or Hypertrophic Scars: These are at a higher level than surrounding skin and occur due to the overproduction of collagen.

What Are the Different Treatments?

The treatment for scars differs depending on the type of scars that have been formed. Most types of scars would require combining multiple treatment modalities for best results.

Scars should not be mistaken for the discoloration left after acne. These fade in a matter of months. Scar treatment should be based on the type of scar and skin type and can be best done with the advice of an expert.

Chemical Peels:

These remove the outer layer of skin, exfoliate, enhancing cell turnover, thereby treating scars. Chemical peels are classified based on their depth of penetration as:

1. Very Superficial: The destruction of the stratum corneum without creating a wound below the stratum granulosum.

2. Superficial: This destroys the epidermis at any level from the basal layer to the granulosum.

3. Medium Depth: Destruction of the epidermis and papillary dermis (part of full).

4. Deep: Destruction of the epidermis, papillary dermis, and even extending into the reticular dermis.

5. Others: Glycolic acid, salicylic acid, trichloroacetic acid, pyruvic acid, and Jessner’s solution are some of the chemical peels.

Depressed Acne Scars:

Atrophic scars or depressed acne scars occur when collagen production is not sufficient enough during wound healing. As the name suggests, there is a slight depression in the surrounding areas.

Acne Scar Surgery:

This is a minor corrective procedure to treat visible acne scars. The treatment leaves behind a less noticeable scar which fades with time. It can be performed by either lifting the scar, bringing the scar closer to the surface in order to make it less prominent, or another method is to break up the scar tissue.

Unlike what the name sounds like, it is a safe procedure that can be done in a dermatologic office without general anesthesia. The patient will not experience any pain as the area will be made numb.

Resurfacing Procedures:

Removing the upper layers of skin is called resurfacing procedure; this promotes the body to produce new skin cells. This is done when the patient has widespread scarring. Resurfacing procedures include:

• Laser skin resurfacing.

• Dermabrasion.

• Chemical peeling.

• Microdermabrasion.

This procedure is best suited for scars that are not too deep and are effective in making scars less noticeable by contouring scar edges. However, deeper scars will require skin surgery and resurfacing.

Skin Tightening:

• A procedure used to tighten the skin, thereby making the scar less visible, is called skin tightening. It is a newer treatment and is more affordable.

• Radiofrequency is the procedure used to tighten skin. This requires multiple appointments, monthly once for four months. The patient may experience a burning sensation for an hour post the procedure, and the skin might be pink for two to three days.

• Follow-up care is required, which includes the use of sunscreen daily morning and moisturizer at night. Sunscreen that offers UVA/UVB protection with an SPF of 30 or above is recommended.

• It is best suited for treating depressed scars and can even treat deep ice-pick or boxcar scars.

Fillers:

• Fillers are used by dermatologists for lifting or plumping depressed scars. Collagen, patient’s fat, or other filler material can be used to fill the scars. Most filler treatments are temporary and may only last from 6 to 18 months. As there are benefits and contraindications, discuss them with the dermatologist before choosing the procedure.

• This can be used for treating depressed scars but is not advisable for icepick scars.

Collagen-Induction Therapy:

• Needling or micro-needling is the type of treatment used for inducing collagen in the skin. The procedure is done by moving a sterile roller that is studded with a needle across the scars. This procedure punctures the skin, and as the skin heals, collagen is formed. Most patients require three to six treatments every two to six weeks for treatment. The treatment will have swelling, which will clear within four to five days.

• This treatment is safe for all skin colors and is suited for widespread depressed acne scars but is contraindicated for raised acne scars, as raised acne scars are caused due to the overproduction of collagen.

Electrodesiccation:

Electric probes are used to heat the tissue, which causes the tissue to die. This is suited for boxcar acne scars. But this treatment option should be combined with other treatments as it is not effective alone. It is useful in reducing the edges of boxcar scars.

Raised Acne Scars:

• Injections:

  • Directly injecting the medicine into the scar helps to soften and flatten the raised thick scars.

  • The treatment is effective after multiple steps and is done once in a few weeks. The duration between the two visits depends on the scar. Typically one may require two to six weeks.

  • Patients may receive Corticosteroids as injections, and interferon used to treat cancer is also found effective.

  • If, even after the fourth session, there is no improvement, acne surgery may be recommended.

  • It is useful in treating painful, raised scars.

• Acne Scar Surgery: This surgery can be done for raised acne scars also. But for better results, it should be combined with another treatment. This treatment can be done in the dermatologist’s office.

• Follow-up Injections: After acne scar surgery, the treated areas may require corticosteroid injections, 5-FU (5 fluorouracil), or interferon. This combination of surgery, followed by injections, is found to be highly effective. The injections may be done monthly once for a few months.

• Follow-up Radiation:

  • Radiation after surgery has been found to be effective in preventing the recurrence of raised scar formation. However, due to the potentially harmful side effects of radiation, it is not recommended.

  • It is suited for raised scars that require a stronger treatment than radiation.

• Laser Therapy: Light therapies like lasers are effective in treating raised scars. A pulsed dye laser is used; it is helpful in reducing pain and itch and diminishing color. It can also flatten a raised scar. For lighter skin types, intense pulsed light can be used. Laser therapy is effective in treating all types of scars.

• Cryosurgery: Cryosurgery for scar treatment employs freezing the scar, so the scar tissue falls off. Multiple sessions may be required, and corticosteroid injections may also be recommended. However, this treatment can cause permanent light spots on the treated skin, which is a major drawback. It can be used to treat raised scars on lighter skin tones and is not recommended for skin of color.

• Silicon Dressings, Scar Creams, and Gels: These are over-the-counter products that can be used by the patient to treat scars. The exact mechanism of how this help reduces scar is not entirely understood. It has been proposed that this helps reduce pain and itch and increase hydration, thereby helping the area heal and making the skin more flexible. To be effective, these methods have to be continuously used; however, it is popular due to their affordability and lesser risk of side effects. It is effective in reducing scar and discomfort, but it is not as effective in raised scar treatment.

What Is the Outcome of Acne Scar Treatments?

Most treatments are effective yet time-taking. The scars fade over time and are barely noticeable. The results will depend on choosing the right treatment modality based on the type of scar, skin type, and combination of treatment types. Safe and properly timed treatment is also another factor that is important in determining the outcome.

Conclusion:

Acne scar can be the dreaded consequence of acne vulgaris. The extent and type of scar change from person to person and with different skin types. The treatment also varies based on this and the type of scars. Depending on this, a dermatologist can determine which modality or which combination of modalities should be used to treat acne scars. The treatment may require multiple sessions and several months, but these treatments are effective in treating scars over time.