Perhaps the most difficult issue to deal with in having an existing or past acne condition or even an occasional blemish is the pitting, discoloration and the leftover scars that can seem like they take forever to fade away.
How does an acne scar occur?
Simply put, scars are the result of injury to the tissue. In the case of acne, a build up of bacteria and sebum in the sebaceous follicle causes the injury. The body responds by rushing white blood cells and inflammatory molecules to the damaged cells, which can remain at the acne breakout site for weeks in order to heal the area and prevent infection. After the infection heals, the damaged tissue sometimes does not return to its former state. In severe cases of nodular acne where a larger infection occurs in the deeper layers of skin, there can be tissue loss and permanent scarring. Squeezing and picking at whiteheads, blackheads and pimples can cause deeper infection and injury to the skin as well as damage healthy, surrounding skin causing scarring.
What are the treatments available for acne scars?
This depends on the type of acne scars you are having:
Ice pick scarring
This common type of scaring is usually deep, very narrow and extends into the dermis. The skin surface looks as though it has been pierced by an ice pick- hence the name. Some ice pick scars are large in size and often look similar to an open pore.
Treatments: The appearance of ice pick scars can be improved with fractional ablative lasers such as Er:YAG laser. Laser resurfacing is promising because the penetration depth into the skin is more easily controlled with a laser than with other methods. The procedure involves passing the laser over the treatment area 1-3 times and can take just a few minutes for small areas or 20 minutes or more for large areas. Local anesthesia is used.
Boxcar scars are usually rounded or oval shaped depressions in the skin with steep vertical sides. This type of scarring is also very common in acne scarring sufferers. Much wider than the ice pick, they resemble the scars left by chicken pox and are usually found on the cheek area.
Treatments: Same as ice pick scars, they can be improved with resurfacing laser treatments. Platelet rich plasma (PRP) is an alternative treatment option for acne scar or it can be combined with lasers for a even better result.
Rolling or “wave-like” undulations across otherwise normal-looking skin is caused by damage under the skin’s surface. These scars tend to be wide and shallow in appearance.
Treatments: Laser resurfacing with Er:YAG can potentially yield a good result for this type of scars. However, those deeper and larger scars might need subcision procedure to enhance the resurfacing effect of the laser. The scar is cut away and unbound from the tissue below, releasing the fibrotic tissue underneath. Collagen and other connective tissues form under the scar, thus leveling it with the surface. Platelet rich plasma (PRP) and Rejuran Healer PN/PDRN is an alternative treatment option for acne scar or it can be combined with lasers for a even better result.
Result of treating acne scars with Er:YAG laser
Pictures courtesy of Fotona
Hypertrophic scarring / Keloid scars
Hypertrophic scars are raised from the skins surface and firm in texture. These types of scars are commonly found on the back or chest area of the body but can also appear on the face and neck. Hypertrophic scars usually reduce in size over time. Keloid scarring is a form of hypertrophic scarring that extends beyond the boundaries of the scars.
Treatments: Intralesional steroid injections help interrupt the inflammatory response and the scar is reduced. This can be coupled with silicon gel application to have a better treatment outcome.
Hyperpigmentation refers to the brown dark marks that are left behind after a pimple heals. These marks are not scars, but are often confused with scars because they can last for months or even years before they fade. For more information on hyperpigmentation and treatment options.