While most people who suffer from acne do not get scars, some severe forms do leave deep scars. For anyone who has scars after a bout of acne, there are many treatment options available. There are different types of acne scars, which may need medical attention.
Of these four create indentations on the skin’s surface. They are caused due to loss of tissue and called crateriform scars or atrophic scars. These are ice pick, boxcar, and depressed fibrotic or rolling scars – based on the shape of the scars. The other acne scars are called keloid and hypertrophic acne scars. These are more difficult to treat than indented scars. These resemble raised fleshy tissue. Cost of acne scarring treatments varies depending on the extent of scarring and the method used. Some most popular acne scarring treatments are provided below.
Treatment options for acne scars
OTC Products : Over-the-counter acne scarring treatments may not completely erase acne scars. Most of these products contain vitamin C, glycolic acid and retinol. Minor depressed scars are treated with OTC medications. They produce a collagen that makes the skin look fuller and camouflage the depression on the skin.
If acne scars cause skin discoloration also, then OTC creams containing 2% or 4% hydroquinone can be recommended depending on the extent of scarring. If OTC products do not work, then other options can be considered. Alpha hydroxyl and beta hydroxyl acids are also OTC products that treat acne scars.
Topical Medications : Topical retinoids such as adapalene, tretinoin and tazarotene, which have anti-inflammatory properties, can prevent the development of acne scars. Topical antimicrobial medications like benzoyl peroxide while they do not heal scars can prevent scarring by treating inflammatory acne lesions. Topical corticosteroid injections are used in treating keloidal scars and hypertrophic scars.
Microdermabrasion : This procedure can reduce acne scars by removing the top skin layers. Repeated sittings for microdermabrasion can even remove deeper scars. It involves using a specialized motorized hand-held devise with a vacuum. Tiny crystals are blown on to the surface of the skin and buff away dead skin cells. Scars found on the chest, face and neck can be treated using microdermabrasion. If you undergo microdermabrasion at home, be careful, for incorrectly using the equipment can cause permanent discoloration and bruising. You may also hurt your eyes if not careful. Some side effects are redness and swelling that can last for a few hours or days. Since microdermabrasion only removes surface skin, it is not a long lasting treatment for deep acne scars.
Dermabrasion : This acne scarring treatment is similar to microdermabrasion but older. It uses a brush to scrape away top skin layers, leaving scar-free skin to grow. Dermabrasion is meant for soft scars.
Chemical Peels : This involves applying chemicals on acne scars. The peel exfoliates the scars and makes them become less visible or disappear. The strength of the chemical peel depends on the extent of scarring and the doctor will know what strength to use. This treatment is more effective for atrophic scars.
Needling : This new technique is said to be a better alternative to dermabrasion and chemical peels. The skin is not damaged and there is no risk of hyperpigmentation. A sterile roller on which are a series of thin, sharp needles are used to puncture the skin. The device is rolled over acne scars creating tiny, microscopic channels in the dermis. This stimulates the body to produce fresh collagen. The procedure is performed under anesthesia.
Surgery : This can be considered the last resort to treat stubborn acne atrophic acne scars such as depressed fibrotic scars, boxcar scars and ice-pick scars. Punch excision is a minor surgery that involves cutting out individual acne scars using cookie-like cutters. The surrounding skin is joined and sutured to close the opening.
Punch replacement is similar to punch excision. The difference is that unscarred skin is used as a skin graft to close the opening. Such skin grafts are usually taken from behind the ear. Punch elevation is when the scar is punched out but not disposed off. Instead it floats to the surface on level with surrounding skin.
Suscising Scars : This is a procedure where the scar tissue is remodeled and restructured by removing fibrous bands that cause tension between epidermis and deeper structures. This aids in new collagen formation and is useful to treat rolling scars.
Tissue Fillers : This procedure involves injecting fat or collagen under the skin and directly into the scarred areas. The skin fills and stretches out making the scars appear less prominent. This procedure must be used frequently since the result is temporary. This procedure can be used for ‘hill and valley’ type rolling scars. Nowadays, newer fillers are being used such as Hylaform and Restylane, which are said to provide longer lasting results.
Superficial Peeling : This is useful in treating boxcar scars and pigmented macular scars. Superficial peels are made from a variety of acids of differing concentrations – salicylic acid, glycolic acid, piruvic acid, trichloracetic acid etc. Such peels limit the damage to the epidermis and the choice of peel depends on the size of the scars. For acne scars, you require at least 4-7 sittings.
Steroid injections or silicone dressings : This treatment is used for keloid acne scars. Cortisone injections or a silicone dressing is placed on the scars. This shrinks the scar tissue. Bigger scars require repeated treatment.
Laser treatment : Laser acne scarring treatment is called laser resurfacing where a laser beam kills the epidermis and heats the dermis. A wound is formed and as it heals, new smooth skin minus scars appears. This is ablative surgery. There is non-ablative surgery, radiofrequency devices and pulsed light devices that are used for acne scars and do not damage the epidermis. Acne scars will be less visible after several sittings.
Pulsed Dye Laser : This treatment uses lasers, which are tuned to a particular wavelength of light. The bright light is absorbed by blood vessels. It helps to improve acne scars.
Diode Laser : This type of laser treatment uses infrared frequencies – long, invisible wavelengths. It is effective in treating both acne and acne scars.
Fractional Photothermolysis : This technique treats fractions of the skin using fractional laser devices. This type of laser source depends on the treatment settings, scar sizes and depth. Carbon dioxide and erbium are the two media used in this therapy. Recovery time is faster and complications are fewer with this treatment. This is said to be a better option than traditional laser resurfacing technology.
Camouflage : Acne scars can create a lot of psychological problems in people. Although there are so many acne scarring treatments, none of them permanently remove scars. Long term medications can harm the body. Corrective cover cosmetic (CCC) or camouflage can be an alternative to medicine. There are CCC clinics where experts guide a patient on ways to clean and hydrate the skin using non-comedogenic and non-allergenic cosmetics. They are taught the right color of foundation to use, how to apply powder etc., to mask blemishes. E.g. a person who has red, gray, brown or bluish acne scars will be taught to apply yellow or green undercover to neutralize these defects.
Emerging Technologies : New technologies developed to deal with wrinkle treatments are now proving effecting as acne scarring treatments. One such technique called ‘Thermage’ uses RF radio frequency emissions directed on the skin’s collagen layers. This treatment is said to be effective on deeper scars as it targets and destroys the sebaceous glands. More research is required to see its long term effect on acne scars.
We see that there are many acne scarring treatments available. Choosing the right treatment could require a trial and error method. It is best safest to consult an experienced dermatologist who can guide you to the best possible treatment.