In our previous article, we mentioned the types of scarring following acne and differentiated between scarring and pigment change. In this article, we will further explore the options of treatment available for acne scars.
A treatment similar to dermabrasion is the laser resurfacing. The CO2 and Erb: Yag lasers are the most common used for laser resurfacing. These lasers destroy the epidermis and superficial dermal layer. As with dermabrasion, the affected skin is removed, and the damaged tissue is allowed to heal. Over time, the skin will reform as healthy collagen helps heal and restore texture to the damaged region. Because this treatment causes cell death, it can have similar risks as dermabrasion. Individuals with darker skin are still at risk for developing further scarring and hyperpigmentation as a result of this treatment.
For atrophic scarring, a needle can be inserted under the scar to release scar tissue. This procedure, known as subcision, has been shown effective as it can target the scar tissue beneath the skin, allowing healthy skin to regenerate and replace the damaged tissue. Patients require local anesthesia prior to treatment.
Deep ice pick scars can be treated through the use of punch excision and grafting. A device known as a punch is used to excise the scar tissue. The edges of the wound are then sewn together with a suture. The procedure replaces a scar with a scar, but the new scar is much smaller. While not directly removing the scar, it is possible to treat this new scar with other methods. For scars too large to treat in this method, a skin graft can be used. Grafts can be contoured with the skin through the use of dermabrasion.
In some cases fillers can be used to add volume to the skin. The procedure serves to flatten the acne scars, but is only temporary. Since this procedure requires re-injection of the filler material to maintain the effect, it is often used in addition to other treatments.
Scar tissue can also be removed through the use of chemical peels. Chemical peels damage the target area of the skin, promoting new tissue growth that improves the skin appearance. The appearance of atrophic acne scars can be improved through the use of medium and deep depth peels, which affect the epidermis and some of the dermal layer. Deeper peels are available, and with more effectiveness come increases in the risk of infection, scarring, and discoloration. There is still a higher incidence of scarring and detriment in individuals with darker skin. The use of glycolic acid peels (a superficial treatment) has been shown particularly effective in the treatment of acne scars in Asian patients.
The treatment of hypertrophic acne scars is more difficult. For an unknown reason, these scars are more likely to reoccur following removal. This problem makes the previous treatments less viable for long-term treatment. Instead, hypertrophic acne scars can be treated with a combination of topical and injected steroids, silicone dressing, and cryosurgery. There are some studies that show promise with the use of pulse dye lasers in removing and preventing regrowth of hypertrophic acne scars.
A recent method of treatment involves the use of small skin grafts from ear tissue. Since some deeper acne scars cannot be treated with previously mentioned methods, it has been difficult to help certain patients. Some deep scars extend deep into the dermal layers, and removal of tissue does not promote new collagen growth that heals the appearance of the skin. This new procedure hides the acne scar through the use of a skin graft, providing an alternative to other treatments. The patient is first injected with a local anesthetic behind the ear and beneath the scar crater. The scar tissue can be removed surgically, while a portion of ear tissue is excised and sealed with sterile strips. While some bleeding is noticed afterwards, there is apparently very little difference.
Depending on the severity and type of acne scar, the course of treatment can be very different. It is important to schedule appointments with your dermatologist to discuss treatment options. Before most of these procedures can be performed, the remaining acne scars should be treated.