Has Your Acne Left Scars?

Learn About Acne Scar Treatment Options

By Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)

Acne affects an estimated 99% of people - mostly teenagers and young adults - at some point in their lives. Although acne is temporary, lasting from a few months to a few years, early therapy is necessary to prevent scarring and dyspigmentation, which, untreated, can persist for life.

If acne scarring has occurred, several treatments are available to improve the appearance of your skin. These include skin filler substances, laser phototherapy and conventional surgery. These can be used alone or in combination.

Classification of types of scarring

The first step in selecting the appropriate treatment for scarring is for your physician to define the type of acne scars you have. For complete information about scarring, see acne scars

The three types of acne scars are:

1. Ice-pick: Ice-pick scars are 1-2 mm in diameter,
2. Rolling: Rolling scars are caused by abnormal fibrous bands and are usually wider than 4 to 5 mm. Rolling scars are so-called because of the appearance they give to the overlying skin
3. Boxcar scars: Boxcar scars measure more than 3 mm in diameter and appear similar to post chicken pox scars.

Increased or decreased skin pigmentation and persistent reddening of the skin also frequently occur following the development of acne.

Treatment options

After your doctor has completed a full examination of your skin, you need to discuss the treatment options. Treatments include subcision surgery, fillers such as Restylane® or Artecoll® and laser skin resurfacing. For complete information about treatments, click on surgical treatments for acne.

Subcision is carried out under local anesthetic to cut the fibrous bands in the deep skin layers. A compression dressing prevents excessive bleeding following the procedure. This is often used for rolling scars.

Shallow boxcar scars can also be treated by subcision or punch grafting and laser skin resurfacing. Treatment for deep boxcar scars includes a combination of punch excision and punch elevation. Following anesthesia, a punch-biopsy surgical instrument is used to remove the scar. In addition, in most cases, punch grafting or punch elevation is also needed for best results. Punch elevation involves lifting the tissue instead of removing the scar. The tissue initially sits slightly higher than the surrounding skin, but retracts as it heals to become level with the remaining skin. Alternatively, skin resurfacing can be achieved with chemical peels or laser techniques.

Laser skin resurfacing

Laser skin resurfacing removes, in a controlled way, the epidermal layer of the skin and part of the underlying dermal layer. The healing process results in smoother skin. Laser techniques should only be carried out by experienced physicians.

Combination treatments

Combination treatments using the surgical techniques described above are often carried out with resurfacing therapies. Any surgical or laser treatment should be delayed at least 6 to 12 months if you are taking Accutane ®, otherwise complications with wound healing can occur.

A 30% to 60% improvement in scarring is considered a reasonable result with these treatments. If you are considering treatment for acne, remember that scar improvement takes time and patience.

About the author:
Mariusz J. Sapijaszko, MD FRCPC is the Director of the Western Canada Dermatology Institute located in Edmonton, Alberta. He is also the Clinical Assistant Professor at the Division of Dermatology, University of Alberta, in Edmonton. His areas of expertise include cosmetic and laser surgery. Learn more on his www.youthfulimage.com

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