Even though acne heals eventually; the condition can permanently damage the skin with scarring of the tissues. But the good news is that there are now several excellent treatment options available to permanently remove acne scars.
What is acne?
Acne is an inflammatory condition of the skin caused by clogged oil glands. It can occur due to excessive oil production in the sebaceous glands (oil glands), bacterial infection in the skin, or hormonal imbalances. Certain medications, stress, and poor diet can also be risk factors for acne. Acne can occur on the face but also on the back, upper arms, and the chest. The condition mostly affects adolescents and those younger than 30. But adult acne is also quite common.
Different Types of Acne Scars
Acne scarring can be due to tissue loss or excess of it. The right treatment plan will depend on the nature of the scars.
Atrophic scars occur when acne damages the tissues and there is insufficient collagen production as the skin heals. These scars are characterized by a depression that forms on the site of the acne. These scars mostly occur on the face. Atrophic scars can be further classified into three different variations. Ice-pick scars are narrow and tiny. Boxcar scars have wide depressions with steep edges. Rolling scars have irregular shapes with rounded edges.
Raised scars occur due to excessive collagen production as the skin heals post an acne breakout. These are further categorized as keloid and hypertrophic scars; the former can be more severe of the two. Raised scars are quite firm and they mostly occur on the torso.
Treatment Options for Acne Scars
The treatment for acne scars can depend on the nature of the problem and the patients’ expectations. Some patients may be fine with slight fading of the scars while others may want to completely eliminate the unsightly depressions on their skin. The patients’ skin types may also be a contributing factor for selecting the right treatment for acne scars.
1. Laser resurfacing
Different types of lasers (both ablative and non-ablative) are used to treat atrophic acne scars. Laser pulses help in the renewed production of elastin and collagen on the site of scars. Traditional ablative laser is considered one of the best treatments for acne scars. Ablative lasers remove skin layers to remove the scars. Some examples of ablative lasers are Er: YAG and CO2 lasers. Non-ablative lasers do not remove the skin layers but help with collagen production and skin tightening. Examples of non-ablative lasers are pulsed-dye and Nd: YAG. Ablative lasers often require fewer treatment sessions than non-ablative lasers. But the latter requires less downtime than the former. Fractional lasers target a small area of the skin in a more precise manner than other types of lasers. Fractional technology doesn’t harm the skin adjacent to the treatment area. It can be used with different light pulses such as the Nd: YAG and diode lasers. A relatively newer laser treatment – the picosecond 75 nm Alexandrite laser – is considered safer than other nanosecond lasers. If redness on the skin (erythema) persists due to acne then the treatment may begin with addressing this problem first before tackling the scars. Pulsed dyed laser (PDL) is considered the most effective treatment for erythema. PDL is also useful for treating raised scars.
2. Chemical peels
Chemical peel treatments are very effective for reducing or fading tiny atrophic scars. Chemical peel treatments include soaking the site of scars in an acidic solution to remove layers of skin. Chemical peel treatments can be superficial, medium, or deep depending on the depth of penetration of the acid. Superficial peels are done using salicylic, lactic, or glycolic acids. Medium peels are mostly done using the trichloroacetic acid. Phenol is often used for deep peels. Medium and deep peels are quite effective for treating acne scars.
Dermabrasion is a treatment that utilizes a handheld device to remove layers of skin. The treatment is very effective for well-defined scars that are not very deep. The tools for the treatment can be a diamond cylinder, a high-speed brush, or silicon carbide sandpaper.
Microneedling involves inducing injury to the skin using a tool with a multitude of needles. The healing process of the skin causes more collagen to form on the injured site. Microneedling is considered quite useful for fading rolling scars. It is a collagen induction therapy that is useful for improving the skin’s texture in many ways. The treatment can make the skin smoother and improve its overall appearance. Microneedling tools are also used to infuse the skin with topical agents such as platelet-rich plasma (PRP). PRP is used to treat various skin-related problems including acne scars.
Non-ablative radiofrequency (RF) helps in the production of collagen. RF is delivered using electrodes to reduce acne scars. But it can also be delivered via microneedles or using fractional technology depending on the specific needs of the patients.
Permanent, semi-permanent, and temporary fillers can help reduce isolated acne scars quite effectively. Dermal fillers are substances that are injected into the skin to treat specific conditions. Temporary fillers can last for a few months while semi-permanent and permanent ones can last for up to two years depending on the filler material. Hyaluronic acid expands quickly inside the skin and helps fade the scars due to the tightening of the tissues. This substance is naturally present in the skin; making it quite a safe filler material to use. Other filler materials are Poly-I-lactic acid and Calcium hydroxylapatite.
The treatment involves severing of the scars from the dermis by inserting a needle under them. The process induces new collagen formation and helps heal the scarred skin. Subcision is quite useful for fading rolling scars.
8. Punch excision and punch elevation
Punch excision involves surgical removal of the scarred skin. The wound is then closed with sutures. It is a highly-useful treatment for both boxcar and ice-pick scars. Punch elevation is used for slightly bigger boxcar scars. The tissues are elevated after the excision procedure and prior to placing the sutures.
Acne scars can ruin the skin’s texture and cause confidence issues in patients. Fortunately, a number of effective treatments are now available for those who wish to remove or fade acne scars from their skin.
Connolly, D., & Vu, H. (2017). Acne Scarring—Pathogenesis, Evaluation, and Treatment Options. The Journal of Clinical and Aesthetic Dermatology, 12-23. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/.