Guide to Acne Scarring

One of the most common questions confronted in dermatology offices amongst patients with acne is how to get rid of acne scarring. This is such an important question because, as acne has its own problems, occasionally the resulting acne scarring can be as cosmetically disturbing as the original acne. Many advances have been made to alleviate the appearance of acne scarring, but no over-the-counter remedies are currently available. The following discussion and suggestions must be carefully reviewed with your experienced dermatologist.

The first step in the treatment of acne scarring is treating the underlying acne. Without an effective anti-acne regimen, treating acne scarring will be futile as more scars will occur despite treatments. For a more thorough discussion on acne and acne regimens, please reference these topics in the DermBlue Learning Center or accompanying EzineArticles:

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Your regimen may include simple over-the-counter acne care or prescription topicals such as Retin-A® or Tazorac®. Other treatment options include antibiotics, Blu-Light Photodynamic therapy, and oral isotretinoin therapy. These choices are made between you and your experienced dermatologist. Acne scarring can be divided into two primary groups: rolling acne scars and ice-pick scars. Rolling scars are best described as hills and valley that are truly accentuated with tangential lighting. Ice-pick scarring is the sharp, deep pitting holes made as if an ice-pick was poked into the skin. The treatment of these two different types of scarring differs in both the methods used and the rate of success. For rolling scars, there are surgical, ablative, and non-ablative methods to reduce scarring. Surgical methods include subcision treatment where a needle/blade is placed underneath the scar and moved side to side to loosen up the underlying scarred tissue. Another treatment option is using a filler such as Restylane® or medical grade silicone to fill up the scar. Non-ablative therapies include using an infrared laser to heat up and remodel the tissue underlying the scar. Ablative therapies include dermabrasion (manual sanding of the skin) or ablative lasers, such as the Er:YAG or CO2 lasers, to remove the top lasers of the skin and essentially even out the “hill-tops and valleys” of the rolling scars.

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For ice-pick scarring, surgical methods include punch excision, where a cookie-cutter circular instrument is used to remove the scar under anesthesia and a stitch may or may not be placed to help with healing. Another new technique involves using 90% Trichloroacetic Acid applied with a toothpick. This serves to damage the skin within the scar and promote scar remodeling. The other treatment methods mentioned above also apply: use of the filler substances, dermabrasion, and laser resurfacing.

In general, non-ablative laser therapy may reasonably lead to 50-70% improvement of rolling acne scars. Subcision and use of fillers are ideally used for limited rolling acne scarring and punch excision treatment may be used if isolated ice-pick scarring is noted. For more extensive scarring of either type, dermabrasion or ablative laser therapy tends to be the best option.

Many of these treatments are skin-type specific and must be determined upon close consultation with your dermatologist. While these treatments are not covered under any insurance, the cosmetic results may be well-worth the price. Make sure to discuss all the possible therapy options and combinations, as well as the reasonably expected results.

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