Acne (commonly known as pimples) affects over 90% of adolescents and persists into adulthood in approximately 12%–14% of cases with significant psychological and social implications. Though acne may be transient, scars remain and remind us of the problem, making the scars more than just skin deep & it becomes frustrating for the patient.
An approach to the treatment of acne scars should always address the acne first so that there is no recurrence of scars once the treatment is complete. Acne scars are stubborn, and no single treatment is best for everyone.
What are the types of acne scars?
1) Atrophic- includes ice-pick, rolling and boxcar scars.
2) Hypertrophic- includes keloidal scars
How to prevent acne scars?
-Treat acne when you first notice it and continue treatment
-Never pick, pop, scratch, or squeeze breakouts.
-Follow a good skin care routine and maintain skin hygiene
Are acne scars permanent?
When an acne scar first appears, you may see a depression (indent in your skin) or a raised scar, along with some discoloration. Over time, the discoloration usually goes away. However, the scar remains. Surface scars may be completely removed, while deeper acne scars may become less apparent.
There are several acne scar treatment options, both medical and procedural, and laser devices are useful in obtaining significant improvement.
How to treat acne scars?
Acne scar treatment can be done using various procedures & devices with a treatment plan tailored to the patient, depending on their scars, skin type and end goals.
Treatment of acne scars includes-
-Resurfacing techniques such as chemical peels, microneedling RF (MNRF) and lasers.
-Tissue augmenting treatment like dermal fillers, fat fillers.
-Surgical methods as Subcision, punch excision, scar revisions.
1) Chemical peels
Application of a chemical solution to the scar tissue to destroy the outer damaged layers helps the body produce more collagen and elastin which helps reduce the scars. Peels are available in strengths ranging from mild to strong depending on the chemical - glycolic acid, phenol, TCA. Sequential sessions at varying intervals may be needed for each individual.
2) Lasers
All patients with box-car scars (superficial or deep) or rolling scars are candidates for laser treatment. Carbon dioxide laser and Erbium YAG laser are the most commonly used fractional ablative lasers for the treatment of acne scars.
Lasers create microscopic thermal wounds to achieve homogeneous thermal damage at a particular depth within the skin leading to collagen induction and remodelling.
3) Microneedling RF (MNRF)
MNRF device uses tiny needles to create micro-injuries on the skin's surface, triggering the body's natural healing response. The radiofrequency energy delivered during the process further enhances collagen synthesis and tightens the skin, leading to a reduction in the appearance of acne scars and other skin imperfections.
4) Augmentation
This treatment adds volume to depressed scars. Fillers can also help your body produce more collagen and elastin to fill in the scars. There are many new and older autologous, non-autologous biologic, and nonbiologic tissue augmentation agents like fillers, fat grafts, bovine collagen, autologous collagen, etc.
5) Subcision
It is a minimally invasive procedure to treat depressed acne scars by releasing the fibrous bands that tether the skin. It involves inserting a needle beneath the scar to break down these fibrous strands, allowing the skin to lift and improve the appearance of the scar. Subcision is particularly effective for rolling and ice-pick scars which are tethered to underlying tissues.
6) Surgical methods
Punch excision which involves cutting out individual acne scars and repairs the wound with stitches or a skin graft. Other options include - scar excision, scar punch elevation.
7) Hypertrophic scar treatment
To diminish raised acne scars called hypertrophic scars, recommended treatments may include laser treatments, injections of corticosteroids into the scar, cryotherapy, surgical excision, silicone gel sheets, etc.
Conclusion
Post acne treatment remains a challenge and generally a combination of various treatments is needed for the best outcome. However it should be noted that none of the currently available treatments can achieve complete resolution of the scar, it can only be made less apparent to give a better/best appearance.