According to the American Academy of Dermatology, acne is the most common skin condition in the United States. While the prevalence of acne is higher in adolescents due to the hormonal changes that come with puberty, this condition persists into adulthood in about 12 to 14% of cases. At any age acne can be embarrassing and negatively affect one’s self-esteem.
What makes this condition even more difficult to deal with is the scarring that can result from these lesions. Fortunately, several effective treatment options exist to reduce or even eliminate the appearance of post-acne scars. This article aims to answer the question “What can you do about acne scarring?” by providing information on the mechanism behind acne scar formation, the different types of acne scars, and the treatment options that exist.
What causes acne scarring?
As with any scar, the development of scar tissue is first initiated when the skin undergoes an injury and the wound healing process ensues. With acne, this injury occurs due to inflammation and damage to the skin’s follicles.
Acne is an inflammatory process that involves the overproduction of sebum, an accumulation of the bacteria P. acnes, and reduced exfoliation within a follicle. The inflammation that occurs when an individual experiences persistent breakouts causes injury to the follicle and surrounding skin structures. Additionally, the inflammation prevents the body from mobilizing the cells and immune system mediators that are necessary for the normal wound healing process. In this situation, the originally healthy skin tissue can be replaced by fibrous scar tissue.
Types of acne scars
Generally speaking, there are three different types of acne scars: atrophic, hypertrophic, and keloid scars. Atrophic acne scars are more common than keloids and hypertrophic scars with a ratio of 3 to 1. Additionally, atrophic acne scars have been sub-classified as ice pick, boxcar, and rolling scars. These scars are caused by a lack of collagen that produces a pitted look to the skin.
On the other hand, hypertrophic and keloidal scars are caused by excess collagen deposition and decreased collagenase activity. Hypertrophic scars have a pink, raised, and firm appearance with thick bundles of collagen that remain within the borders of the original site of injury. In contrast, keloids form as reddish-purple papules and nodules that expand beyond the borders of the original wound. Hypertrophic and keloidal scars are more common in darker-skinned individuals. (Dermatology Research and Practice, 2010)
Treatments for acne scarring
Acne scarring may seem like a permanent problem, but with advances in technology and science, many treatment options are available to reduce or even eliminate the appearance of acne scars. Current treatment options include the following:
- Chemical peels: Chemical peeling involves applying chemicals to the skin to destroy the outer damaged layers and accelerate the repair process. A popular chemical peel that can treat acne scarring along with other skin concerns such as hyperpigmentation and wrinkles is The Vitalize Peel®. It contains a blend of alpha- and beta-hydroxy acids, as well as resorcinol and retinoic acid, to restore a smooth radiance and even skin tone and texture.
- Dermabrasion/microdermabrasion: As the name implies, dermabrasion uses an electrical machine to abrade the skin. This process removes the top layers of skin and as the skin heals, the surface appears smoother. Dermabrasion procedures typically require 5 to 7 days at home for recovery. Microdermabrasion is less invasive and is performed over a series of treatments with no downtime.
- Laser treatment: Traditional lasers used to treat acne scars use high-energy light to burn away damaged skin. At the Art of Dermatology, Dr. Jessica Krant utilizes the Picosure laser, an unprecedented innovation in laser technology. PicoSure® is the world’s first safe and effective picosecond aesthetic laser, which reduces the appearance of acne scars through a non-invasive procedure that only requires about 10 minutes. A series of Picosure treatments are typically required to see optimal results.
- Needling: Skin needling involves using a sterile roller comprised of a series of fine, sharp needles to puncture the skin, which in turn increases collagen production and improves the skin’s texture.
- Injectable dermal fillers: Atrophic acne scars can be treated with injectable dermal fillers, such as Juvéderm® or Restylane®. Both Juvéderm® and Restylane® involve injecting hyaluronic acid into the treatment areas.
- Intralesional steroid therapy: Corticosteroids can be injected into keloids and hypertrophic scars to reduce the volume, thickness, and texture of scars.
- Cryotherapy: Cryotherapy procedures freeze scar tissue, causing it to die and eventually fall off. Cryotherapy has the potential risk of lightening the skin, causing the treated area to be lighter than the surrounding skin.
- Punch grafts: Punch grafts are small skin grafts used to replace scarred skin. First, a hole is punched in the skin to remove the scar. Then, unscarred skin (often from the back of the earlobe) is placed over the area. Punch grafts can help treat deep acne scars.
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