Understanding the type of acne scar can help in determining the most appropriate treatment based on the specific type and severity of acne scars.
Types of acne scars
- Atrophic Scars:
further subdivided into:
- Ice Pick Scars: Deep, narrow, and pitted scars that extend into dermis.
Treatment: Punch excision, TCA CROSS (trichloroacetic acid chemical reconstruction of skin scars), microneedling, laser resurfacing, electrocautery and acne subcision.
- Boxcar Scars: Broad, box-like depressions with sharply defined edges.
Treatment:Dermal fillers, microneedling, laser resurfacing, chemical peels, punch excision, electrocautery and acne subcision.
- Rolling Scars: Broad depressions with sloping edges, giving the skin a wave-like appearance.
Treatment: Subcision, microneedling, laser resurfacing, electrocautery, acne subcision and dermal fillers.
- Hypertrophic Scars:
Raised, firm scars that form above the skin’s surface. They are usually the same size as the original acne lesion.
Treatment: Corticosteroid injections, laser therapy, silicone gel sheets, cryotherapy.
- Keloid Scars:
Similar to hypertrophic scars but extend beyond the original acne lesion’s boundary. They can continue to grow over time.
Treatment: Corticosteroid injections, laser therapy, silicone gel sheets, cryotherapy, surgical removal (often combined with other treatments to prevent recurrence).
Treatment:
Treatment of acne scars depend upon on the type and severity of the scars.
1.Topical Treatments:
- Retinoids: Promote cell turnover and collagen production.
- Silicone Gels/Sheets: Flatten and soften raised scars.
- Alpha Hydroxy Acids (AHAs) and Beta Hydroxy Acids (BHAs):
Exfoliate and improve skin texture.
- Laser Resurfacing:
- Ablative Lasers: Remove the outer layers of skin and stimulate collagen production (e.g., CO2 laser).
- Non-Ablative Lasers: Stimulate collagen without removing skin layers (e.g., Nd:YAG laser).
- Microneedling:
Microneedle to create controlled micro-injuries in skin. These micro-injuries stimulate the body’s natural wound healing processes, leading to increased collagen and elastin production, which helps to improve the appearance of acne scars.
- Chemical Peels:
Applying a chemical solution to the skin, which exfoliates the outer layers and promotes the growth of new, smoother skin. The depth of the peel can vary depending on the type and concentration of the chemical used, as well as the specific skin concerns.
Superficial peel: For epidermal layer used glycolic acid, salicylic acid, AHA and BHA
Medium depth peel: For epidermal layer and Upper dermal layer used TCA
Deep depth peel: For reticular dermis used Phenol.
Common agents include:
- glycolic acid
- salicylic acid
- trichloroacetic acid (TCA).
- Acne subcision: Acne scars are adherent to deeper layers of skin by fibrous band, ance subcision breaks down these fibrous bands reducing tge depth of acne scars.
- Dermal Fillers:
Injectable fillers (e.g., hyaluronic acid) can raise depressed scars to the level of surrounding skin.
- Sugar threads:
Sugar threads, also known as polydioxanone (PDO) threads, PDO dissolvable threads into the superficial layers of skin, generally in the areas of the forehead, cheeks, jawline and neck. It can primarily used in aesthetic medicine for skin lifting and rejuvenation.
- Minimally invasive with relatively quick recovery time.
- Immediate lifting effect with gradual improvement in skin texture.
- Stimulates natural collagen production.
- Subcision:
A needle is inserted under the skin to break fibrous bands pulling down the scar, allowing it to lift.
- Steroid Injections:
Used for raised, hypertrophic scars to reduce inflammation and flatten the scar.
- Platelet-Rich Plasma (PRP) Therapy:
Uses the patient’s own blood plasma, rich in growth factors, to promote healing process, and collagen production.
Vampire facial:
Combination of PRP with microneedling (needle depth 2mm) can create microbleeding remain on skin.
- Radiofrequency (RF) Therapy:
Uses radiofrequency energy to heat the skin and stimulate collagen production.
Fractional RF: Combines microneedling with RF energy to target deeper skin layers. Examples include devices like Morpheus8, 4D fractora and Profound RF.