Acne Scarring
What are the different types of Acne Scarring and Acne Scar Treatments?
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Scarring remains one of the most troubling complications of common, chronic condition we call acne.
When a patient comes in for an acne or acne scar evaluation, dermatologists often consider whether the marks on 'scars' on the skin are of the temporary or more permanent variety.
The most common leftover marks from acne are changes in skin pigmentation, either an increase in pigmentation called hyperpigmentation or a decrease in pigment called hypopigmentation. These changes in color or pigment are the result of inflammatory damage to the surface of the skin called the epidermis. The pigment cells reside in the lower levels of the epidermis. These pigment cells can drop down into the middle levels of skin leaving brown marks or be damaged and cause lighter or red marks where the pimples were.
These changes in color or pigment from acne inflammation are troublesome, but fortunately rarely permanent. The color almost always returns to a more normal shade with time, once the inflammation of acne decreases.
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Deeper damage from acne inflammation causes disruption to the middle layer of the skin called the dermis. Dermal damage can cause a loss of collagen in the dermis, called atrophy, or can cause a piling up of abnormal collagen, called hypertrophy.
Atrophic or collagen loss scars are classified into three types:
1. Ice-Pick Scars: Narrow, V-shaped, often Deep.
2. Rolling Scars: Wider, Shallower.
3. Boxcar Scars: Flat, U-shaped base, similar to chickenpox scars.
Hypertrophic Acne Scars or thickened acne scars can be of two types:
1. Hypertrophic Scars: remain confined to the size of the original acne lesion.
2. Keloidal Scars: Continue to enlarge outside of the original acne lesion.
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Treatment of acne scars usually involves an evaluation by someone experienced in acne treatment and surgery.
The underlying acne should be controlled as much as possible to reduce the chances of further inflammation and subsequent scarring.
Treatments include topical medications including topical retinoids and alpha hydroxy acids. Dermal fillers play a role in the treatment of some depressed or atrophic scarring.
Some Surgical treatments include
- punch excisions, punch grafts (using a circular blade called a 'punch')
- dermabrasion
- laser resurfacing
- subcision (dermal surgery to release tight or pinched scarring)
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Reference:
Acne Scarring: Status Report on Treatment and Management
Grace Kim DO and James Del Rosso DO
Cosmetic Dermatology February 2009 Volume 22 No.2
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