Acne Scars: You Don’t Have To Live With Them Anymore

Acne Scar

Submitted by: Nelson Lee Novick

Acne scarring, which may result from either the severity of the disease or undue delay in obtaining appropriate treatment, is estimated to affect to a greater or lesser extent some 95 percent of acne sufferers. All types of acne from the simple pimples and pustules variety to the deep painful cystic types can cause scarring. First and foremost, then, it is imperative that appropriate antiacne treatments be started early enough to prevent this unhappy consequence.

Happily, these days, should scarring occur, one need no longer despair. A number of new and refined cosmetic dermatologic surgical procedures are available for dealing with even the toughest and most disfiguring forms of postacne scarring.

Acne scarring is a direct result of acne inflammation within hair follicles (pores) and of the tissue destruction and loss that often follows. By far the majority of acne scars are of the atrophic type, meaning that there is a loss of underlying tissue. As scars mature and contract they draw in the surface layers of the skin leading to the appearance of indentation. This sunken appearance is commonly referred to as a pock scar. When the scar is very narrow but deeply penetrating, it is called an ice pick scar.

In general, the more severe and extensive the inflammation and the longer it persists before treatment, the more tissue destruction is engendered and the wider and deeper the resultant scar. Scars typically become increasingly visible and disfiguring with time as age-related losses of dermal and fat tissue accentuate the defects.

Abnormalities in color, shape, contour and texture are the reasons that scars stand out to the observer. To the extent possible, cosmetic procedures are, therefore, directed to remedying each of these variables. Although each patient and each scar must be treated individually, it is generally the type of scar and its location that most determine the specific treatment modality.

Superficial scars, those that only effect the epidermis and the uppermost layers of the dermis, can appear as reddish or more commonly brownish blemishes of the skin. If protected from the sun, most of these superficial scars/discolorations will fade significantly or completely within three to eighteen months. In some individuals, particularly with olive skin or darker nightly home applications of tretinoin (Retin A) coupled with morning applications of a noncomedogenic moisturizing sunscreen may be sufficient to improve the appearance of these scars after several weeks to months of continued use. Others may additionally benefit from an in-office series of light glycolic acid or beta hydroxyacid peels or microdermabrasion to hasten the fading of the lesions and to promote collagen synthesis. For more extensive superficial scarring, where scores of lesions may be present, dermasanding or laser resurfacing may be needed.

Not uncommonly, after a grouping of deeply situated cysts heal, multi-channeled tracts, known as sinus tracts, may form below the skin surface. These are often best treated by direct surgical excision of the scar and subsequent buffing (scarabrasion) of the area sometime between six and ten weeks later. Where still more extensive inflammation and deep tissue destruction have resulted within the dermis or even further down within the fatty layer, troughed scars may ensue. Such instances are best benefited by the injection of filling substances, such as Restylane or deeper filling agents like Radiesse.

Dermaspacing to promote native collagen synthesis has also proven quite useful. And as long as the acne problem remains under strict control and further tissue destruction prevented , the latter method possesses the additional advantage that the cosmetic improvements achieved can be anticipated to be permanent. All other therapies are likely to need periodic touch ups to maintain the desired degree of correction.

Icepick scars, which are typically very narrow and penetrate quite deeply and often numerous, present perhaps the most difficult therapeutic challenge. These are best treated by either punch excision, punch elevation or punch replacement. The word punch refers to the razor sharp circular cutting instrument used by the dermatologic surgeon to core out the scar. In punch excision, the icepick scar is cored out and the resulting wound either simply sutured closed or, if small enough, allowed to heal on its own. In punch elevation, the cored sample is not removed, but elevated up toward the surface to eliminate the depression, and then allowed to heal on its own. In punch replacement, a small graft of normal color-matching tissue, usually taken from skin overlying the bone directly behind the ear, is used to replace the cored out scar.

Another useful procedure for ice pick scars is known as the CROSS technique, which stands for chemical reconstruction of skin scars. This method entails the use of a very high concentration of trichloroacetic acid (TCA) inserted deep within each scar to promote shrinkage and closure. Usually more than one session is required, but for properly selected scars, this method can produce highly gratifying results.

It is not unusual for individuals with postacne scarring to have a number of different types of lesions, which necessitate the combined or sequential use of any of the above therapies. Dermatologic science can take pride not only in the diversities of the currently available treatments, but even more in the reality that no one with acne scarring need any longer throw up his/her hands in despair.

Acne Scar