Acne Scars

Acne scars comes in different variety forms and each should be treated with different methods. Types of acne scars are:

Macular scars. This type of acne scar is characterised by flat areas of increased and decreased pigmentation as a result of acne. Although there are not any indentations in the skin or raised scars, this is considered as a scar by many patients who has this problem.
Box scars. These acne scars are superficial punched out scars that have sharp vertical edges on cross section, and can be round or oval shaped when seen from above.
Rolling scars. These acne scars appear as undulations in the skin and are usually caused by tethering of the skin to the underlying structures.
Ice-pick scars. Deep but small holes in the skin, similar to the indentation left by an ice-pick.
Hypertrophic scars. Where there is a raised and often pigmented scar as a result of acne.
Keloid scars. Where the size of the scar is significantly raised, red/purple and disproportionate to the size of the initial trauma caused by the acne.
Deep divot scars. These are simply very deep scars that involve loss of subcutaneous tissue volume and result in a large divot (Ogawa, 2020).

Acne scarring results from deeper dermal layers of the skin's injury. These marks most often occur as a result of extreme inflammation, such as rupture of the pilosebaceous unit or oil glands. Such inflammation disrupts the regularly ordered structure of the collagen resulting in acne scarring (Deflorin et al., 2020).

Can acne scars be treated?

Acne scars can be substantially reduced by a variety of techniques including chemical peels, skin needling, and fractional laser resurfacing (Chilicka et al., 2020). To repair the scarring, the old collagen has to be remodelled while rebuild the new collagen to restoring the even structure of the skin. This forms the basis of scar revision, which basically to break down the fibrotic tissue and stimulates new collagen and elastin fibers (Al Qarqaz & Al-Yousef, 2018; Villani et al., 2020) .

The first thing to understand is that acne scars are hidden deep in the skin. Superficial procedures such as microdermabrasion can not achieve the depths required to treat acne scarring. In order to effectively cure acne scars, the target is the dermis to rebuild the collagen. This can be achieve with superficial to medium deep chemical peels (Sun & Lim, 2020) such as high percentage of Glycolic acid > 50%, TCA and TCA CROSS methods and other treatment is skin needling (Juhasz & Cohen, 2020). TCA encourages collagen formation, lifting deep scars. Ice pick scars in particular can be challenging to treat. AHA peels such as Glycolic acid can be benefits in cases of mild acne scarring .

At Skinderm Aesthetics, we recommended series treatments whether it's a standalone service or best to combine treatments for acne scars such as:

It takes about 6 - 8 weeks for normal skin cells to regenerate, however, for collagen it takes about 12 - 16 weeks for the new collagen rebuild. Therefore, patience and commitment are the most important keys in treating acne scars.

REFERENCES

Al Qarqaz, F. & Al-Yousef, A. (2018). Skin microneedling for acne scars associated with pigmentation in patients with dark skin. Journal of cosmetic dermatology, 17(3), 390-395. doi:https://doi.org/10.1111/jocd.12520

Chilicka, K., Rusztowicz, M., Szyguła, R., & Nowicka, D. (2022). Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. Journal of clinical medicine, 11(10), 2744. doi:https://doi.org/10.3390/jcm11102744

Deflorin, C., Hohenauer, E., Stoop, R., van Daele, U., Clijsen, R., & Taeymans, J. (2020). Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis. Journal of alternative and complimentary medicine, 26(10), 854-865. doi:10.1089/acm.2020.0109

Juhasz, M., & Cohen, J. L. (2020). Microneedling for the Treatment of Scars: An Update for Clinicians. Clinical, cosmetic and investigational dermatology, 13, 997-1003. doi:https://doi.org/10.2147/CCID.S267192

Ogawa, R. (2020). Total Scar Management From Lasers To Surgery For Scars, Keloids, and Scar Contractures. doi:https://link.springer.com/book/10.1007/978-981-32-9791-3

Sun, C., & Lim, D. (2022). Chemical peels for atrophic scarring: evolution of peel types and methods. Australiasian Journal of Dermatology, 64(1), 18-27. doi:https://doi.org/10.1111/ajd.13959

Villani, A., Carmela Annunziata, M., Antonietta Luciano, M., & Fabbrocini, G. (2020). Skin needling for the treatment of acne scarring: A comprehensive review. Journal of cosmetic dermatology, 19(9), 2174-2181. doi:https://doi.org/10.1111/jocd.13577