Acne scarring is a common complaint, and I am frequently asked by patients if there are treatments that can improve the appearance of their acne scars. There are several different types of acne scars. Rather than rehash this topic, I’m going to refer you to a great article available on this topic at the science of acne website. For our purposes, we can divide acne scars into two types:
- Depressed. These include boxcar, rolling, and icepick acne scars (see below).
- Pigmented or red scars
The first step to treating any acne scarring is to make sure your acne is under control. It doesn’t make sense to spend time and money treating scars if you are still forming new scars. Check out my previous posts on treating acne for more information.
Let’s talk about pigmented or red scars first. This darkening of the skin isn’t a true scar, but rather happens when inflammation due to a wound, pimple, or rash causes your skin to make more melanin than normal. Melanin is the pigment which gives skin its color, so PIH results in uneven pigmentation of the skin. Depending on your skin tone, PIH may appear dark brown, red, or even purple in color. The good news is that this will fade with time. But it could take up to two years to do so. Topical treatments such as hydroquinone can help. Chemical peels or laser treatments can also speed the process along.
And that brings us to depressed scars. Some depressed scars, such as icepick scars (so named because they resemble the wound made by stabbing the skin with an icepick) are best treated by removing the scar surgically. This is done with a biopsy punch, which is a sharp tool used to cut out a small circle of skin. A suture is used to close the resulting wound, and the scar left when the wound heals is usually less noticeable than the acne scar that was removed.
Larger depressed scars such as rolling or boxcar scars are better treated with chemical or laser peels. Chemical peels or full-surface laser peels such as the micro laser peel, work well on shallow acne scars. Deeper scars are better treated by fractional laser peels (Profractional, Pixel, Fraxel etc.) These fractional peels damage the skin all the way down into the dermis, stimulating collagen synthesis that helps smooth the scars. Fractional laser treatments do work, but as many as 8-10 treatments spaced 6 weeks apart may be required before you see a significant difference. Unfortunately this may be cost-prohibitive if you need to treat a large surface area.
Have you had any treatments for acne scars? What was the result?