Acne Scarring

Acne scarring is a result of injury to the dermal layers, as a consequence of inflam­ matory lesions. Acne scarring can cover a spectrum ranging from nearly invisible to severely disfiguring. The depth of the scar is usually contingent on the severity of the acne lesion. Likewise, the method by which the appearance of scarring can be mini­ mized or resolved is dependent on the type of scar. Typical examples of common acne scars are:

• Superficial and deep soft scars
• Icepick scars
• Hypertrophic scars

Superficial and deep soft scars. Superfi­ cial and deep soft scars are of varying depth and generally have gently sloping rolled edges. (Fig. 1) These scars are small and are either circular or linear in shape. One of the characteristics that differentiate these scars from other similar scar formations is that the tissue is soft and pliable. When the skin surrounding the area is pinched the scar is elevated and less noticeable. These scars can also be easily stretched and are not fibrotic (hard).

(fig.1)

Icepick Scars. Icepick scars may be superficial or deep and most commonly oc­ cur on the cheeks. The surface is usually fairly small with a somewhat jagged edge,

sharp margins and steep sides. (Fig. 2) The name "icepick" comes from the shape of the scar which may widen as it goes deeper.

(fig.2)

Hypertrophic Scars. These scars are also called fibrotic nodules. The lesions may be large, often wide and elevated above the surface. (Fig. 3) At first they are very red, later changing to porcelain yellowish-white. Hypertrophic scars are hard and lumpy and the surface is shiny without follicular open­ ing. With time, the lesions will flatten, but the process may take years.

(fig.3)

TREATMENT OF ACNE SCARS

A number of medical and non medical treat­ ments are available to treat acne scars. The objective of any therapy or surgery is to give the patient a more acceptable physical appearance regarding the surface of the skin. Although a total correction of scarred tissue deformities cannot always be achieved, the primary goal is to improve the patient's self-image.

Collagen Injections. Soft scars usually respond well to collagen injections. Typi­ cally a minimum of three injections is administered at monthly intervals. The collagen not only fills in the scarred area by elevating the base of the scar, it also stimulates production of the patient's col­ lagen. Over a period of approximately 16 weeks, the injected Bovine collagen (from cows) is replaced by human collagen.

Dermabrasion. Dermabrasion of scars involves the use of a high-speed wire brush or diamond fraise that is designed to alter the contour of scars by planing the differ­ ent levels in order to more closely match the unscarred areas. In general, deep pitted lesions, or icepick scars, do not respond well to dermabrasion. In fact, dermabrasion may make icepick scars more noticeable because the scar is often wider at the bottom than at the top area being dermabraded.

Dermabrasion that goes too deep (to the deep reticular dermis) may produce more scar­ ring. rather than overtreat, after a suitable healing period, additional dermabrasions can produce further improvement.

Punch Elevation. In this procedure, a depressed scar may be improved by elevat­ ing the base of the scar to a level that is flush with the surrounding skin. Sometimes stitches are necessary in order to secure the skin in its newly elevated position.

Punch Excision. Punch excision is often ideal for icepick scars. This procedure in­ volves removing the base of the scar using a punch excision and then replacing the plug with skin from another area of the body where the skin is normal. By filling in the excised area, the scar becomes close

to the level of the surrounding skin and can then be dermabraded if desired.

Lasers. recently, excellent results have been achieved using lasers, in particular the carbon dioxide (CO 2 ) laser. These lasers precisely plane scar edges, layer by layer, without the risk of going too deeply into the dermis. Healing is similar to what oc­ curs with dermabrasion.

Chemical Peels. Some types of scarring may be improved with chemical peeling agents such as phenol or TCA. However, icepick scars do not respond favorably to chemical peels and deeper peels may even make the scar appear larger as the wider deeper scar layers are exposed. Soft depressed scars may show improvement.

Glycolic Acid. Medical studies demon­ strate that higher strengths of glycolic acid, (peels) along with consistent use of glycolic acid home care products, can make a dra­ matic improvement on the appearance of skin scarred from acne. research shows that the depth of shallow depressed scars can be reduced significantly with repeated glycolic acid use. Areas that are hyperpig­ mented as a result of acne, as well as enlarged follicles, also greatly benefit from glycolic acid. Unlike procedures that resolve only the scar itself, glycolic acid provides overall skin resurfacing and retexturization, encouraging a more reflective, even toned surface. Additionally, glycolic acid can address scarring while at the same time it can act as a potent tool for resolving the acne process and preventing new lesions.

New research demonstrates that specially balanced combinations of glycolic acid, sali­ cylic and azelaic acid may provide even greater skin resurfacing benefits.