Raised Acne Scars: Treatment Can Ease Pain, Diminish Scars

When acne clears, some people see raised scars on their skin. With time, these scars may become larger and more noticeable. Some raised scars itch. They can even be painful and tender. To ease the discomfort and diminish the appearance of these scars, dermatologists offer patients a number of treatment options.

2 Types of Raised Acne Scars
Before treatment begins, a dermatologist will examine the scar to see type of raised scar you have. Two types of raised scars can form after acne clears:

   

Keloid

 

Keloid on face and neck

Keloids on chest

A keloid is a type of raised scar that grows beyond its border. Keloids often become extremely thick, rubbery, and large, such as the keloid on this man’s face and neck.

Keloids are more common in people of African, Asian, or Latino descent.

Keloids can develop anywhere on the skin, but most form on the earlobe, chest, shoulders, or upper back. The keloids in this photograph developed on the chest of a young man after his acne cleared.

 

Hypertrophic Scar

 

Hypertrophic scar

Keloid (man’s face) - This photograph was published in the Journal of the American Academy of Dermatology, 1998 Aug; 39(2 Pt 3):S98-103. Halder RM. “The role of retinoids in the management of cutaneous conditions in blacks.” Copyright Elsevier (1998).

Keloids (chest) and hypertrophic scar – These photographs are used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

This type of raised scar does not grow beyond its border. With time, many hypertrophic scars become less noticeable.

Treatment Options for Raised Acne Scars
Your dermatologist considers many things before deciding how to treat a raised scar. Considerations include where the scar appears on the body, the size of the scar, and how long the scar has been there. Your dermatologist will use this information to create a treatment plan.

Often a treatment plan will include more than 1 treatment option. Raised scars, especially keloids, often respond better when treated this way. Treatments that dermatologists use to treat raised scars include:

Injections
These injections, which your dermatologist may call “intralesional injections,” help shrink raised scars. Injections of corticosteroids can soften and flatten thick, raised scars. Interferon can help soften a keloid and make it feel smoother.

Dermatologists generally give a series of injections. Usually given every few weeks, the frequency will depend on the type of scar and many other considerations. Some patients receive an injection every 2 or 3 weeks. Others get an injection once every 3 to 6 weeks. If a scar does not respond (or stops responding) by the 4th injection, scar surgery may be recommended.

Acne Scar Surgery
When raised scars do not respond to injections, your dermatologist may recommend surgery to remove the scar. This surgery can be performed in a dermatologist’s office, and you can go home afterward.

When treating a keloid, dermatologists do not recommend surgery alone. Most keloids have a high risk (between 45% and 100%) of returning when surgery is the only treatment. To prevent a keloid from returning, dermatologists use other treatments before and after surgery. Many people receive injections of corticosteroids before surgery.

The following often are used after surgery:

  • Surgery, followed by pressure - Applying pressure by wearing a pressure garment or pressure device can help prevent a keloid from returning.

  • Surgery, followed by injections – After surgery, dermatologists often treat raised scars with injections of corticosteroids or interferon. Combining surgery with these shots remains one of the most effective treatments for raised scars, especially keloids. Most patients receive corticosteroid injections once a month for a few months.

  • Surgery, followed by radiation – Studies are showing that radiation can prevent raised scars from returning after surgery.

Lasers and Other Light Therapies
More dermatologists are using lasers to treat raised scars. The pulsed dye laser (PDL) can be effective for treating some keloids and hypertrophic scars. Treatment with a PDL can help reduce the itch and pain, diminish the color, and flatten a raised scar. For people with lighter skin, intense pulsed light (IPL) also may be a treatment option.

To help prevent keloids from returning after laser treatment, injections of corticosteroids or pressure therapy may be used.

Cryotherapy
This treatment freezes the scar tissue. Freezing the tissue causes it to die and gradually fall off. To improve the results, dermatologists may schedule a series of cryotherapy sessions and corticosteroid injections. This combination often produces the best results. It can effectively diminish hypertrophic scars and flatten some keloids.

Cryotherapy, however, can leave the treated skin looking lighter than the surrounding skin. This limits its use in people with skin of color.

Gels, Creams, and Tapes
Many of these are available without a prescription and can be used at home to treat raised scars. Products containing silicone may help reduce the itch and discomfort of both hypertrophic scars and keloids. One study found that some (34%) keloids actually flattened a bit when patients applied a silicone gel continuously for 6 months.

Your dermatologist may prescribe a medication that can be applied to a raised scar. Applying tretinoin (a prescription medication used to treat acne) twice a day to keloids may help stop the itch and pain. This medication also may help reduce the size of the keloid. Sometimes your dermatologist will prescribe a strong corticosteroid that you can apply to the scar. Applying both tretinoin and a strong corticosteroid to a keloid seems to improve the results.

To be effective, gels, creams, and tapes must be used continuously. This can be difficult, especially for scars on the face. Many people are willing to do this because these treatments have little risk of side effects. Even so, with continuous use, some people develop itchy, irritated skin.

None of these gels, creams, or tapes is likely to eliminate a raised scar, but these can help reduce the discomfort and the size.

What Studies Show About Other Treatments
Raised scars can be especially difficult to treat, so researchers continue to look for better treatments. They are hopeful that they will discover a safe, more effective treatment. Some treatments that have recently been studied for treating raised scars are:

  • 5-Fluorouracil (5-FU) – Injections of this medication have been effective for treating hypertrophic scars and sometimes keloids. Combining 5-FU with injections of corticosteroids may be more effective than either 5-FU or corticosteroids alone.

  • Imiquimod - One study found that fewer keloids returned when patients applied imiquimod 5% (a cream approved to treat genital warts and some skin cancers) after the keloid was removed with surgery. Another study did not find this to be true.

  • Radiation therapy (alone) - Dermatologists are finding that radiation therapy alone can effectively treat some keloids. It seems most effective for keloids that have been on the skin fewer than 5 months.

Trust Your Dermatologist
Raised scars can be a challenge to treat. With many treatment options now available, your dermatologist can tailor a treatment plan to help diminish raised scars and provide you with tips to reduce your risk of developing new raised scars.

References:
Halder RM. “The role of retinoids in the management of cutaneous conditions in blacks.” Journal of the American Academy of Dermatology August 1998; 39: S98-103.

Halder RM, Nootheti PK. “Ethnic skin disorders overview.” Journal of the American Academy of Dermatology June 2003; 48: S143-8. 

Kelly AP. “Keloids.” In: Kelly AP, Taylor SC editors. Dermatology for Skin of Color. China, McGraw Hill Medical; 2009. p. 178–194.

Wolfram D, Tzankov A, Pulzl P et al. “Hypertrophic scars and keloids--a review of their pathophysiology, risk factors, and therapeutic management.” Dermatologic Surgery February 2009; 35: 171-81.

Zurada JM, Kriegel D, Davis IC. “Topical treatments for hypertrophic scars.” Journal of the American Academy of Dermatology December 2006; 55: 1024-31.


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Keloids are much easier to treat when they first appear. Keloids that have been around for years can be difficult to treat and require many appointments with your dermatologist.

 
 
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Page last updated  9/17/09

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