Acne Scars: Types and Treatment
skin can sometimes have less to do with aging than with a defect
that makes the skin look prematurely old. One such skin problem—and
a fairly common one—is acne scars.
Acne is one of most common skin
conditions in the world, afflicting 40 to 50 million Americans.
Nearly 80 percent of people aged 11 to 30 years have acne, most
often on the face, chest and back. However, acne is not restricted
to any age group; adults in their 20s, 30s and even into their 40s
can get acne. Most cases of acne responds to treatment and clears up
without leaving scars. Healed acne does leave scars in some people,
however, and it is not easy to predict who will have scars after
acne and who will not. Severe, inflamed, cystic acne always leaves
scars after healing, but in some people even superficially inflamed
acne can result in scarring.
Whether acne scarring is deep or
superficial, extensive or scattered, the esthetic result can be less
than desirable and even disturbing. Acne scars can give the skin an
"old" look. Scars may also contribute to an appearance of age as the
skin loses its elasticity over the years.
A number of treatments are available to
remove or improve acne scars. The type and depth of scars influences
the choice of treatment to a large degree. Here are some basic facts
about acne scars:
Types of Acne Scars
Acne scars result from two types of tissue response to the
inflammation of acne: (1) increased tissue formation, and (2) loss
Increased Tissue Formation
Scars caused by increased tissue formation are caused by a build
up of collagen in the skin. These are called
hypertrophic and keloid scars. Keloid resulting from acne
is shown in this photo:
Keloid-type acne scars on the back of a
young man’s neck.
(Photos used in this discussion are
with permission of the American Academy of Dermatology National
Library of Dermatologic Teaching Slides)
Keloids tend to "run in the
family"—that is, there is a genetic predisposition to form keloids
after tissue injury. African-Americans often have a predisposition
to keloid formation. Some families also tend to form hypertrophic or
Scars Resulting from Loss of Tissue
Acne scars resulting from loss of tissue are more common than
scars resulting from increased tissue formation. There are several
Ice-pick scars get their
name from their appearance. They may be superficial or deep, are
usually small in diameter and have steep sides like an ice-pick
wound. They may be hard or soft to the touch; the soft scars are
usually more superficial and the hard scars deeper. The base of hard
scars under the skin may be wider than the scar at the surface of
Depressed fibrotic scars are
usually large scars that have sharp margins and steep sides. They
are similar in appearance to deep chicken pox scars.
Superficial and deep soft scars
are variable in size, and have sloping edges that merge with normal
Atrophic macules are soft, flat
scars that often have a bluish or violet color on white skin due to
underlying blood vessels. Macules tend to fade over time and become
Treatment of Acne Scars
A person may seek treatment for acne scars (1) as a procedure to
remove or improve the scars, or (2) in conjunction with an overall
program of skin rejuvenation.
It is essential for the patient to
discuss the desired outcome of the procedure with the dermatologist
or dermatologic surgeon. Selection of a skin rejuvenation procedure
may be guided, in part, by the result the patient wishes to have
Laser or resurfacing of scars
Intralesional steroid injection
Excisional surgery in selected cases
can improve small, depressed scars and some larger scars. Peeling
may also be effective in treating any remaining acne by removing
comedones (blackheads and whiteheads). Ice-pick scars and deep
fibrotic scars are not treated effectively by chemical peels.
Keloids are usually not treated by chemical peels. Repeated and/or
deep peels may be necessary to improve deep or extensive scarring.
was originally developed as a procedure to treat acne scars, and is
still a procedure commonly used for that purpose. It can reach
deeper layers of skin than a chemical peel and is a possible choice
for treating both deeper and hypertrophic scars. In the past,
dermabrasion was not considered effective in treating ice-pick scars
because removal of the top layer of skin sometimes opened up a
wider, fibrotic scar in deeper layers. Today a combination of
dermabrasion and "punch" excision of scar tissue make many ice-pick
scars treatable by dermabrasion.
Laser treatment of acne scars is
a newer technology but one that can be very effective in selected
patients. The various energy and tissue-penetrating power of
different lasers may be used to treat complex scars. For example,
the deep tissue penetration of a YAG laser may be used to "sculpt"
irregular scarring and the infrared beam of the carbon dioxide laser
may be used to tighten collagen fibers in the skin and elevate
can correct some atrophic (loss of tissue)
scars. Injections of subcutaneous fat or collagen under the scars
elevates them to bring the surface of the scars even with the
surface of surrounding skin. The procedure may have to be repeated
from time to time.
Injection of steroids
directly into keloid scars can sometimes result in scar improvement.
An intralesional injection can be combined with surgery to reduce
the size of scars in carefully selected patients. Keloid surgery
should be performed only by a dermatologic surgeon.
Acne scars are an unwanted reminder of
a condition that can cause embarrassment and social isolation. Scars
can also contribute to an appearance of premature aging. The good
news is that acne scars can usually be treated by a dermatologist or
dermatologic surgeon, and do not have to be endured.
• Cunliffe W. The Acnes. (Chapter reprints from previous
AcneNet Advisory Committee).
• AAD Press Releases.
• Roenigk HH, Jr. Treatment of the aging face. In: Roenigk RK,
Roenigk HH, Jr. (Eds). Dermatologic
Surgery. Principles and Practice. New York: Marcel Dekker,
Inc.; 1996: 1057-1160.
• Jordan RE, Cummins CL, Burls AJ, Seukeran DC. Laser
resurfacing of acne scars (Cochrane
review). Cochrane Database System Rev 2001; 1:CD001866.
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