Types of Acne Scars and Acne Scar Treatments
Acne scars can develop after inflammatory acne. They are a result of a loss of collagen in an area that had acne as a result of a strong inflammatory reaction. Acne scars are more likely to develop on those who pick and pop their active acne lesions.
The type of acne scar you have may dictate which treatment is best for removal. The most common types are:
- Atrophic scars – shallow pitted scars with smooth borders. Ice pick scars are a specific type of atrophic scar; ice pick scars are deep, pitted scars with very sharp borders.
- Hypertrophic scars – raised scars that are palpable above the skin’s surface. This type is less common on the face than atrophic scars, we often see them on the back and chest.
Scar development can be influenced by many things, one of them being genetic. We find that some people are just prone to acne scarring and develop a pitted acne scar from even mild acne. We often see this running in families. For this reason, it is important to begin an acne-fighting regimen as soon as acne presents, in order to avoid future potentially scar-causing breakouts. Not all patients get scarring and sometimes it is hard to predict which patient will be left with residual scars from acne. This is why it’s important for even mild acne to be treated promptly by a dermatologist. Starting an acne regimen early can eliminate the acne lesions before they lead to scarring. It is also helpful to avoid picking at acne and popping acne at home, as this type of manipulation may increase the likelihood of scarring.
Removing Red Marks from Acne
Post-inflammatory erythema, or the red marks left behind after acne, can be treated with the KTP laser or V-Beam laser. Two or three treatments with the KTP laser are usually sufficient for greatly reducing the post-inflammatory erythema.
Post-inflammatory hyperpigmentation (PIH) results from an increase of skin pigment production after some injury or stress on the skin. Post-inflammatory hyperpigmentation often forms after an inflammatory reaction in the skin, like acne. In layman’s terms, PIH is when the skin becomes discolored or darkened in an area that was recently inflamed-like a painful acne cyst.
Inflammatory acne lesions can cause post-inflammatory hyperpigmentation, particularly in skin of color. We tell our patients that it is like the ashes after a fire. The fire was the breakout (inflammatory acne) and the ashes are remnants of the fire (PIH) that indicate where the pimples used to be. These ashes can sometime stick around for many months without treatment.
Post-inflammatory hyperpigmentation (PIH) can improve with time, but without treatment it may linger for 6-12 months or longer. Topical prescription medications, such as hydroquinone, azeleic acid and tazarotene can be used to improve the appearance of PIH. Chemical peels and laser treatments, such as the Fractional Erbium Glass laser (Fraxel® laser), are very effective in treating PIH.
Acne Scars Over Time
Atrophic acne scars, which have the appearance of a sunken recess, or a pit, in the skin, usually do not improve over time without treatment. However, lasers such as the fractional CO2 laser and the Erbium Glass fractionated laser (Fraxel® laser) can stimulate the production of collagen to smooth out the pitted areas.
Effectiveness of Creams for Acne Scars
Pitted acne scars do not improve much with use of topical creams only. Retinoids can stimulate collagen production, but rarely to a degree that is able to repair the pitted areas of acne scarring. Residual dark marks (called post-inflammatory hyperpigmentation) left behind after acne can sometimes be treated with creams such as hydroquinone, retinoids or azeleic acid. If the dark spots don’t resolve after use of these creams, the Fraxel® laser or chemical peels can improve the remaining dark spots.
Acutane® for Treating Acne Scars
Patients taking Accutane® experience impaired skin healing and light sensitivity, these qualities continue for months after Accutane® is discontinued. Depending on your skin type, dose of Accutane®, and the treatment modality chosen for treatment of acne scarring, your dermatologist will recommend an appropriate timeline for beginning treatment of acne scars. Standard guidelines are to wait six months after completion of Accutane® to initiate acne scar laser therapy.
When to Start Treating Acne Scars
Acne scars may be treated once the acne is mostly improved, though acne does not need to be completely clear prior to treatment. For some patients, if they were to wait until their acne was 100% clear, they would never be able to address acne scars.
You don’t have to live with acne scars. Contact us today to schedule a consult with one of our board-certified dermatology providers and get on the road to a scar-free complexion. Call 844-DERM-DOC or email us at firstname.lastname@example.org.