Chemical peels are classified by the depth of skin injury. These can be effective treatments for acne scars as the injury caused by the peel stimulates collagen remodeling. However, the results are more limited and require multiple treatments. Most commonly, the 1550nm or 1540nm NAFR lasers are used to ablate a narrow microscopic column of skin instead of ablating the entire surface. Nonablative fractional laser resurfacing (NAFR)Īs an attractive alternative to traditional ablative laser resurfacing due to less down time (one to three days), this is a highly effective treatment. This procedure is rather invasive and requires multiple weeks of down-time. These lasers target water, causing the precise ablation of the epidermis and dermis leading to thermal injury which promotes collagen remodeling. It is the most effective, but most aggressive procedure that may not be tolerated by all patients. This uses either of a 2940 nm erbium:yttrium aluminum garnet (Er:YAG) laser or 10,600 nm carbon dioxide (CO2) laser. Examples of treatments that can induce collagen growth include traditional ablative laser resurfacing, nonablative fractional laser resurfacing, ablative fractional laser resurfacing, chemical peels, dermabrasion, and skin microneedling with platelet-rich plasms (PRP). Since atrophic scars result from a loss of collagen, this phase of treatment consists of procedures meant to induce collagen growth. Ice pick and narrow boxcar scars respond to the chemical reconstruction of skin scars technique (CROSS technique) where a high-strength (90-100%) trichloroacetic acid (TCA) peel solution is placed at the base of scars with the goal to promote dermal remodeling.Rolling acne scars are typically treated with subcision, a procedure in which a small needle is inserted under an acne scar with the goal of releasing the fibrosis tissue that teethers the scar and causes the depression.įinally, another option to treat difficult ice pick and boxcar scars is to surgically remove them by punch biopsy. To treat individual scars that may be resistant to other treatments, typically a surgical approach is preferred. Typically, it requires three to four treatments spaced out every month. To target erythema, the treatment of choice is the pulse-dye laser. Treating erythema is important as the redness accentuates the scar and makes it more noticeable. The goal of this phase is to treat scar erythema (redness) and treat individual scars that may be resistant to collagen remodeling procedures. The ideal way to treat acne scars is a three-step approach, consisting of (1) an initial treatment phase, (2) a collagen remodeling procedure, and (3) additional treatments to address resistant scars and to supplement results of previous procedures. Hypertrophic scars stay within the margin of the wound whereas keloids extend beyond the wound margin. These are less common and are characterized by collagen gain, resulting in a firm raised lesion. They are typically round or oval shaped dimples that can either be shallow (less than 0.5mm) or deep (more than 0.5mm) These scars are wider at the base compared to ice pick scars and do not taper. They have an undulating appearance with the rise and fall of skin surface due to abnormal collagen attachment. This type of scarring is usually wider (4-5mm) and are more shallow than ice pick scars. They are wider at the top of the skin and taper as they go deeper. These are narrow (less than 2 mm), deep, and sharply demarcated tracts. They can be depressed (atrophic scars) or raised (hypertrophic scars/keloids).”Ītrophic scars are the most common type of acne scars and they are caused by the destruction of collagen, and present as indentations.Ītrophic scars can be classified into three categories: ice pick, rolling, and boxcar scars. “Acne scars are classified based on their appearance on physical exam. Selection of the appropriate treatment depends on type/degree of acne scarring, patient preference, side effects/down-time, cost, and treatment availability. To achieve best cosmetic results, typically, multiple different treatments are needed. Īlthough there are many scar treatments, no single therapy removes acne scars completely. To find out more about Accutane, please check out my previous blog. Accutane (isotretinoin) should be considered for any acne patient that has scarring potential. Early, aggressive, and effective treatment is the best way to minimize and prevent acne scarring. This is a common skin disease that frequently results in scarring, leading to physical disfigurement with a profound psychosocial impact. For this reason, patients who come to us put a lot of faith in our understanding of scars and how to help heal them.Īmong one of the worst culprits in scarring is acne vulgaris. It’s very difficult to heal scars and do so properly and permanently. Scarring is one of the most sensitive issues with skincare.
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