What causes acne scarring?
Not all acne lesions result in scars. Large cystic lesions are most likely to leave a mark. However, even smaller pustule or bumps leave a scar. The first approach to all acne scarring is to prevent and treat the original acne lesions. Only when the acne is “settled down” or greatly decreased in activity, can we address the scars and make reasonable progress.
What is the typical progression of an acne scar?
Most acne scars start as a persistent red mark after the acne lesion has resolved. If allowed to progress, the chronic inflammation in this red area can cause a depression. As acne scarring progresses, often the skin becomes more dull and less reflective. It has a “waxy” appearance. Finally chronic acne scarring can result in the loss of the fatty tissue underneath the skin, giving the patient a “gaunt” or older appearance. Not all acne scarring progresses.
What is the best approach to acne scars?
There is no one best approach to the treatment of acne scars. Most experts agree that it is a multifaceted approach that best handles acne scarring. First of all, not all acne scarring is the same. The classes of scarring include; superficial macular scars, ice pick scars, sloping scars, and “boxcar” scars (chicken pox like). The use of topical therapies and superficial chemical peeling can improve superficial macular scars. Some patients with more advanced scaring choose this form of therapy as it improves the quality and texture of the skin, even though it does not obliterate the deeper component of the scar. Ice pick scarring is the most difficult type to treat and it can be resistant to treatment. Boxcar scars are often best approached by excision, or punch grafting. Finally, dermabrasion or laser resurfacing work best on sloping scars, and give the skin an all over fresher appearance. The gaunt appearance caused by subcutaneous tissue loss may be corrected with fat transfers.
The bottom line is that acne scarring is a complex condition in which no one therapy will correct all the components. For more information on treatment see: topical therapy, superficial chemical peels, subscision, dermabrasion and laser information.