Acne Scars (For Professionals)

• Scarring in acne as in other skin diseases is the result of an initally active process. Consider two situations:

1. either the pimples are still developing

2. the pimples have stopped developing and only scars are left

1. In this situation, it is important to prevent new pimples from developing as they are developing “bombs” which will later change into the active (red) bumps and the eventual new scars. At this juncture, it is important to talk with your dermatologist to determine if creams (antiobiotic, benzoyle peroxyde, sulfur-resorcinol, antiseptics…) will be enough or if an oral medication would be necessary and if you are suitable to take these medications.

2. Scar treatment  can take place, but it is important to understand that it only treeats already formed scars and that the formation of new ones will not be prevented. Recent therapeutic modalities include light treatment. The light sources utilized include blue light, pulsed-dye laser (PDL), intense pulsed light (IPL) and red light. Recent studies have shown them to be effective (Riddle et al., A review of photodynamic therapy (PDT) for the treatment of acne vulgaris, J Drugs Dermatol. 2009 Nov;8(11):1010-9.)

2. In this situation, scars remain. It is important to determine the type of scars to determine treatment:

-depressed scars (ice pick or box cars):

1. filler injection: effective but temporary
2. fractional CO2 laser: effective but downtime. Effective means a 20-45% improvement. It is often difficult to achieve better results.
3. fractional non-ablative laser (FRAXEL…): less effective but little downtime, expensive as multiple sessions of often temporary
4. chemical peels:

• superficial peels but temporary effect
• medium peels: be aware of the high risk of post inflammatory pigmentation in darker skin (Asian skin…).

5.  IPL (intensed pulse light) is to my mind ineffective

6.  surgical undermining: only in surgically experienced hands.

Elevated and red (+/- painful) (could be hypertrophic or keloidal (check with your dermatologist):

-hypertrophic scars

1. cryotherapy (freezing) (be careful about post-inflammatory hyperpigmentation)
2. pulsed dye laser for color lightening

-keloid scars

1. intralesional steroid injectiion
2. surgical with cryotherapy and intralesional steroid injection +/- cryotherapy
3. difficult to treat

For scars only, no cream appears to be effective.

Treatment has to be done by experienced people: preferably dermatologists or physicians whom one is certain that they have the necessary experience.

This advice is for informational purposes  only and does not replace therapeutic judgement done by a skin doctor.

Contributors

Dr Husain Ali Mahdi Juma  (دكتورحسين علي جمعه) – dermatologist. Manama, Bahrain