Acne Scar Treatment

Acne scar treatment may be considered by people with acne.

Although most individuals recover from acne without permanent effects, some retain disfiguring acne scars. Scarring may result if the condition is not managed properly. Picking or squeezing or scratching the spot forces infected material deeper into the skin, causing additional inflammation and the increased possibility of scarring. These scars may be visible for a lifetime.

After a spot has healed, it can leave a red or hyper-pigmented mark on the skin. This is a post-inflammatory change. Healing takes place gradually over a few months. If no more spots develop in that area, the skin may be completely healed. Any reddening still present after a few months is considered to be a scar.

Types of acne scar:
Dermatologists have developed an acne scarring classification system that helps in the diagnosis and treatment of acne scars.
Scars may be classified as ice pick, boxcar, or rolling.

• Ice pick scars
  As the name suggests, ice pick acne scars are thin, sharp scars. The skin looks as if it has been sliced with an ice pick. The scars are narrow, but deep – extending into the deep layers of the skin or the subcutaneous layer, just under the skin’s surface.
  
• Boxcar scars
  Unlike ice pick scars, boxcar scars do not taper to a point. Instead, they are round pits that have sharp vertical edges. Skin resurfacing techniques such as dermabrasion or laser resurfacing may be used to treat shallow boxcar scars. Deeper scars require full-thickness treatment techniques.
  
• Rolling Scars
  Rolling scars appear to have a rolling or undulating texture. They are the result of folds in the skin to the subcutaneous tissue below. Rolling scars must be treated by breaking up the fibrous bands that are causing the skin to fold or roll. Subcutaneous incision is the method most commonly used to treat this condition.

• Chemical Peels (for mild scars):
  High potency acid is applied to the skin in order to remove the top layer of the skin. This reveals the smoother layer underneath. A chemical peel takes about 15 minutes to administer, and several treatments are necessary. Side effects include redness or swelling and possible flaking or dryness as the top layer of skin is removed. Recovery varies from a day to several weeks.
  
• Dermabrasion (for shallow scars)
  This procedure uses a power-driven hand held tool to remove damaged skin by abrasion, allowing new skin to grow in its place. Before this process takes place, the skin is usually anaesthetised. As a result of this treatment, the skin may look sore for several days and then a scab will form. Swelling often occurs. Some people who have this treatment choose to take a holiday from their usual routine to allow the scabbing to clear up and the reddening to be reduced. This method is less effective with scars that are sunken. Microdermabrasion is a more gentle and less invasive technology for exfoliating the skin.
  
• Laser Resurfacing (for shallow scars)
  This works by burning off the top layers of the skin. The area that has been affected then heals, with the scarred skin being replaced by new skin. The treatment may take only a few minutes and several treatments are usually required. Afterwards, the skin may become swollen and reddened. This may last for a few weeks. Collagen is stimulated for up to six months and this new lifts and supports the skin's surface. This improves the appearance of acne scars. Depending on the depth of the scars, some people may need one  to three treatments for acne scar removal.
  
• Punch Techniques: (for deep ice pick scars):
  Three different punch techniques exist:
  
• Punch Excision – This uses a punch biopsy tool. Under local anaesthetic, the scar is cut out with the punch tool.  Then the wound is closed and allowed to heal.
  
• Punch Elevation – This also uses a punch biopsy tool. It cuts the base of the scar leaving the walls untouched. The base is then brought up to the level of the skin that surrounds it.
  
• Punch Replacement – Again, the punch biopsy tool is used, but the area is filled with a skin graft instead of suturing the edges of the skin together. The skin graft is usually taken from behind the ear. This method is considered to be highly successful for treating deep scars. This treatment may take several weeks to heal.
  

• Augmentation: (for deep scars and atrophic scars)
  Material is injected under the scar to bring it to the same level as the surrounding skin. Filler substances (collagen, restylane, cosmoderm and cymetra) may be used.  The results are temporary and they may last between three to six months. Very little time is needed to recover and most people can return to their routine immediately.
  

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