Types of Acne Scars

It's crucial to identify the type of acne scar you have before choosing a treatment:

• Atrophic Scars: Shallow, depressed scars. Further classified as boxcar scars (wide with sharp edges), ice pick scars (narrow, deep scars), and rolling scars (wide with sloping edges).

• Hypertrophic Scars: Raised, thick scars.

• Keloid Scars: Raised scars that extend beyond the original acne wound.

• Post-inflammatory hyperpigmentation (PIH): Dark or red spots left after acne, not true scars.

Best Treatment Options

1. Topical Products

• Retinoids: Promote cell turnover and collagen production, improving the appearance of mild atrophic scars and hyperpigmentation. (Reference: Efficacy and tolerability of newer topical retinoids in skin of color. Kong R, Bhushan R, McNairn A, Wu JJ. J Dermatolog Treat. 2021 Dec;32(8):940-948: [https://pubmed.ncbi.nlm.nih.gov/34233130/])

• Silicone-based gels or sheets: Applied directly to scars to improve hydration and may help flatten raised scars over time. (Reference: Use of silicone adhesives in the treatment of hypertrophic scars and keloids. Ogawa R. J Med Invest. 2008 Aug;55(3-4):303-12.: [https://pubmed.ncbi.nlm.nih.gov/18797140/])

• Chemical Peels: Exfoliate the top layers of skin, improving the appearance of shallow scars and hyperpigmentation. (Examples: salicylic acid, glycolic acid, lactic acid) (Reference: Chemical peels for acne and acne scars. Sarkar R, Garg V, Mysore V. J Cutan Aesthet Surg. 2010 Jul;3(2):96-104.: [https://pubmed.ncbi.nlm.nih.gov/21042406/])

2. In-Office Procedures

• Microneedling: Tiny needles create micro-injuries stimulating collagen production, improving the appearance of scars. Effective for most scar types. (Reference: Microneedling therapy in atrophic facial scars: an objective assessment. El-Domyati M, Barakat M, Awad S, Medhat W, El-Fakahany H, Farag H. J Cosmet Dermatol. 2015 Mar;14(1):50-5.: [https://pubmed.ncbi.nlm.nih.gov/25556502/])

• Lasers:
  • Ablative lasers: Remove the top layer of skin, triggering regeneration, suitable for deeper scars.
  • Non-ablative lasers: Heat deeper layers of skin stimulating collagen without harming the surface, suitable for milder scars and hyperpigmentation. (Reference: Lasers and lights for the treatment of active acne and acne scars. Taub AF. Facial Plast Surg. 2005 May;21(2):166-81.: [https://pubmed.ncbi.nlm.nih.gov/16032661/])

• Fillers: Injected into depressed scars to temporarily plump them up, providing immediate improvement. (Reference: Temporary hyaluronic acid fillers for post-acne scars. Wollina U. Skinmed. 2012 Jul-Aug;10(4):230-4.: [https://pubmed.ncbi.nlm.nih.gov/23009571/])

• Subcision: A minor surgical procedure to break up the fibrous bands under scars, improving their appearance. (Reference: Subcision for acne scarring: a systematic review. Al-Dhalimi MA, Arnoos AA. J Cutan Aesthet Surg. 2015 Apr-Jun;8(2):88-99.: [https://pubmed.ncbi.nlm.nih.gov/26124824/])

3. Treatment for Specific Scar Types

• Hypertrophic and Keloid Scars: Steroid injections, cryotherapy (freezing), or laser therapy to help reduce their size and thickness.