Acne scarring varies and may be simple discoloration or more permanent, such as depressed or raised scars. Each type of scarring warrants a different treatment. Skilled dermatologists work with patients to treat acne scars as well as the acne itself. More than one type of treatment is often necessary because most patients have multiple types of scarring.
Skin Lighteners
Acne sufferers often have discoloration after the acne clears, such as red or brown spots where the acne used to be. Skin lighteners may be used to treat this. Bleaching creams that contain up to 2 percent hydroquinone are available over-the-counter. Hydroquinone lightens brown or red spots on the skin. Creams containing up to 4 percent hydroquinone are available by prescription. Some prescription acne medications, such as tretinoin, also have skin-lightening effects.
Laser Resurfacing
Skin resurfacing lasers are either ablative or nonablative. Ablative lasers remove the top layer of skin and stimulate collagen production underneath. Up to two weeks of downtime is involved in ablative laser therapy. Improvements in skin texture become apparent as the skin heals and for up to 18 months afterward. Nonablative lasers stimulate collagen production in the underlying skin. Patients can often return to normal activities immediately, but multiple treatment sessions are required before improvements are noticed. Laser resurfacing is most effective on skin discoloration and depressed scars.
Injections
Injections may be used to fill in depressed scars and to shrink raised scars. Fillers for depressed scars consist of collagen or collagen substitutes and are used to plump up depressed scars. Repeated treatments are needed to keep the scars from returning. Corticosteroids are injected into raised scars because they soften and flatten raised scars and keloids. This also reduces the pain associated with raised scars. A series of corticosteroid injections is typically recommended, with one injection given every few weeks. According to the American Academy of Dermatology’s AcneNet, if raised scars don’t respond by the fourth injection, other treatments are typically pursued.
Scar Surgery
Punch excision is used to remove depressed acne scars. A biopsy tool, like a tiny cookie cutter, is used to cut the scar from the skin. The wound is then closed by using a stitch, sewing in a skin graft or by elevating the extracted scar tissue to the level of the surrounding skin and sewing it back into place. The latter is referred to as a punch elevation. Punch procedures are done under local anesthesia and in the doctor’s office. Aftercare includes changing bandages and applying antibiotic ointment. Once the punch excisions heal, laser resurfacing may be performed to further reduce the scarring. Raised scars may also be surgically removed if they don’t respond to injections. Following surgical removal of a raised scar, pressure garments, injections or radiation may be used to prevent the raised scars from returning.
