Understanding Acne Scar Treatments
Suffering from active acne pustules and clogged pores is hard enough, but the scars left behind are usually the most detrimental to our psyche and our confidence. We wanted to make an easy flow chart to help guide your decisions towards how to approach acne scarring treatments and what might be best for you based on what kind of scarring you have.
If you suffer from acne that leaves behind dark marks, then your options typically include topical creams with our without prescription like Adapalene gel (0.1% OTC or 0.3% in prescription form), Tretinoin (0.025-0.1%), Tazarotene (0.05%-0.1%), Dapsone (5%-7.5%), Hydroquinone (1-3% OTC or 4+% in prescription form), cysteamine cream (physician formula), glycolic acid, salicylic acid, and or lactic acid in OTC formulations. Certain cleansers can also have a substantial impact on dark spot resolution, especially those containing alpha-hydroxy acids and/or beta-hydroxy acids. When using cleansers with acids for dark mark correction, be sure to adequately moisturize to avoid dryness, which could ultimately lead to more inflammation and acne. It is a good rule of thumb to start slow and with decreased frequency of use for any new topical on your skin (prescription, or otherwise) to avoid side effects. If unsure about any regimen, talk with your provider about starting a new regimen and the best course of action for you based on your skin type and sensitivity.
In addition to topical treatments, in-office procedures like chemical peels ranging from singular acids like salicylic acid or glycolic acid, or in combination with other acids or chemicals like Jessner’s solutions (combination of salicylic acid, lactic acid, and rescorsinol) with or without retinol, kojic acid, hydrocortisone, hydroquinone, etc. Light therapies can be used as well for dark marks with or without chemical peels, but caution must be advised in those with darker skin types to prevent adverse effects of hyperpigmentation of the skin from the treatments.
A mainstay of treatment for any individual (with or without dark marks) is sunscreen or sunblock so that the pigment of the dark marks appears less pronounced and appears on the skin for a shorter duration. Some sunblocks or screens contain antioxidants as well, like niacinamide, ubiquinone, melanin, and vitamin E.
For deeper acne scars, commonly identified as atrophic scars, they usually start out as darkly pigmented in some way with the indentation, but then the pigment excess fades and the indentation of depression remains. These are inherently some of the most difficult types of acne scars to treat, as they are related to a sort of “pulling-down” phenomenon caused by scar tissue tugging on the top surface of the skin. The fibers tugging the skin inward are below the surface of the skin, therefore making its treatment usually require more aggressive/invasive techniques. The shapes and depths of the acne scars are designated with the names boxcar scars, rolling scars or ice pick scars, but the stigma remains no matter what they're defined as.
In the case of newer and more pigmented atrophic scars, many people can see improvements with chemical peels alone. Whether the peel superficial or medium in depth. Superficial peels contain lower acidity levels and require little to no down time, whereas medium depth peels have more extensive peeling afterwards that may or may not be feasible for someone who doesn’t want coworkers or family to question. Medium depth peels are more likely to impact the deeper scars better, however, than the superficial peels. Any combination of peels with retinol therapy is also typically recommended as a multi-faceted approach to improving skin tone and texture overall. Not to mention, those modalities will have the added benefit of improving any fine lines or wrinkles, as well as improve pore size.
Procedures performed in the office for atrophic scars include microdermabrasion, with or without chemical peels, radiofrequency, radiofrequency with microneedling (i.e. IntraCel), laser therapy (i.e. Fraxel, Nd-Yag, etc.), and dermal fillers. Laser treatments have been around for years to help with acne scarring and skin rejuvenation. They have continually upgraded in their parameters and cooling mechanisms to be optimal for various skin concerns and skin types. Laser treatments are typically one of the priciest treatments for acne scarring, but have been deemed one of the best based on their longevity and their consistency with results. Dermal fillers used for acne scars c an be a challenging injection technique for any provider, even those with years of experience, but depending on the fillers used and the scars intended to be filled, they can have fantastic, and life-changing results. Many dermal fillers are made up of hyaluronic acid, but some are different, like Radiesse (by Merz) which is calcium hydroxyappetite. A majority of the dermal fillers on the market are not appropriate for atrophic acne scars, but thinner hyaluronic acid fillers can be a great option to explore if you’ve had no success with alternative therapies.