Acne can be mild, moderate and severe. It has a huge impact on self esteem and can lead to lifelong scarring. Early intervention for acne is essential to help prevent permanent scarring. Dermatologists are experts in the management of acne and will tailor your treatment to your individual needs. Acne is a complex disease and treatments that offer long term cure are better than some techniques that improve your acne for a short period only.

Acne Scarring and Treatment

The residual effects of acne can leave a variety of different types of scars. Up to 40% of suffers with moderate to severe acne will have some form of scarring.

Skin Colour Changes

Skin colour changes are extremely common. In patients with white skin this is usually characterized by flat pink/ red change once that is left behind once the “bumpiness” has resolved. We call this macular erythema or postinflammatory erythema. People with darker skin often get darker brown marks once the acne has resolved, this is commonly known as post-inflammatory hypopigmentation. White marks can also occur once acne has resolved. Unfortunately, these post inflammatory changes do not improve with oral antibiotics or topical anti-acne therapy.

Much of this will improve with time (6-18 months) naturally. Sun protection is important and some topical bleaching creams (eg Kojic and azelaic acid) can help with dark spots. Red spots may respond to laser (flash pump dye laser). Scars develop over time and there is some evidence that early treatment of post inflammatory redness (macular erythema) may reduce the development of scarring in the future.

Scars

There are a wide variety of scar types that develop following acne. The type of scar influences the way they are managed and often multiple treatment modalities are required. Deep pitted scars are called ice-pick scar. Flat thin scars are called atrophic scars and thicker, lumpy tender scars are keloid or hypertrophic scars. Most individuals have a combination of scar types and hence a range of approaches is required.

Techniques

Techniques used to manage scars need to be indiviualised. Laser resurfacing using Fraxel is usually required. To manage certain elements of your scarring, this may need to be combined with other techniques that may include punch grafting, filler injection for acne scars, subcision, photodynamic therapy or injection of corticosteroids.

• Punch grafting: this involves removing the scar with a special instrument and then replacing it with normal skin. This procedure is then followed up with laser resurfacing.
• Subcision®: which involves dividing the scar tissue beneath the scar and returning it to its original position.
• Fillers injection for acne scars: Flat atrophic scars respond well to fractionated laser, but deeper ones may require injection of fillers.
• Thick keloid like scars. Keloid or hypertrophic scars require the injection of steroid into the scar. Multiple injections separated by 4 to 6 weeks may be required. Fraxel laser following steroid injection will continue to improve the scars.