Atrophic Acne Scarring: A Review of Treatment Options

Abstract

• Background: Scarring from acne causes psychological distress.
• Objectives: Review treatment options for atrophic acne scarring.
• Methods: Literature review on dermabrasion, subcision, punch techniques, chemical peels, tissue augmentation, and lasers.
• Results: Various treatments show efficacy; combining modalities may yield superior results.
• Conclusion: Safety and efficacy are established, but more comparative studies are needed.

Introduction

• Acne vulgaris is common, affecting adolescents and adults.
• Scarring from acne is prevalent, with a significant psychological impact.
• Atrophic scars are classified into boxcar, icepick, or rolling types.
• Various therapeutic interventions are available, tailored to scar type.

Treatment Modalities

Dermabrasion

• Used since the 1950s, involves mechanical abrasion to the dermis.
• Microdermabrasion is a less invasive variant.
• Operator-dependent, long healing, and potential for adverse effects.
• Largely replaced by resurfacing lasers.

Subcision

• Introduced in 1995 for rolling scars.
• Involves needle undermining to create a favorable environment for collagen deposition.
• Shows 50-60% improvement in studies.
• Effective alone but improved with combination treatments.

Skin Needling

• Also known as collagen induction therapy.
• Uses a rolling barrel of needles to puncture the skin and induce collagen.
• Studies show up to 25% improvement in scar depth.

Punch Techniques

• Suitable for deep icepick scars.
• Includes punch excision, elevation, and grafting.
• Often combined with other treatments like laser resurfacing for better results.

Chemical Peels and CROSS Technique

• Superficial and medium-depth peels have modest results; deeper peels have significant side effects.
• CROSS technique uses high concentration TCA for focal treatment with improved results.

Tissue Augmentation

• Aims to replace volume and stimulate collagen.
• Hyaluronic acid (HA), calcium hydroxyapatite, PLLA, and autologous fat transfer are options.
• Artefill offers a more permanent solution but is not first choice due to risk.

Fat Transfer (FT)

• Provides an autologous, natural filler option.
• FT often combined with subcision for better results.
• Short-lived effectiveness and operator-dependent.

Autologous Fibroblast Transfer (AFT)

• New technique using cultured fibroblasts for possibly permanent results.
• Limited side effects observed in trials.

Laser Resurfacing

• Emerging as a leading treatment option.
• Includes CO2 and Er:YAG lasers, with fractional photothermolysis offering fewer side effects.
• Non-ablative lasers show modest efficacy but less downtime.
• Combination treatments may improve efficacy.

Isotretinoin and Acne Scar Treatment

• Historical concerns about scarring with isotretinoin are being challenged.
• Recent studies support safe scar treatment during isotretinoin therapy.
• Decisions should be individualized, with caution advised.

Conclusion

• Multiple treatment options exist, often requiring a combination for optimal results.
• Physician skill and treatment knowledge are crucial for patient satisfaction.
• Realistic expectations must be communicated, as no treatment achieves 100% improvement.

References

• References to studies and trials providing evidence and further reading.

Disclosure: Dr. Hession has no conflicts; Dr. Graber is a consultant for Medicis.