Treatment of Acne Scarring

M. Alam, MD, MSCI; J. S. Dover, MD, FRCPC, FRCP

Disclosures

Skin Therapy Letter. 2006;11(9):7-9. 

In This Article

Nonablative Resurfacing

Nonablative resurfacing with laser and lights warms the dermis and can provide modest improvement of acne scarring by stimulating collagen remodeling. All subtypes of acne scars can be improved by nonablative therapy. Among the lasers used for this indication are devices originally developed for otheruses, such as pulsed-dye lasers, intense pulsed light devices, and Q-switched Nd:YAG lasers. However, more recently nonablative devices have been optimized to specifically target textural irregularities. For example, a series of treatments with infrared lasers can significantly improve uneven contour associated with acne scarring.[4] These treatments are typically uncomfortable and may require oral and/or topical analgesics.

Similarly, fractional resurfacing is quite effective in the treatment of acne scarring. Fractional resurfacing is a minimally ablative technique that creates microscopic zones of dermal injury in a grid-like pattern.[5] Because only a small proportion of the skin surface is treated at one time, and since the stratum corneum is not perforated, recovery is quick. However, a series of treatments is needed.

Fillers

During the past 5 years, many new injectable prepackaged soft-tissue augmentation materials have become available in the US. Among these are the so-called linear fillers, which permit fine correction of individual lines and depressions: human collagen, hyaluronic acid derivatives, calcium hydroxylapatite (off-label use), and silicone (off-label use).

Injectable linear fillers can enable short-, medium-, or long-term correction of acne scars. Large-particle fillers such as calcium hydroxylapatite have a longer persistence in vivo and are appropriate for larger areas of rolling scars; thicker fillers must be injected no higher than the dermal subcutaneous junction.Collagen or hyaluronic acid products can be injected directly beneath individual pitted or box-car scars, or be used to buttress areas of rolling scars. Patients should be advised that the duration of action varies, with collagen lasting 2-3 months, hyaluronic acid products, 4-6 months, and calcium hydroxylapatite, 1 year. Volumetric fillers, such as poly-L-lactic acid, may not be appropriate for acne scars, except for rolling scars. By definition, volumetric fillers are designed to correct skin and subcutaneous wasting over wide areas rather than individual fine textural abnormalities.

Injectable silicone is a controversial product gaining new acceptance as a filler for correction of acne scars, especially pitted and box-car scars.6 Now approved by the US FDA for intraocular tamponade, medical-grade silicone is used off-label for permanent correction of acne scars. To avoid delayed hypersensitivity and immune reactivity, very small aliquots of 0.01ml, known as "microdroplets’, are used, and placement is sparse. Repeat treatments with small quantities enable gradual complete correction. The inconvenience of numerous treatments, as well as the theoretical risks of adverse events are mitigated by the promise of permanence.

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