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

Caveats and Cautions

Before commencing treatment of acne scars, in-depth discussion with the patient is necessary. It is crucial to communicate the fact that acne scars are seldom completely or almost completely removed, and that several procedures may be required to collectively provide the optimal correction. The patient´s willingness to incur downtime must also be clarified since some procedures, like ablative resurfacing, may require post-treatment resting at home for up to 2 weeks.Patients with active acne should not be treated for acne scarring. Many acne scarring treatments, like resurfacing, excision, and subcision, can exacerbate acne, even stimulating the production of nodulocystic lesions. Those with active acne should be reassured that the physician is not abandoning them, and remains interested in treating their acne scarring. First, however, they must undergo treatment for their acne, which should be quiescent for at least 6 months to 1 year before therapy for the scarring is begun.

Finally, darker-skinned patients with Fitzpatrick skin types IV-VI are at risk for procedure-related hyperpigmentation. Asian, Mediterranean, and African-American patients can have diffuse, widespread hyperpigmentation lasting a year or more after laser resurfacing. Excision procedures can induce a similar problem. In susceptible patients, nonablative resurfacing, fillers, and subcision may be preferred, unless the patient is otherwise a candidate for ablative resurfacing, and also indicates a willingness to endure protracted hyperpigmentation.

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