Acne scarring is a common complication with social and psychological implications for the patient. Therefore, we need to treat acne in a timely manner and prevent its occurrence as much as possible. However, some patients will develop this complication even with early intervention, either because of the degree of inflammation, the time it takes for the outbreak to resolve or the manipulation of the acne lesions.
The healing process is divided into three stages
- Inflammatory phase. There is constriction of the blood vessels to produce haemostasis and subsequent vasodilation with subsequent erythema. This process can stimulate melanin and cause hyperpigmentation.
- Proliferative phase. Regeneration of damaged tissue and release of growth factors that stimulate fibroblast proliferation and collagen production to heal the tissue.
- Remodeling phase of the extracellular matrix. An imbalance can result in atrophic scars due to a lack of collagen production or hypertrophic scars due to an overproduction of fibrous tissue.
The most common acne scars are atrophic scars, which are caused by collagen loss and are most often found on the face. They may also be accompanied by other skin changes such as redness, hyperpigmentation or irregular texture. They are classified according to their width, depth and shape:
- Iceberg or ice pick scars: These are deep, pointed scars and are the most difficult to treat. They have a ‘V’ shape with a narrow exit, less than 2 mm, and an epithelial tract that extends into the deep dermis or subcutaneous cellular tissue.
- Wavy or rolling: they have a wide base, between 4 and 5 mm, and are formed by changes in the anchoring fibres between the dermis and the hypodermis, giving them a wavy appearance in the shape of an ‘M’.
- Boxcar: They are characterised by well-defined vertical edges with a wider base, giving them an oval or ‘U’ shape. They are divided into shallow (<0.5 mm) and deep (>0.5 mm) and have a base between 1.5 and 4 mm.
Treatment of acne scars aims to improve the appearance of the skin, taking into account the characteristics of the scars, previous treatments, the presence of inflammatory acne lesions, skin phototype and patient expectations.
Treatment options include microneedling, carboxytherapy, subcision, hyaluronic acid lifting, biostimulation with platelet-rich plasma (PRP) or exosomes, non-ablative lasers such as 1340 and ablative lasers such as Erbium:YAG or CO2.
It is important to understand that scars are not removed, but reshaped and improved. Any scar treatment should be carried out with the application of an anaesthetic cream prior to the procedure.
