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Management of Acne Scarring

 Chang D

Short Communication: Acne scarring is a fibrous process involving new collagen production to heal a   wound. It affects those with acne vulgaris and is pre- dominant in nodulocystic acne [1]. Options for treat- ment depends on acne scarring severity, scar type   (Table 1), scar site and patient skin type, choice of treatment modality and side effects risk profile. This paper attempts to share with you the management of acne scarring [2]. Different types of scars Symptoms Flat scars These can be red, brown or pale flat marks Mild hypertrophic and atrophic scars Sunken or raised scars, not visible at distances of 50cm or more Moderate hypertrophic and atrophic scars Visible at distances of≥ 50 cm, camouflaged and can be even out by stretching the skin Severe hypertrophic and atrophic scars Visible at distances ≥ 50 cm, difficult to be camouflaged and cannot be even out by stretching of the skin Unfortunately, hypertrophic or keloid scars tend to reappear even after a good result is obtained post   treatment. Traditionally, scar revision surgery is em- ployed. Ablative lasers, carbon dioxide and erbium   YAG laser are successful for surgery. To improve the   color of scars, Pulse Dye Laser (PDL) has been effec- tively utilized. The PDL can reduce erythema and tex- tures of the scar. Multiple treatments are needed.   A microneedle radiofrequency laser, an example of which is the INTRAcel from Korea, has produced significant results. It uses an insulated microneedle that delivers radiofrequency energy to the dermis,   reducing damage to the epidermis, hence speeding   up recovery. In my practice, I use a schedule of 4 ses- sions of INTRAcel, and can achieve results of 60% up- wards for acne scars. More recently, the plasma laser   have been used, achieving good results with minimal downtime and epidermal damage. Ultimately the challenge is true acne scars never completely fade, although they visibly improve as   time passes. The good thing is, they can be con- cealed. Patient skin type is also an important factor.   Skin type can be classified from Fitzpatrick 1 to 6.   Darker skin types have a higher risk of post inflam- matory hyperpigmentation. Hence they benefit   more from fractional laser compared to traditional full ablative lasers. Scars can occur anywhere on the   body, although the upper chest and shoulders are es- pecially prone to them. This is due to poorer regen- eration capability, from the lower density of adnexa   structures (sebaceous glands, hair follicles). Technology and Treatment Factors The major complication of acne is scarring, which results in severe comorbidity for patients. On the bright side, there exists several options to treat acne scarring. Studies support combination treatment to achieve the best results. The safety and efficacy has   good evidence, but there is a dearth of split-face tri- als [3].   Scar types and treatment • Grade 1 scars: Topical treatment with silicone based gels combined with careful use of pigment, vascular and fractional lasers.   • Grade 2 mild scars: Fractional, vascular and pig- ment lasers as well as microneedling.