madman
Super Moderator
Abstract
Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well‐being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aim to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefits compared to the implementation of a single method.
Introduction
Atrophic scars present clinically as indentations in the skin due to destructive inflammation in the deep dermis as a result of delayed or inadequate acne treatment. Atrophic post-acne scars are further classified into ice-pick scars (V‐shaped epithelial tracts with a sharp margin that can extend deeper in the skin), boxcar scars (a round-to-oval scar with sharp vertical sides that can extend deeper in the skin), and rolling scars (irregular scars with a rolling or undulating shape) [1]. Atrophic post-acne scar risk assessment depends on the worst-ever severity of acne, the duration of acne, family history of atrophic post-acne scars, and lesion manipulation behaviors. This provides a dichotomous outcome: lower versus higher risk of developing scars [2].
Early effective treatment of acne is the best strategy to prevent or limit postacne scarring. Different factors influence the treatment choice for acne scars, for example, color, texture, distensibility, and morphology. For example, the selection of the chemical peeling agent and concentration depends on the patient’s skin type and severity of scarring. Moreover, considering the flexibility and low cost, chemical peels, ingeneral, play an important role in the management of all grades of acne scars. However, trichloroacetic acid (TCA) chemical peeling carries the risk of postinflammatory hyperpigmentation(PIH), particularly in darker skin phototypes [3]. Regarding lasers, choosing the type and appropriate settings while taking into consideration the depth of the scar, skin type, and tendency to develop PIH is of utmost importance [4]. Nevertheless, severe scars are poorly treated and do not improve greatly with resurfacing procedures, where punch excision and punch elevation can be tried instead [3].
Pre-procedure considerations include the acne-free period, isotretinoin-free period, history of skin infections (eg, herpesvirus), history of general or local skin disorders affecting healing, history of keloids or hypertrophic scarring, history of tanning, skin phototype, and sun exposure habits, as well as the history of systemic or local therapies affecting healing [5]. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, subcision, punch excision, or punch elevation [6].
This narrative review aimed to focus on facial atrophic scarring interventions in brief. The outcomes, including adverse events, participant satisfaction, and postprocedure downtime, are reviewed.
*Scars-Associated Erythema Management
*Ablative Laser Resurfacing
*Nonablative Laser Resurfacing
*Radiofrequency
*Skin Needling
*Dermabrasion and Microdermabrasion
*Chemical Peels
*PRP and Stem Cell Therapy
*Filler
*Individual Atrophic Scars Surgical Management
*Other Treatments
Conclusions
Early effective treatment of acne is the best strategy to prevent or limit postacne scarring. Treating SAE is the gold standard, an initial, and dramatic step toward improving acne scarring. Combining less invasive, less traumatizing procedures is more beneficial and more appreciated with less side effects and less downtime.
Future studies should recruit sufficient participants for blinded trials and include combined therapies versus placebo. Trials should collect baseline variables (participant demographics, acne lesions, and extent, skin phototype, scar duration, and depth of scars) to ensure that they are balanced. Trials outcomes should be assessed by both participants and investigators, including adverse events, participant satisfaction, and quality of life, as well as cost and postprocedure downtime.
Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well‐being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aim to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefits compared to the implementation of a single method.
Introduction
Atrophic scars present clinically as indentations in the skin due to destructive inflammation in the deep dermis as a result of delayed or inadequate acne treatment. Atrophic post-acne scars are further classified into ice-pick scars (V‐shaped epithelial tracts with a sharp margin that can extend deeper in the skin), boxcar scars (a round-to-oval scar with sharp vertical sides that can extend deeper in the skin), and rolling scars (irregular scars with a rolling or undulating shape) [1]. Atrophic post-acne scar risk assessment depends on the worst-ever severity of acne, the duration of acne, family history of atrophic post-acne scars, and lesion manipulation behaviors. This provides a dichotomous outcome: lower versus higher risk of developing scars [2].
Early effective treatment of acne is the best strategy to prevent or limit postacne scarring. Different factors influence the treatment choice for acne scars, for example, color, texture, distensibility, and morphology. For example, the selection of the chemical peeling agent and concentration depends on the patient’s skin type and severity of scarring. Moreover, considering the flexibility and low cost, chemical peels, ingeneral, play an important role in the management of all grades of acne scars. However, trichloroacetic acid (TCA) chemical peeling carries the risk of postinflammatory hyperpigmentation(PIH), particularly in darker skin phototypes [3]. Regarding lasers, choosing the type and appropriate settings while taking into consideration the depth of the scar, skin type, and tendency to develop PIH is of utmost importance [4]. Nevertheless, severe scars are poorly treated and do not improve greatly with resurfacing procedures, where punch excision and punch elevation can be tried instead [3].
Pre-procedure considerations include the acne-free period, isotretinoin-free period, history of skin infections (eg, herpesvirus), history of general or local skin disorders affecting healing, history of keloids or hypertrophic scarring, history of tanning, skin phototype, and sun exposure habits, as well as the history of systemic or local therapies affecting healing [5]. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, subcision, punch excision, or punch elevation [6].
This narrative review aimed to focus on facial atrophic scarring interventions in brief. The outcomes, including adverse events, participant satisfaction, and postprocedure downtime, are reviewed.
*Scars-Associated Erythema Management
*Ablative Laser Resurfacing
*Nonablative Laser Resurfacing
*Radiofrequency
*Skin Needling
*Dermabrasion and Microdermabrasion
*Chemical Peels
*PRP and Stem Cell Therapy
*Filler
*Individual Atrophic Scars Surgical Management
*Other Treatments
Conclusions
Early effective treatment of acne is the best strategy to prevent or limit postacne scarring. Treating SAE is the gold standard, an initial, and dramatic step toward improving acne scarring. Combining less invasive, less traumatizing procedures is more beneficial and more appreciated with less side effects and less downtime.
Future studies should recruit sufficient participants for blinded trials and include combined therapies versus placebo. Trials should collect baseline variables (participant demographics, acne lesions, and extent, skin phototype, scar duration, and depth of scars) to ensure that they are balanced. Trials outcomes should be assessed by both participants and investigators, including adverse events, participant satisfaction, and quality of life, as well as cost and postprocedure downtime.
