Acne Scars: An Update on Management

In This Article

Abstract and Introduction

Abstract

Acne vulgaris is a troubling skin disease known to have both physiologic and psychological effects on patients. Acne scars, a frequent complication, can further impact patients' quality of life. Scars result from an impairment in the healing process. Acne scars can be categorized as follows: atrophic scars (including ice pick, rolling, boxcar subtypes) and trophic (including hypertrophic and keloid scars), the latter being less common. Though various treatment approaches have been suggested, there is a lack of high-quality evidence on effective, type-specific acne scar approaches. Herein, we aim to review the current evidence for treating various acne scars.

Introduction

Acne vulgaris is the most common skin disease affecting adolescents and adults.^[1] Studies have demonstrated that about 99% of the population has had acne at some point in their lives, varying in degree of severity, duration, and age of onset.^[1]

The psychological impact of acne is well known. Acne can have social and psychological consequences beyond the apparent visual deformity. This common condition has been linked to stress, anxiety, depression, and suicidal ideation.^[2] Singam et al. reported that severe acne is associated with comorbid mental health disorders in 25% of acne patients, including anxiety, adjustment, personality, and substance use disorders.^[3] Acne has also been associated with reduced academic achievement and social difficulties.^[1]

Acne scars are a frequent complication that results from damage to the skin during the healing process of lesions, with studies indicating that 50% of those suffering from acne may develop scars.^[4] Increased risk of scarring is associated with severe disease, time between acne onset and first effective treatment, relapsing acne, and males.4 Herein, we discuss different types of acne scars and present an updated review on type-specific management approaches.

Table 1. Clinical presentation and treatment options of acne scars
	Presentation	Treatment Options
Ice pick	• Narrow (<2 mm) at the surface and tapers as they extend to deep dermis • Extend vertically into the deep dermis or subcutaneous tissue	• Punch excision • Chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA) • Laser resurfacing • Radiofrequency • Platelet-rich plasma
Rolling	• Dermal tethering of abnormal fibrous bands which produces a dell in the skin. • Scars are 4–5 mm wide that are sloped with shallow borders	• Subcision • Injectable fillers • Non-ablative laser • Microdermabrasion • Microneedling • Platelet-rich plasma
Boxcar	• Broad, round-to-oval or rectangular depressions, usually box-like depressions with sharply defined edges	• Resurfacing laser • Punch excision • Punch elevation • Microdermabrasion • Chemical peeling • Injectable fillers • Non-ablative lasers • Platelet-rich plasma
Hypertrophic	• Pink raised lesions that persist within the borders of the original site of injury	• Intralesional corticosteroid injections • Vascular laser (e.g., pulsed dye) • Intralesional 5-fluorouracil (5-FU) • Laser resurfacing Cryotherapy • Imiquimod cream
Keloids	• Reddish-purple scars that frequently extend beyond the borders of the original site of injury	• Intralesional corticosteroid injections • Intralesional 5-FU • Intralesional interferon • Intralesional bleomycin • Imiquimod cream • Laser resurfacing