Acne Scars: Over 90% of adolescents have acne and 1% of the population have acne scars.
Why Acne Scars? Acne scars are created by the wound healing process occurring after the acute process of inflammation, follicular rupture and perifollicular abscess formation.
Types of Acne Scars. The resulting acne scars may be atrophic or hypertrophic (Fabbrocini et al., 2010). Approximately 80% of scars are atrophic associated with a net loss of collagen during the matrix remodeling process. A minority of scars are hypertrophic or have keloid formation. Atrophic scars are classified as:
- Ice pick (70%) – These are the narrow < 2mm punctiform depressions with a “V” cross-section.
- Boxcar (20%) – These are round or oval scars with well-established vertical edges with a wide base and a “U” cross-section.
- Rolling scars (10%) – These wide > 4 mm scars have an “M” cross-section and give an undulating appearance to the skin.
Grade of acne scarring Level of Disease Clinical Features
- Macular Erythematous hyper- or hypo-pigmented flat marks. These do not present a contour defect but rather color problem.
- Mild Mild atrophy or hypertrophy scars that are not obvious at social distances of > 50 cm and may be covered by makeup or facial hair.
- Moderate Moderate atrophic or hypertrophic scarring that is obvious at social distances of > 50 cm and is not covered by makeup or facial hair. Scar will flatten by manual stretching of the skin.
- Severe Severe atrophic or hypertrophic scarring that is obvious at social distances of > 50 cm and is not covered by makeup or facial hair. Scar will not flatten by manual stretching of the skin.
Micro Needling Acne Scar Treatments There are many treatments for acne scars, each with characteristic side effects. For most treatments, the principle treatment side effect is postinflamatory hyperpigmentation (Fabbrocini et al., 2010) which is most pronounced in darker skin types (Shah and Alexis, 2010). Postinflammatory hyperpigmentation may result from dermabrasion, chemical peels and laser resurfacing.
Treatment Type Mechanism – Indication Side Effects
Chemical Peel Best results with macular scars. Only variable results with icepick and rolling scars. Temporary hyper-pigmentation or irritation.
Dermabrasion Completely removes the epidermis to the papillary or reticular dermis. Will treat icepick and rolling scars. General anesthesia and infection risks. Significant patient downtime. Darker skin may become discolored and blotchy.
Microdermabrasion Removes outer layer of the epidermis. Does not treat deep scars. Only rare complications.
Needle Dermabrasion Leaves epidermis largely intact. Full effect seen after 6 weeks as mechanism of action is enhanced collagen production. Lowest risk of postinflammatory hyperpigmentation than the other procedures.
Fractional laser Treatment Ablative is more effective than nonablative. Quantifiable improvement of 40 -80% in scar depth. Patient must stop isoretinoin. Dark skin is at risk of postinflammatory hyperpigmentation. Hyperpigmentation using conventional CO2 laser is 36% (Alster and West, 1996)
Dermapen Micro Needling Treatment of Acne Scars. The Dermapen is a convenient and effective way of performing needle dermabrasion.
The Dermapen adjustable needles penetrate a controlled depth into the dermis. The dermis develops multiple microbruises, which start a cascade of growth factor release and collagen production. Punch biopsy histology demonstrates thickening of the skin with dramatic increases in new collagen and elastin fibers (Fabbrocini et al., 2010). As collagen is deposited, the skin texture improves. Results are initially seen in six weeks and full effect will take three months to develop.
Severity grade of rolling scars has been shown to be statistically reduced in a clinically meaningful fashion after two sessions of needle dermabrasion (Fabbrocini et al., 2009). Importantly, there was no sign of hyperpigmentation in the 32 patients studied.
Micro Needling References
Alster TS, West TB (1996) Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. Dermatol Surg 22: 151-155.
Camirand A, Doucet J (1997) Needle dermabrasion. Aesthetic Plast Surg 21: 48-51.
Fabbrocini G, Fardella N, Monfrecola A, Proietti I, Innocenzi D (2009) acne scarring treatment using skin needling. Clin Exp Dermatol 34: 874-879.
Fabbrocini G, Annunziata MC, D’Arco V, De Vita V, Lodi G, Mauriello MC, Pastore F, Monfrecola G (2010) Acne scars: Pathogenesis, classification, and treatment. Dermatol Res Pract 2010: 893080.
Goodman G (2003) Post acne scarring: a review. J Cosmet laser Ther 5: 77-95.
Goodman GJ, Baron JA (2006) Post acne scarring: a qualitative global scarring grading system. Dermatol Surg 32: 1458-1466.
Graber EM, Tanzi EL, Alster TS (2008) Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol Surg 34: 301-305.
Jacob CI, Dover JS, Kaminer MS (2001) acne scarring: a classification system and review of treatment options. J Am Acad Dermatol 45: 109-117.
Levy LL, Zeichner JA (2012) Management of acne scarring, Part II: A comparative review of non-laser based, minimally invasive approaches. Am J Clin Dermatol 13:331-340.
Shah SK, Alexis AF (2010) Acne in skin of color: practical approaches to treatment. J Dermatolog Treat 21:206-211.