In this day and age where beauty is given so much importance acne scars can result in a lot of emotional and psychological pain for a person. This is where various treatments for acne scars come into the picture. 

Causes of Acne Scars

Acne scars are a result of injury that is caused by the body’s inflammatory response to dead cells, bacteria as well as sebum that is present in the plugged sebaceous follicles. What happens is that when a tissue suffers because of an injury, the body rushes to repair the injured site. This repairing procedure is undertaken with white blood cells and also an array of inflammatory molecules. Now once these repair elements complete their task of fighting infection and repairing tissue, they leave behind fibrous scar tissue.

Scarring differs from one individual to another, in other words some people are more inclined to develop scars compared to other people. Generally scarring is a result of severe nodulocystic acne which comes out deep in the skin, but there are instances when scarring also happens from superficial lesions. Acne scars may last a lifetime or become smaller as years go by; this phenomenon is still not well understood!

Types of Acne Scars

Generally there are two types of acne scars:

1. Scars that are a result of Increased Tissue Formation
2. Scars that are a result of Loss of Tissue

Scars that are a result of Increased Tissue Formation

Hypertrophic scars or keloid is the term used for scars that result from increased tissue formation. Both these scars are linked to excess cell substance called collagen. What happens is that when there is an injury, there is an overproduction of collagen which then gets collected in the fibrous mass and later results in a characteristic smooth, firm and irregularly-shaped scar.

Most keloid or hypertrophic scars are 1 to 2 mm in diameter, though some may be about 1 cm or even larger. Keloid scars are more likely to occur in people who have relatives who also have the same types of scars. Both the acne scars mentioned here remain for years but may become smaller in size over some time.

Scars that are a result of Loss of Tissue

The acne scars that belong to this category are more common than the ones caused by increased tissue formation and are similar to the scars caused by chicken pox. Acne scars that are a result of loss of tissue are:

• Ice-pick Scars
  These scars usually come out on the cheek and are small and possess a kind of jagged edge with steep sides, very much like the wounds caused by an ice-pick. These scars maybe shallow or deep and can feel hard or soft when touched. Soft acne scars can be improved by simply stretching the skin whereas hard scars cannot be stretched.

• Depressed Fibrotic Scars
  Large scars with steep edges and sharp sides are called depressed fibrotic scars. When touched, the base of these scars will feel firm. Ice-pick scars may turn into depressed fibrotic scars as time goes by.

• Soft Scars (deep or superficial)
  These acne scars are soft and have sloping edges that blend with normal skin. They are generally small and linear or circular in shape.

• Atrophic Macules
  These scars are small when they come out on the face but may increase in size on the body. Atrophic macules are soft, and often possess a slightly wrinkled base. It may also be bluish to look at because of the blood vessels present under the scar. As time goes by these acne scars turn ivory white in color in people who have white skins, this make the scare less obvious.

• Follicular Macular Atrophy
  These are white, soft and small lesions that more likely develop in the back of chest of a person who has acne. Also known as "perifollicular elastolysis," these lesions may last for a few months to a few years.

Treatment for Acne Scars

Before you go for treatment or meet a dermatologist you should ask yourself how you feel about your acne scars. Are they psychologically or emotionally affecting your life" Can you live with you scars and wait for it to fade away with time" Once you have made up your mind to go ahead with the treatment for your acne scars you should meet with you dermatologist who will guide you about the type of treatment best suited for your skin type, the cost as well as what the treatment will accomplish.

Collagen Injection

Collagen injections are used to treat acne scars. In this treatment, collagen which is a substance present in the body is injected under the skin in order to fill out and stretch certain types of deep soft and superficial scars. This type of treatment is often not recommended for keloids and ice-pick scars as they do not work as well. People who suffer from autoimmune disease are not given collagen derived from cows or other non-human sources; this is when human collagen or fascia is helpful. The benefit of this treatment usually lasts for 3 to 6 months after which additional collagen injections need to be taken to maintain the cosmetic benefit of this treatment. These additional collagen injections are provided at an additional cost.

Laser Treatment

Different types of lasers that vary in wavelength and intensity maybe used in order to reduce the redness of the skin around healed acne lesions and recontour scar tissue. Of course the choice depends entirely on the results you want to accomplish with the laser treatment. Powerful instruments like the carbon dioxide laser are capable of removing tissue! Permanent results are usually obtained with a single treatment. Of course like most other treatments, there may be post-treatment redness for many months as the skin absorbs powerful bursts of energy from the laser.

Dermabrasion

Considered the best treatment for acne scars, dermabrasion is done under local anesthesia. In this treatment, a high-speed burst of fraise or brush is used to get rid of surface skin and also change the contour of scars. The depth of deeper scars maybe reduced and superficial scars removed with the help of dermabrasion. This acne scar treatment does not work on all kinds of scars, such as ice-pick scars. Dermabrasion may also bring about changes in pigmentation in darker-skinned people!

Microdermabrasion

Unlike dermabrasion, microdermabrasion uses crystals of aluminum oxide that are passed through a vacuum tube to remove skin from the surface. In this acne scar treatment only the top surface skin is removed thus causing no other wound. Microdermabrasion may require multiple procedures with no significant improvement in the scars.

Autologous Fat Transfer

In this treatment, fat is taken from another part of your body and prepared for injection into your skin. This is done beneath the surface of the skin in order to elevate scars that are depressed. Autologous fat transfer is generally done to get rid of deep contour defects which are a result of scarring from nodulocystic acne. In most instances, this procedure has to be repeated as the skin reabsorbs fat over a period of 6 to 18 months. Multiple fat transfers could help in achieving longer lasting results.

Punch Excision and Grafting

Ice-pick scars are best treated by complete removal. In this treatment a small, round device (punch) that resemble a cookie-cutter is used to cut out the scar. The edges of which are then sewn together with a suture. Using this treatment, deep large scars are replaced by tiny scars that can later be treated to blend into the skin. If the scar is large, it can still be removed and filled with a skin graft. These grafts are later contoured with the help of dermabrasion to blend in with the rest of the skin.

Chemical Peels

Also known as chemical resurfacing, chemical peels are treatments that are used to produce an improved appearance of the face. Using this treatment controlled injury is produced to the skin, which then promotes the growth of new skin. The different chemical solutions used for this procedure produce different levels of injury to the skin. The appearance of atrophic acne can largely be improved with medium depth and deep peels which produce the injury within the dermis. The deeper peels are of course more effective but also carry more risks such as scarring, infection as well as discoloration especially with darker-skinned people. Studies are still being conducted to find the appropriate chemical peel for patients with dark skin.