Acne scars

Acne scars result from deep inflammation or unprofessional manipulation of acne lesions. If acne produces scars it is generally considered to be severe acne. In this case a dermatologic consultation and treatment is highly recommended. It is much easier to prevent scars than to treat them.

The treatment of acne scars has to take into consideration the type of scarring.

Scars may disturb aesthetically, itch or be prone to discomfort. They consist of colour alterations, difference in skin level or skin texture. Depending on age, localisation and individual aspects they can have different appearances and the indicated treatment can vary.

Treatment options for scars
We primarily assess whether or not scar corrections are appropriate and will have promising results. A scar may improve by itself within a year or two. It may sometimes be better either to wait and sometimes to treat the scars at an early stage; this must be decided by an individual assessment.

Scars can rarely be improved to such an extent that they become invisible. Typically scar treatment will make scars look less visible but will not make them disappear completely.

Treatment of colour variations

Too red:
A scar appears red because it is still inflamed or intermingled with broken vessels. In this case, an anti-inflammatory cream or laser therapies are considered.

Too dark:
The inflammation of the scarring process may lead to the production of too much brown pigment; hence hyperpigmentation is the result. This may happen spontaneously but is more often the result of sun and other UV exposure.
Therefore it makes sense to protect a scar from UV light in the first 1 – 2 years. Avoid sunlight and sun parlours, apply sunscreens and if possible also use make-up. Hyperpigmented scars may be treated with bleaching creams, peelings or medical laser therapies. They may also be camouflaged with water-resistant camouflage make-ups.

Too light:
A scarring process may lead to hypopigmentation. Until this day there are no really satisfactory treatment options for this situation. Some people will profit from camouflage make-ups, self-tanning lotions or even fractionated laser therapy. Having hypopigmented scars tattooed harbours considerable problems. We discourage you from this.

Treatment of level differences of the skin

Too high:
Typically, these rare, so-called hypertrophic scars, sometimes keloids, develop due to an individual predisposition. Hypertrophic scars may be treated with intralesional cortisone injections. This results in flatter scars, but having a tendency to develop broken vessels within the scar, which in turn can easily be treated with medical lasers. Sometimes it is preferable to surgically remove a hypertrophic scar, immediately followed by a special X-ray treatment to prevent another hypertrophic scar from developing.

Too shallow:
These are called atrophic scars, and are the most common acne scars. They exist in various forms:

Saucer shaped
They can be recognised by pulling at the edges. In doing so, they become flat. The previously used treatments like dermabrasion, deep peelings and laser skin resurfacings have mostly been replaced by fractionated laser therapies. They ‘drill’ little holes into the tissue and stimulate new collagen formation. New collagen is tighter than scar collagen: the scar gets flatter and the skin texture becomes smoother.
Saucer shaped scars may also be filled with biologically degradable Hyaluronic acid fillers.

Boxcar scars
They have steep edges and a flat base. The treatment of first choice here is ablative laser therapy. The edges are flattened and the base is raised.

         Ice pick scars
They are deep and precipitous. Typically they are surgically removed.

Treatments of acne scars need good planning and are often best performed in small steps. It is always a lengthy process. It is important to us that we give you realistic information as to the social and professional down-time and the result that can be expected.