TABLE 1.
Main types of acne scars and considerations by the dermatologist in treatment
| DESCRIPTION | THERAPY | CONSIDERATIONS | COMMENT |
|---|---|---|---|
| ROLLING ATROPHIC SCARS | |||
| Rolling atrophic scar | Filler and/or ablative resurfacing | Resurfacing will smooth out the scar but a dermal filler is necessary to help support it after the energy device treatment. | The initial appearance following resurfacing will be good, but as undulations start to reform, their smoothness will diminish over time. |
| BOXCAR SCARS | |||
| Boxcar scar | CO2 laser or erbium-YAG laser, treat individual scars to efface edges and then use a fractional ablative or nonablative technology for global improvement | Isolate the boxcar scars and treat them individually. Treat the edges to create more of a saucer shape. Turn a crevasse into an undulation. Remove the edge (shadow effect) | Test behind ear or in inconspicuous place first for darker skin types. Asian and Spanish patients may experience transient hyperpigmentation and should be told in advance. There may be a need for volume (filler) underneath the scar to help support it after treatment |
| ICEPICK SCARS | |||
| Icepick acne scar where lesion runs up and down | Surgical or punch excision | Inject numbing medicine to trace, excise, use 5-0 or 6-0 absorbable sutures (two stitches) | Stitches can be left in 8 to 10 days; if a surgical scar is left, it can be ablated |
| Icepick acne scar where lesion does not run up and down but may fan out | Trace the path of the pores and follow that path | ||