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TREATMENT GUIDE |


treatment guide Acne and acne scars


Ilaria Ghersetich and Lara Tripo discuss the commonly used treatment options for acne and acne scarring


Atrophic scars are more common than keloids


A


CNE IS ONE OF THE most common skin disorders treated in routine dermatologic care, which may result in permanent


scars. and


extend vertically into the deep dermis or subcutaneous tissue. Rolling scars occur from dermal


A simple and easily


hypertrophic scars. A simple and easily a p p l i c a b l e classification system has been proposed for atrophic acne scars, dividing them into three basic types: ice-pick, rolling and boxcar scars1


.


Ice-pick scars are deep, narrow and sharply shaped epithelial tracts that


applicable classification system has recently been proposed for acne atrophic scar.


tethering of skin. Abnormal fibrous anchoring of the dermis to the subcutis leads to superficial shadowing and gives a rolling appearance to the overlying skin. Boxcar scars are


round or oval depressions with sharply demarcated vertical


edges.


Although they are clinically wider at


the surface than ice-pick scars, they may be either shallow (0.1–0.5 mm) or deep (>0.5 mm). Colour changes in acne scars can include red, white or brown, and they


often diminish over time, but do not always completely resolve.


Acne scar revision A variety of approaches are available for the revision of each of the three scar types, even if there is currently no standardised approach to management. They include a variety of types of resurfacing (chemical peels, dermabrasion, conventional and fractional ablative and non-ablative lasers) and surgical methods such as subcision, punch excision, and elevation2


. Resurfacing techniques destroy the


epidermis and allow re-epithelialisation with collagen remodelling. Most of these invasive procedures may have an unacceptably long recovery time for some patients3


. Furthermore, all resurfacing


treatments usually require a sub-surfacing ‘filling’ with collagen injections, artificial dermal fillers, or autologous fat transfer to correct the depression. Medium-depth chemical peels such as


trichloroacetic or glycolic acid are more useful than dermabrasion for correcting small depressed scars4


such as carbon dioxide (CO2


. Ablative lasers, ) and pulsed


erbium-doped yttrium-aluminum-garnet (Er:YAG) emit high energy densities at extremely short pulses to vaporise target tissue, leading to collagen shrinkage and remodelling, with limited damage to the surrounding skin. All types of ablative resurfacing have


possible side-effects, such as erythema and oedema, along with different possible complications (e.g. infection, milia and stains). One of the newest trends in scar treatment is the non-ablative light, or


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