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Updated May 08

Post Acne Scarring: A Salford Experience    

V. MADAN and P.J.AUGUST

Acne is a common skin disorder which affects 80% of the population between 11 and 30 years of age. Acne scarring has a major effect on self esteem; confidence and can lead to social ostracism, social withdrawal, unemployment, lost relationships, significant depression and even suicide. Scarring of varying severity occurs early and affects 95% of patients with acne.

Acne scars are icepick, varicelliform, hypertrophic, keloid and if numerous and widespread cause elastolysis with appearance of premature ageing.

Not all acne scars are alike and an individual with acne will have different types of scars. This means that there is no single best treatment for established acne scars. Treatment of acne scarring is usually sought for facial rather than truncal lesions. Each scar and patient is treated individually on their merits and according to the patients’ and the scars characteristics.

Many treatments are available for acne scarring. Glycolic acid peels while possibly useful in minimal superficial scarring acne, are more useful for photo-ageing and pigmentary changes seen in acne scarring. Also, improvement with these peels is usually temporary. Surgical techniques include punch excision or elevation of icepick scars, undermining of contoured scars (subcision), dermal fillers, and fat transplantation for wide shallow scars, intralesional steroid injection for hypertrophic or keloid scars can be extremely useful. Often a combination of these techniques is employed. However, the mainstay treatment of the commonest icepick and varicelliform scarring with the best permanent results is CO₂ laser resurfacing.

At the Dermatology Centre, Hope Hospital, Salford we have been treating acne scarring with CO₂ laser resurfacing for the past ten years. Over 300 patients have been treated with consistently good results and 97% patient satisfaction as audited last year.

Patients are referred by their dermatologists or general practitioners for a pre-treatment consultation when they are counselled about the pros and cons of the treatment and shown photographs of previous patients’ results. Patients are given detailed written explanations and a consent form is signed and returned by the patients. It is important that patients have realistic expectations.

Potential side effects are also discussed which includes less than a perfect outcome, minor recrudescence of acne, long standing pallor (5-10%), hypertrophic (thick) scarring (1%) and post laser infections which are rare.

Patients receive their treatment within 4-5 months (local anaesthetic) and 18 weeks (general anaesthetic). This allows a ‘cooling off’ period, during which they can reflect on the information and decide if they wish to go ahead. Patients will be refused treatment if they have unrealistic expectations, or are unduly concerned about minor blemishes (dysmorphophorbia), or are too severely affected for correction although this is rare. 

In general patients with icepick scarring with 20-50 pits per cheek do very well. Deep scars and elastolysis do less well and icepick scars on the trunk cannot for practical purposes be treated at all.

The procedure is carried out under local or general anaesthetic depending upon the extent of the scarring, patients’ fitness and preference. A test patch may be treated initially to monitor treatment response especially in dark skinned patients all of whom develop transient post-inflammatory pigmentation for 3-6 months. Each session may last between 15-30 minutes.

Post treatment antibiotic ointments are prescribed and analgesics may be required. Patients are discouraged to smoke as this delays healing. Post treatment crusting and inflammation are common and subside within 1-2 weeks.

The freshly healed skin has a pink colour similar to the lips but reverts to normal in 1-3 months. This colour can easily be hidden by make-up but this doesn’t help male patients. 

At outpatient review at 3 months most patients will have a good result after one treatment and be discharged but those with the worst scars will need repeated treatments.

Dr Vishal Madan and Dr P.J. August

The Dermatology Centre

Hope Hospital, Eccles

Manchester M6 8HD