Practical evaluation and management of atrophic acne scars: tips for the general dermatologist

Abstract

Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, which may be associated with significant psychological distress. General dermatologists are frequently presented with the challenge of evaluating and providing treatment recommendations to patients with acne scars. This article reviews a practical, step-by-step approach to evaluating the patient with atrophic acne scars. An algorithm for providing treatment options is presented, along with pitfalls to avoid. A few select procedures that may be incorporated into a general dermatology practice are reviewed in greater detail, including filler injections, skin needling, and the punch excision.

Figure 1

Subtypes of atrophic acne scars. Adapted from Jacob et al.

Figure 2

Photos before (A) and after (B) hyaluronic acid filler injected immediately beneath rolling acne scars of the lower face. This patient was also treated with botulinum toxin to the lower face.

Figure 2

Photos before (A) and after (B) hyaluronic acid filler injected immediately beneath rolling acne scars of the lower face. This patient was also treated with botulinum toxin to the lower face.

Figure 3

Photos before (A) and immediately after (B) injection with poly-L lactic acid demonstrating how volumetric filling of the mid-face can improve the appearance of acne scars accentuated by underlying soft tissue loss. Although this effect is temporary, it approximates what the patient will ultimately achieve with 2 to 4 sessions of treatment.

Figure 3

Photos before (A) and immediately after (B) injection with poly-L lactic acid demonstrating how volumetric filling of the mid-face can improve the appearance of acne scars accentuated by underlying soft tissue loss. Although this effect is temporary, it approximates what the patient will ultimately achieve with 2 to 4 sessions of treatment.

Figure 4

Needling device consisting of a rolling barrel studded by 2mm-long needles

Figure 5

Before (5A and 5C) and after (5B and 5D) photos after three sessions of skin needling. Although some of the improvement is from clearance of active acne, the patient also noticed improvement of her atrophic acne scars.

Figure 5

Before (5A and 5C) and after (5B and 5D) photos after three sessions of skin needling. Although some of the improvement is from clearance of active acne, the patient also noticed improvement of her atrophic acne scars.

Figure 5

Before (5A and 5C) and after (5B and 5D) photos after three sessions of skin needling. Although some of the improvement is from clearance of active acne, the patient also noticed improvement of her atrophic acne scars.

Figure 5

Before (5A and 5C) and after (5B and 5D) photos after three sessions of skin needling. Although some of the improvement is from clearance of active acne, the patient also noticed improvement of her atrophic acne scars.

Figure 6

Elliptical excision of a hypopigmented, sclerotic boxcar scar. Pretreatment (A), immediately postoperatively (B), one month postoperatively (C) showing improvement in color and contour

Figure 6

Elliptical excision of a hypopigmented, sclerotic boxcar scar. Pretreatment (A), immediately postoperatively (B), one month postoperatively (C) showing improvement in color and contour

Figure 6

Elliptical excision of a hypopigmented, sclerotic boxcar scar. Pretreatment (A), immediately postoperatively (B), one month postoperatively (C) showing improvement in color and contour