What causes Acne Scarring?
Dr. McNeill: Picking!!!! No matter how much acne, or how large acne cysts become, they will not cause scarring if left untouched. The skin may hyperpigment and become darker for a while, but this hyperpigmentation will not be permanent. Picking at acne can cause scars that are permanent.
Sometimes, patients will have cysts injected with cortisone to get rid of them, is it possible to cause scarring with the needle used? Also, what about facials? Some aestheticians perform extractions with small utensils and lancets, can this lead to scarring?
Dr. McNeill: The needle is smaller than the opening of a pore; I have never seen scarring from a cyst injection. The best way to do extractions is with a comedone extractor, they can be purchased at most drugstores, for example Tweezerman makes a good one. Steam your skin in the shower, clean the extractor with alcohol, place the loop in the extractor over the blemish, and push lightly. If nothing comes out, then give up and try again the next day. No digging at them!
Doctors have long adopted Benjamin Franklin’s famous saying, “An ounce of prevention is worth a pound of cure.” This seems particularly true of acne, if you do not get it, you cannot pick at it, and there will be no acne scars.
Dr. McNeill: ABSOLUTELY! Properly treated, acne will subside long before the appearance of permanent scars. And, treatment for acne is covered by most health insurance plans. Treatment for acne scarring, however is not. So, definitely stop acne before it leads to scarring
Alright, but for those that do have acne scars, what are their options?
Dr McNeill: There are 4 main treatments that are recommended:
1) TCA-CROSS, which stands for Trichloracetic Acid (TCA) and Chemical Reconstruction Of Skin Scars (CROSS). The treatment is a very strong acid applied by a board certified dermatologist monthly for three or four treatments. The physician will use a Qtip like device to place the acid on each scar, and it makes each scar less deep. This treatment works best on pitted or “ice-pick” scars that tend to be the deepest. TCA-CROSS treatment prices vary, but generally run about $550 per session. This treatment is thought to be the most effective treatment for ice-pick scars
There will be some mild scabbing after each treatment, in localized patches. NO PICKING at the scabs!
2) Derma Roller – this is a tool that looks bit like a pizza cutter, with tiny needles on it. The roller is moved over the scars, to “pound out” or smooth scarring, as well as stimulate collagen, which will reverse the scarring. This procedure works best on scars that are more shallow and are sometimes called “box car” scars. Costs range, but are about $650 per treatment, with at least 3 treatments necessary.
3) Fractionated CO2 Ablative Laser Treatment – This is an aggressive laser treatment that works best on very shallow acne scars. The laser “resurfaces” the face. There is just one treatment, and costs range from $4200-$5000. Skin will be red and swollen for up to a couple of weeks, and patients need to plan on at least a week off of work. The treatment is not recommended for dark complexions.
4) Fractionated 1540 XF Non-Ablative Laser Treatment-This is a less aggressive laser treatment that also helps acne scars. It can give just as much improvement as CO2 treatment, but it is spread over 5-6 monthly treatments. After each treatment there is minor swelling and redness that resolves quickly. It costs about $650 per treatment.
There are websites, beauty salons and beauty supply stores that sell some of these treatments, or versions of them, are they safe and effective?
Dr. McNeill: I would not recommend any ‘home’ version of products for scarring. In order to treat scarring, we are being very aggressive and there is always a risk of further scarring if these procedures are done improperly.
