Presentation is loading. Please wait.

Presentation is loading. Please wait.

Acne scarring Dr Paul Charlson President British College of Aesthetic Medicine GPwER in Dermatology and Medical Director Skinqure and Intoskin Clinics.

Similar presentations

Presentation on theme: "Acne scarring Dr Paul Charlson President British College of Aesthetic Medicine GPwER in Dermatology and Medical Director Skinqure and Intoskin Clinics."— Presentation transcript:

1 Acne scarring Dr Paul Charlson President British College of Aesthetic Medicine GPwER in Dermatology and Medical Director Skinqure and Intoskin Clinics Welton Leeds Chelsea and Canary Wharf

2 Myth – acne scaring is just “cosmetic”
“I have not looked in the mirror in years, and is painful not to be able to do that, and that is a direct result of acne, the acne scarring.” “I think that if I had more self-esteem about the way I looked, I think I would have been more outgoing. I would have gone to more parties” “Our study showed that post-acne scars have a significant negative effect on the QOL of young adults. It highlights the need to increase public awareness of acne vulgaris and its sequelae through education programs and advocating early treatment to reduce the risk of scarring.” J Cutan Aesthet Surg Jul-Sep; 8(3): 153–158. The Impact of Post-Acne Scars on the Quality of Life Among Young Adults in Singapore

3 Myth – Acne scaring is not treatable or preventable
Treatment can have good results – up to 75% reporting good to excellent Even a “medical failure” might please the patient Early treatment will reduce incidence of scarring Picking spots may increase scarring

4 Who gets acne scarring? Nearly all patients get some degree of scarring Men are more likely to get truncal scarring and this can often be hypertrophic or keloid There is a correlation between severity of acne and degree of subsequent scarring Scarring is explainable by the depth and severity of the inflammation within the active acne lesion and individuals ability to heal There is a lag time of up to 3 years from comedone to scar

5 HISTORY Which aspects of the patient's scarring are the most bothersome to him/her? How distressed is the patient about his or her scars? What are the patient's goals for treatment? Have any prior procedures been performed to treat the scars? Has the active acne cleared completely? How recently did the acne clear? Was isotretinoin used? How recently was it discontinued? Is there a history of postinflammatory hyperpigmentation (PIH)? Is there a history of keloids or hypertrophic scars? PHYSICAL EXAMINATION Direct overhead lighting is optimal Have a mirror for the patient to point out lesions Evaluate for active acne Define types of scars (icepick, rolling, boxcar, severely atrophic/sclerotic) Assess color (hypopigmentation, hyperpigmentation, purple/red discoloration) Assess depth of the lesions Stretch skin to see if scars disappear Palpate for underlying fibrosis Evaluate skin type (types III–V have increased risk of PIH with most procedures)

6 Goodmans 4 point acne scarring scale
GRADE 1: MACULAR • Erythematous, hyper-, or hypopigmented marks GRADE 2: MILD DISEASE • Mild atrophy, can be covered with makeup or facial hair GRADE 3: MODERATE DISEASE • Moderate scarring, not covered by makeup but can be flattened by manual stretching of the skin GRADE 4: SEVERE DISEASE • Scarring not flattened with manual stretching of the skin

7 Types of acne scar 1. Macular marks – not true scars PIE post inflammatory erythema 2. Atrophic scars- rolled, ice pick, boxcar, atophic macules 3. Raised – hypertrophic or keloid scars 4. Other pigmentary issues – hypopigmentation, persistent post inflammatory hyperpigmentation.

8 Pigmented Marks PIE – post inflammatory erythema-blanches on pressure
PIH – post inflammatory hyperpigmentation

9 Treatment of PIE marks They fade over six months
Regular sun protection Vascular laser

10 Treatment of PIH Inhibit tyrosinase – reduce melanin production
Increase cell turnover – spots fade faster Block the sun Arbutinin, Hydroquinone,azeliac acid kojic acid, liquorice root extract – all inhibit tyrosinase Tranxemic acid and Niacinamide also prevent melanin production AHA , retinoids- increase cell turnover

11 Main types of Atrophic Acne Scar


13 Rolling Scars Gently slopping sides rolled edges
Fibrous bands of tissue develop between the skin and the subcutaneous tissue below. These bands pull the epidermis, binding it to deeper structures of the skin.

14 Depressed fibrotic boxcar scars
Steep sides often larger, firm to touch. Inflammatory breakout destroys collagen, tissue is lost. The skin over this area is left without support, and a depressed area is created. Boxcar scars may be superficial to severe, depending on the amount of tissue lost

15 Treatment Planning Treatments are often long term and combination
Expectations and goals- psychological assessement Financial considerations Time constraints Downtime Non ablative laser or micro-needling better than fractional ablative Excision likely to heal quicker than subcision or ablative resurfacing

16 Subcision 18 G Nokor needle Topical / local anaesthetic
Inserted bevel upwards into deep dermis and then back and forth and fan like motion. Only allow a small haematoma to form Ice and pressure Bruising and swelling are significant


18 Dermaroller / Dermal Pen
Percutaneous collagen induction Safe and minimal downtime Takes six months and sometimes several treatments required 75% show good or excellent result Best with shallow to medium depth scars


20 Dermaroller treatment

21 Dermaroller

22 Laser Lasers are usually fractional where there are islands of untreated skin as this reduces downtime. Ablative lasers affect the surface of the skin whilst non ablative work have less epidermal effect reducing downtime but are less effective in a single treatment Good improvement and can treat a range of scars Deeper scars better treated with more ablative laser Downtime up to 2 weeks depends on type Expensive and cannot use in type 5 and 6 skin



25 CROSS TCA Chemical reconstruction of scars
70-100% TCA for 10 seconds or when frosting occurs- wash off with saline Often need to repeat up to 5 times Care in pigmented skin as hyperpigmentation can occur

26 Cross TCA

27 Dermal fillers Soft scars are filled with a Hyaluronic acid filler
Tether scars are subcised using a Nokor needle first. It bruises – Then filled – 90% are improved

28 Surgery Good for isolated ice pick scars
Use a punch biopsy and suture or glue Punch elevation In larger ones graft a small area of skin Good result

29 Icepick Scars Small jagged scars – steep sides
Develop after an infection from a cyst or other deep inflamedblemish works its way to the surface. Skin tissue is destroyed, leaving a long column-like scar.

30 Treatment of rolling scars
Subcision Dermal filler after subcision Microneedling Fractional laser – ablative or non ablative

31 Treatment of Boxcar scars
Cross TCA – small lesions Punch excision for small deep scars Punch elevation –moderate medium sized scars Punch grafting – deep scars Ellipse incision Skin needling Fractional laser – choice of ablative laser or non ablative

32 Treatment of Ice Pick Scars
Cross TCA Punch Excision

33 Keloid acne scars Difficult to treat Often recur after treatment
Can use pulsed dye laser Inject with steriod + or - cyrotherapy


35 Keliod after pulsed dye laser

Download ppt "Acne scarring Dr Paul Charlson President British College of Aesthetic Medicine GPwER in Dermatology and Medical Director Skinqure and Intoskin Clinics."

Similar presentations

Ads by Google