J AM ACAD DERMATOL
Scarring is an unfortunate complication of acne vulgaris in the general population. To adequately manage this occurrence, one should understand the underlying cause so that attempts at prevention can be effectively implemented. However, if pre-emptive intervention is not effective or the patient presents after the lesions are already established, then knowledge of proper treatment options is essential. There are multiple options that can be tailored to each individual’s needs, tolerance, and goals along with the physician’s assessments, skills, and expectations. Medical, surgical, and procedural options are all historically proven and often modified methods to consider. More contemporary options include fillers and laser or energy-derived therapies that are constantly being introduced and currently being tested. Whatever the choice, it should be clearly understood by both physician and patient that, at present, improvement of acne scarring, rather than total cure, is the probability.
1. Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Australas J Dermatol 1997;38: 115-23.
2. Johnson MT, Roberts J. Skin conditions and related need for medical care among persons 1-74 years, United States, 1971- 1974. Washington, DC: US Department of Health, Education and Welfare, Vital and Health Statistics, Series 11 No. 212, November 1978.
3. Burke BM, Cunliffe WJC. The assessment of acne vulgaris: the Leeds grading technique. Br J Dermatol 1984;111:82-93.
4. Goulden V, Stables Gl, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol 1999;41:577-80.
5. Kranning KK, Odland GF. Prevalence, morbidity and cost of dermatological diseases. J Invest Dermatol 1979;73(Suppl): 395-401.
6. Tan JK, Vasey K, Fung KY. Beliefs and perceptions of patients with acne. J Am Acad Dermatol 2001;44:439-45.
7. Ross EV. Acne, lasers, and light. Adv Dermatol 2005;21:1-32.
8. Sultzberger MB, Zaidems SH. Psychogenic factors in dermatological disorders. Med Clin North Am 1948;32:669.
9. ‘‘ Scar.’’ The American Heritage Stedman’s Medical Dictionary. Houghton Mifflin Company. Available from: URL: http://dictionary. reference.com/browse/scar. Accessed October 17, 2007.
10. Holland DB, Jeremy AH, Roberts SG, Seukeran DC, Layton AM, Cuncliffe WJ. Inflammation in acne scarring: a comparison of the responses in lesions from patients prone and not prone to scar. Br J Dermatol 2004;150:72-81.
11. Rivera AE, Spencer JM. Clinical aspects of full-thickness wound healing. Clin Dermatol 2007;25:39-48.
12. Kromayer E. Die Heilung der Akne durch ein neues nabenloses Operations verfahren. Munchn Med Wochenschr 1905;52:943.
13. Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol 1994;19: 303-8.
14. Koo J. The psychosocial impact of acne: patients’ perceptions. J Am Acad Dermatol 1995;32(Suppl):S26-30.
15. Tuan TL, Nichter LS. The molecular basis of keloid and hypertrophic scar formation. Mol Med Today 1998;4:19-24.
16. Bouzari N, Davis SC, Nouri K. Laser treatment of keloids and hypertrophic scars. Int J Dermatol 2007;46:80-8.
17. Acne scarring. Dermanetwork. Available from: URL: www. dermanetwork.org/information/acne_scars.asp. Accessed September 25, 2007.
18. Ketchum LD, Cohen IK, Masters FW. Hypertrophic scars and keloids. Plast Reconstr Surg 1974;53:140-54.
19. Alster TS, West TB. Treatment of acne scars: a review. Ann Plast Surg 1997;39:418-32.
20. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol 2001;45:109-17.
21. Jemec JB, Jemec B. Acne: treatment of scars. Clin Dermatol 2004;22:434-8.
22. Friedman PM, Skover GR, Payonk G, Kauvar ANB, Geronemus RG. 3D in-vivo optical skin imaging for topographical quantitative assessment of non-ablative laser technology. Dermatol Surg 2002;28:199-204.
23. DrenoB,BodokhI,ChivotM,Daniel F,Humbert P,Poli F, et al. ECLA grading: a system of acne classification for every day dermatological practice. Ann Dermatol Venereol 1999;126:136-41.
24. Dreno B, Khammari A, Orain N, Noray C, Merial-Kieny C, Mery S, et al. ECCA grading scale: an original validated acne scar grading scale for clinical practice in dermatology. Dermatology 2007;214:46-51.
25. Goodman GJ, Baron JA. Postacne scarringea quantitative global scarring grading system. J Cosmet Dermatol 2006;5: 48-52.
26. Goodman G, Baron JA. Post acne scarringea qualitative global scarring grading system. Dermatol Surg 2006;32: 1458-66.
27. Kadunc BV, Trindale de Albeida AR. Surgical treatment of facial acne scars based on the morphologic classification: a Brazilian experience. Dermatol Surg 2003;29:1200-9.
28. Callender VD. Considerations for treating acne in ethnic skin. Cutis 2005;76(Suppl):19-23.
29. Goodman G. Post acne scarring: a review. J Cosmet Laser Ther 2003;5:77-95.
30. Goodman GJ, Baron JA. The management of postacne scarring. Dermatol Surg 2007;33:1175-88.
31. Tsau SS, Dover JS, Arndt KA, Kaminer MS. Scar management: keloid, hypertrophic, atrophic and acne scars. Semin Cutan Med Surg 2002;21:46-75.
32. Harris DW, Buckley CC, Ostler LS, Rustin MHA. Topical retinoic acid in the treatment of fine acne scarring. Br J Dermatol 1991; 125:81-3.
33. Berardesca E, Gabba P, Farinelli N, Borroni G, Rabbiosi G. In vivo tretinoin-induced changes in skin mechanical properties. Br J Dermatol 1990;122:525-9.
34. Jalali M, Bayat A. Current use of steroids in management of abnormal raised skin scars. Surgeon 2007;5:175-80.
35. Phillips TJ, Gerstein AD, Lordan V. A randomized controlled trial of hydrocolloid dressing in the treatment of hypertrophic scars and keloids. Dermatol Surg 1996;22:775-8.
36. Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, et al. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 2007; 33:1291-303.
37. Orentreich DS, Orentreich N. Subcutaneous incision (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg 1995;21:543-9.
J AM ACAD DERMATOL VOLUME 59, NUMBER 4 Rivera 675
38. Grevelink JM, White VR. Concurrent use of laser skin resurfacing and punch excision in the treatment of facial acne scarring. Dermatol Surg 1998;24:527-30.
39. Doornbos JF, Stoffel TJ, Hass AC, Hussey DH, Vigliotti AP, Wen B-C, et al. The role of kilovoltage irradiation in the treatment of keloids. Int J Radiat Oncol Biol Phys 1990;18:833-9.
40. Akita S, Akino K, Yakabe A, Imaizumi T, Tanaka K, Anraku K, et al. Combined surgical excision and radiation therapy for keloid treatment. J Craniofac Surg 2007;18:1164-9.
41. Atkins D, Frodel J. Skin rejuvenation in facial surgery. Facial Plast Surg 2006;22:129-39.
42. Lee JB, Chung WG, Kwahck H, Lee KH. Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method. Dermatol Surg 2002;28:1017-21.
43. Landau M. Advances in deep chemical peels. Dermatol Nurs 2005;17:438-41.
44. Savardekar P. Microdermabrasion. Indian J Dermatol Venereol Leprol 2007;73:277-9.
45. Orentreich D, Orentreich N. Acne scar revision update. Dermatol Clin 1987;5:359-68.
46. Stal S, Hamilton S, Spira M. Surgical treatment of acne scars. Clin Plast Surg 1987;14:261-76.
47. Roenigk HH Jr. Dermabrasion: state of the art. J Dermatol Surg Oncol 1985;11:306-14.
48. Klein AW. Skin filling: collagen and other injectables of the skin. Dermatol Clin 2001;19:491-508.
49. Ellis DA, Segall L. Review of non-FDA-approved fillers. Facial Plast Surg Clin North Am 2007;15:239-46, vii.
50. Dermal filler product comparison. Aesthetic Buyers Guide 2007;10:94-6.
51. Gampper TJ, Tholpady A. Collagen injections. Emedicine. Updated May 3, 2007. Available from: URL: http://www.emedicine. com/plastic/topic439.htm. Accessed November 7, 2007.
52. Matton L. The history of injectable biomaterials and the biology of collagen. Aesthetic Plast Surg 1985;9:133-42.
53. Solish N, Raman M, Pollack SV. Approaches to acne scarring: a review. J Cutan Med Surg 1998;2(Suppl):24-32.
54. Lemperle G, Romano JJ, Busso M. Soft tissue augmentation with Artecoll: 10-year history, indications, techniques, and complications. Dermatol Surg 2003;29:573-87.
55. Bagal A, Dahiya R, Tsai V, Adamson PA. Clinical experience with polymethylmethacrylate microspheres (Artecoll) for softtissue augmentation: a retrospective review. Arch Facial Plast Surg 2007;9:275-80.
56. Cohen SR, Berner CF, Busso M, Gleason MC, Hamilton D, Holmes RE, et al. ArteFill: a long-lasting injectable wrinkle filler materialesummary of the US Food and Drug Administration trials and a progress report on 4- to 5-year outcomes. Plast Reconstr Surg 2006;118(Suppl):64S-76S.
57. Owens JM. Soft tissue implants and fillers. Otolaryngol Clin North Am 2005;38:361-9.
58. Homicz MR, Watson D. Review of injectable materials for soft tissue augmentation. Facial Plast Surg 2004;20:21-9.
59. Maloney BP, Murphy BA. Cole HP III. Cymetra. Facial Plast Surg 2004;20:129-34.
60. Burres S. Fascian. Facial Plast Surg 2004;20:149-52.
61. Bauman L. CosmoDerm/CosmoPlast (human bioengineered collagen) for the aging face. Facial Plast Surg 2004;20:125-8.
62. Beer K. Evolence: the thing of shapes to come. Skin Aging 2007;15:22-3.
63. Pinski KS, Roenigk HH. Autologous fat transplantation. J Dermatol Surg Oncol 1992;18:179-84.
64. Moseley TA, Zhu M, Hedrick MH. Adipose-derived stem and progenitor cells as fillers in plastic and reconstructive surgery. Plast Reconstr Surg 2006;118(Suppl):121S-8S.
65. Hochberg MC, Perlmutter DL. The association of augmentation mammaplasty with connective tissue disease, including systemic sclerosis (scleraderma): a meta-analysis. Curr Top Microbiol Immunol 1996;210:411-7.
66. Webster RC, Fuleihan NS, Gaunt JM, Hamdan US, Smith RC. Injectable silicone for small augmentations: twenty-year experience in humans. Am J Cosmet Surg 1984;1:1-10.
67. Barnett JG, Barnett CR. Treatment of acne scars with liquid silicone injections: 30-year perspective. Dermatol Surg 2005; 31:1542-9.
68. Brandt FS, Cazzaniga A. Hyaluronic acid fillers: Restylane and Perlane. Facial Plast Surg Clin North Am 2007;15:63-76, vii.
69. Narins RS, Bowman PH. Injectable skin fillers. Clin Plast Surg 2005;32:151-62.
70. Bisaccia E, Saap L, Kadry R, Scarborough D. Non-invasive procedures in cosmetic dermatology. Skin Aging 2007;15: 38-40.
71. Monheit GD. Hyaluronic acid fillers: Hylaform and Captique. Facial Plast Surg Clin North Am 2007;15:77-84, vii.
72. Hirsch RJ, Cohen JL. Soft tissue augmentation. Cutis 2006;78: 165-72.
73. Monheit GD, Prather CL. Juvederm: a hyaluronic acid dermal filler. J Drugs Dermatol 2007;6:1091-5.
74. Burgess CM, Lowe NJ. NewFill for skin augmentation: a new filler or failure? Dermatol Surg 2006;32:1530-2.
75. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983;220:524-7.
76. Walia S, Alster TS. Prolonged clinical and histological effects from CO2 laser resurfacing of atrophic acne scars. Dermatol Surg 1999;25:926-30.
77. Woo SH, Park JH, Kye YC. Resurfacing of different types of facial acne scar with short-pulsed, variable-pulsed, and dualmode Er:YAG laser. Dermatol Surg 2004;30:488-93.
78. Tanzi EL, Alster TS. Single-pass carbon dioxide versus multiplepass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates. Dermatol Surg 2003;29:80-4.
79. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 2004;34:426-38.
80. Alster TS, Tanzi EL, Lazarus M. The use of fractional laser phothermolysis for the treatment of atrophic scars. Dermatol Surg 2007;33:295-9.
81. Chiu RJ, Kridel RW. Fractionated photothermolysis: the Fraxel 1550-nm glass fiber laser treatment. Facial Plast Surg Clin North Am 2007;15:229-37, vii.
82. Hasegawa T, Matsukura T, Mizuno Y, Suga Y, Ogawa H, Ikeda S. Clinical trial of a laser device called fractional thermolysis system for acne scars. J Dermatol 2006;33:623-7.
83. Goldberg DJ. Nonablative laser surgery for pigmented skin. Dermatol Surg 2005;31:1263-7.
84. Baugh WP, Kucaba WD. Nonablative phototherapy for acne vulgaris using the KTP 532 nm laser. Dermatol Surg 2005;31: 1290-6.
85. Dierickx C, Goldman MP, Fitzpatrick RE. Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients. Plast Reconstr Surg 1995;95:84-90.
86. Alster TS, Kurban AK, Grove GL, Grove MJ, Tan OT. Alteration of argon laser-induced scars by the pulsed dye laser. Lasers Surg Med 1993;13:368-73.
87. LipperGM, Perez M.Nonablative acne scar reductionafter a series of treatments with a short-pulsed 1,064-nm neodymium:YAG laser. Dermatol Surg 2006;32:998-1006.
88. Keller R, Junior WB, Valente NYS, Rodrigues CJ. Nonablative 1,064-nm Nd:YAG laser for treating atrophic facial acne scars: histologic and clinical analysis. Dermatol Surg 2007;33:1470-6.
89. Rogachefsky AS, Hussain M, Goldberg DJ. Atrophic and a mixed pattern of acne scars improved with a 1320-nm Nd:YAG laser. Dermatol Surg 2003;29:904-8.
90. Uebelhoer NS, Bogle MA, Dover JS, Arndt KA, Rohrer TE. Comparison of stacked pulses versus double-pass treatments of facial acne with a 1,450-nm laser. Dermatol Surg 2007;33: 552-9.
91. Fournier N, Mordon S. Nonablative remodeling with a 1,540 nm erbium:glass laser. Dermatol Surg 2005;31:1227-36.
92. Goldberg DJ. New collagen formation after dermal remodeling with an intense pulsed light source. J Cutan Laser Ther 2000;2:59-61.
93. Bellew SG, Weiss MA, Weiss RA. Comparison of intense pulsed light to 595-nm long-pulsed pulsed dye laser for treatment of hypertrophic surgical scars: a pilot study. J Drugs Dermatol 2005;4:448-52.
94. Alster TS, Lupton JR. Nonablative cutaneous remodeling using radiofrequency devices. Clin Dermatol 2007;25:487-91.
95. Ruiz-Esparza J, Gomez JB. Nonablative radiofrequency for active acne vulgaris: the use of deep dermal heat in the treatment of moderate to severe acne vulgaris (thermotherapy): a report of 22 patients. Dermatol Surg 2003;29:333-9.
96. Bogle AB, Arndt KA, Dover JS. Plasma skin regeneration technology. J Drugs Dermatol 2007;6:1110-2.
97. Potter MJ, Harrison R, Ramsden A, Bryan B, Andrews P, Gault D. Facial acne and fine lines: transforming patient outcomes with plasma skin regeneration. Ann Plast Surg 2007;58:608-13.
Acne Scarring A review and current treatment modalities BACKGROUND and ACNE SCARS ACNE SCARS page 2 ACNE SCAR TREATMENT and MEDICAL MANAGEMENT SURGICAL MANAGEMENT PROCEDURAL MANAGEMENT PROCEDURAL MANAGEMENT page 2 TISSUE AUGMENTATION TISSUE AUGMENTATION page 2 TISSUE AUGMENTATION page 3 TISSUE AUGMENTATION page 4 Light, laser, and energy therapy Light, laser, and energy therapy page 2 Light, laser, and energy therapy page 3 Light, laser, and energy therapy page 4 Conclusion and REFERENCES Manufacturers of brand name drugs mentioned in this article