Acne, a photo by Jason Craft on Flickr.

I have acne scars on my cheeks, ice pick type scars – not discoloration, and would like to smooth them a bit. I do not want to go to the dermatologist but instead would like to find an at home treatment. Do you know of anything that would help these that I could do at home?

Sincerely,
Hannah
Dear Hannah,
The best treatments for acne scarring are, unfortunately, available from a dermatologist’s office.  However, with time and effort, there are several treatments that will make a difference at home.

As with in-office treatments, at-home treatments vary for raised, “ice-pick” type acne scars versus flat, “saucer-like” acne scars (Acne: Diagnosis and Treatment, 2000):

Non-raised Scars: Microdermabrasion, bovine collagen (available only from a dermatologist), local excision (available only from a dermatologist)

The advice makes perfect sense. According to Dr. Audrey Kunin, M.D., microdermabrasion is only used for flat “saucerlike” acne scars, as microdermabrasion superficially sandpapers the skin, sloughing away the surface layers. This means microdermabrasion is not to be used for jagged ice-pick type scars or raised scars, as the irregularity would not be improved, and could actually be made worse.

Still, microdermabrasion can make a world of difference for flat acne scars.  Once reserved for spas and salons, you can now purchase your own microdermabrasion at home kit for a reasonable price.  These kits often come with their own exfoliating wand, cleanser, and moisturizer. They’re great for removing dead skin, helping with acne, and massaging away fine lines – but they can also be rough on sensitive skin, so proceed slowly. Check out some microdermabrasion products online at retailers like ShopNBC.

Raised Scars: Use Retinoic acid (available only by prescription), steroid cream (available only by prescription), intracisional triamcislone (available from a dermatologist)

Retinoic acid is one of the only agents that has been shown to reduce the appearance of raised or hypertrophic scars. In one study in the British Journal of Dermatology, the appearance of scars was reduced by 77-79% with daily application of 0.05% retinoic acid. The results were confirmed as retinoic acid has been shown to produce a decrease in fibroblast collagen production and proliferation within the dermis of the skin, resulting in less scar formation (Journal of the American Academy of Dermatology, 1986).

Unfortunately you are not as likely to experience the same results from over-the-counter retinol, which is about twenty times less potent than retinoic acid (Clinics in Dermatology, 2001). Considering the fact that an OTC product like  Neutrogena Healthy Skin Anti-Wrinkle Cream contains only about 0.025% retinol (from my best guess), imagine what other, more potent formulas could do! Some of my favorites of these include Green Cream Level 6 (with 0.6% retinol) and Skinceuticals 1.0 (with 1.0%) retinol. Keep in mind, however, that retinol can cause redness, flaking, and itching upon initial use, and should be kept to use every other day until your skin comes to tolerate it. As always, however, check with your dermatologist first.

Bottom Line

Scarring is a serious business, and dermatologists have many more tools at their disposal than we do at home to deal with it. Nevertheless, if you have a raised scar – i.e., keloid scar, or an “ice-pick” type scar like Hannah – you cannot use microdermabrasion and would benefit more from over-the-counter retinol. Conversely, if you have a flat scar, you would benefit more from microdermabrasion. At any rate, while other agents, such as alpha hydroxy acids and salicyclic acid, may refine the skin, these have not been documented to improve scarring like retinoic acid for raised scars and microdermabrasion for flat scars. As always, consult with your dermatologist!