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)
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.
- Cost: About $300-500 for TCA peel; $100-200 for Jessner’s
- Time of procedure: Less than 1 hour
- Recovery time: About 1 week for TCA peel; 2-3 days for Jessner’s (if not less)
- Effects last: 3-5 months
TCA (trichloroacetic acid) peels and Jessner’s peels can be used separately or together. When used together, Jessner’s is considered a “prep” for the deeper TCA, which helps it to be more effective in the short term, and last longer in the long-term. A Jessner’s peel is a superficial peel that is sometimes used alone to refresh young skin (teens, 20s) or mild acne. On the other hand, TCA peels vary from 10-35%:
- 10% is superficial. Considered a bit stronger than Jessner’s. Will take 2-3 days to peel/reach full effect.
- 20% can reach the papillary dermis. Will take 5-7 days to peel/reach full effect.
- 30-35% can reach the deeper papillary dermis. Will take 7-10 days to peel/reach full effect.
What the Studies Show
TCA peels have been clinically proven to treat discoloration, skin tone, texture and fine lines and wrinkles. The disadvantage to TCA and Jessner’s peels in comparison with IPL is that these treatments do not help broken blood vessels.
However, the advantage is that TCA and Jessner’s peels are considered to be more safe than IPL for those with olive and light brown skin, though risks still exist for scarring.
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.
For Acne Scars Associated with Hyperpigmentation: IPL Photofacials
Skin before and after IPL treatment. Source: Realself.com
- Cost: About $300-500 per session (usually takes 2-7 sessions); average $2300 total. One month between procedures is generally recommended.
- Time of procedure: 30-90 minutes
- Recovery time: Minimal downtime
- Effects last: May be permanent (depends on your lifestyle, UV exposure, etc.). Takes 1-2 weeks to see the full effect.
For your specific array of problems, IPL Photofacials are truly a godsend. They have been clinically proven to treat:
- Sun spots
- Rosacea
- Broken blood vessels (telangiectasias)
- Oily skin/acne
- Fine lines and wrinkles
How It Works: From Bedside to Benchside
During an IPL treatment, your eyes will be covered, and a cool gel is placed on your skin. For 30-90 minutes, the smooth glass portion of the handpiece will be gently applied to your skin. You may feel a very slight sting, like the snapping of a small rubber band. This “sting” is the laser emitting energy at wavelengths that fragment melanin and help to dissolve hemoglobin in blood vessels, making them less visible.
At the end of the treatment, your face is cleansed, and a moisturizer with sunscreen is applied. If your skin is particularly reddened or swollen, you may be given an icepack.
Side Effects and Duration
- Redness and bruising generally subside in 1-2 days.
- Age spots may paradoxically look darker for 3-7 days, and then subside thereafter.
- Crusting may last up to ten days.
- The skin is completely healed from a treatment after one month.
- Transient hypopigmentation is a common side effect, where the skin looks lightened for a period of time before returning to its normal state (Lasers in Dermatology and Medicine, 2012).
It is important to speak with your dermatologist or aesthetician before undergoing treatment due to these potential side effects.
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!