Non-surgical Management of Pimple Scarring
It is fair to state that the medical or non-surgical treatment of acne scars is far from satisfactory. These traditional types of treatments are limited in their usefulness due to the superficial mode of action of the topical applications.
Acne Scar Medical Treatments
Most superficial acne scars are skin colored, but some of the scars may be brownish or grayish black in color. The aim of medical or non-surgical treatment of acne scars is twofold: one, to reduce the pigmentation, if any; and, two, to gently abrade the skin to remove the superficial scars and stimulate regeneration of new skin underneath.
Topical Applications Useful in Acne Scars
Most topical applications used to treat superficial acne scars are exfoliants which remove the superficial cells in the skin and cause mild abrasion of the skin to smooth the surface out.
• Topical Tretinoin: Topical tretinoin has a dual role to play in acne scars. It acts against normal acne bumps and also straightens out mild superficial acne scars. It loosens the epidermal debris and dead cells and removes them to give the skin a fresh, shiny appearance. By affecting the epidermal cell turnover, tretinoin helps prevent blockage of the sebaceous and hair ducts and also plays a role in inhibiting inflammatory response within. Topical tretinoin is not effective in deep and medium depth acne scars.
• A combination of mandelic acid and salicylic acid is used as a peel and is useful in some types of superficial acne scars.
• Tap water iontophoresis with added tretinoin, estrogen and associated electric stimulation of skin (ESS) was found effective in reducing acne bumps and also fading superficial acne scars.
• Ablation of the scars with sterile needles followed by application of copper peptides improves the appearance of acne scars by stimulating collagen production.
• Topical steroids under occlusion may be used for short lengths of time for hypertrophic acne scars. These have to be used very carefully as they may initiate fresh attacks of acne bumps.
• Glycolic Acids, from strengths 20-70%, are used as chemical peels and are useful in superficial acne scars.
• Intralesional steroid injections and silastic gel sheeting are effective to reduce the size of keloidal acne scars.
• Hydroquinone 2-4%, Kojic acid 4%, Licorice extract 10-40%, Arbutine 1%, Azelaic acid 15-20% are used in combination with the exfoliants to reduce the pigmentation of the scars. Topical tretinoin is sufficient in most cases to get rid of the pigmentation in acne scars, though.
• Finally, there are some camouflage creams available in the pharmacies which would hide the ugly acne scars and blemishes temporarily. The technique of application of camouflage creams for acne is similar to the camouflage of vitiligo patches, though tackling the depth is an important differentiating factor.
In addition to the above, there are many OTC products and home remedies purported to be effective for acne scars, the claims about the usefulness of most of them are unfounded and unpredictable. Some, like citrus fruit juices, contain alpha hydroxy acids which cause superficial exfoliation; but at the natural strengths, are unable to produce much improvement in acne scars.