Acne and Rosacea Charity Training Manual

Atrophic scars
A large number of treatments have been used to treat atrophic scarring with varying degrees of success. All treatments work in the same principle of
causing an injury to the dermis which leads to a healing response with the induction of new collagen which fills the defect.
Older treatments with dermabrasion and CO 2 laser resurfacing and now rarely used as the success rate was poor and there was considerable down time.
Modern techniques include the Derma roller, automated needling devices and Fraxel laser.
Before deciding on treatment it is important to properly document the type of scar that is present. There are 3 types of atrophic scars that we see in the
acne sufferer:
1. Rolling scars – these look like someone has pressed on the skin and left a dent
2. Box scars – these have sharp edges like a box and can be very small, looking like large skin pores or large looking like craters
3. Ice pick scars – these are deep and fibrotic so feel very hard, and as the name suggests, looks like someone has punctured the skin with a sharp
pick.
Ice pick scars are thankfully rare as the only effective way of getting rid of them is to remove them with a skin punch and repair with a suture. This will leave
a small linear scar.
Rolling and box scars can be free and will flatten completely if the skin is lightly stretched or tethered by scar tissue to deeper areas of the dermis and will
not flatten when the skin is stretched. In such tethered scars additional treatment with subcision may be needed to give good results.
Rolling Scars
Box scars
Ice pick scars