Acne scar treatments improving rapidly

Treatments for acne scars are improving rapidly, although complete fixes remain impossible and repairs require long-term treatment planning and management, according to a speaker Friday at the 2014 Annual Meeting of the American Society for Dermatologic Surgery.

READ: More coverage of the ASDS 2014 Annual Meeting

“Patients should realize that multiple technologies will be needed, multiple sessions will often be required, improvement is slow, and they need to stick with treatments,” says Greg Goodman, M.D., of The Dermatology Institute of Victoria in Australia. He took a moment to speak with Dermatology Times before his session about acne scarring.

Dr. Goodman cautions that “many acne scars are different even in the same patient, and no two patients need exactly the same range of techniques.”

He offers these tips:

• Fillers are “tremendously useful,” and “some of the older surgical punch procedures are still very valid.”
• “Fractional techniques are better, not worse, than dermabrasions and older laser procedures.”
• “Scarring the inside of the scar in some cases by 100% CROSS (TCA) or laser punch-out techniques is counterintuitive but useful.”
• “Intralesional cryotherapy looks very interesting for hypertrophic scars.”

What about lasers and energy-based devices? “These have always been our go-to set of procedures and are at their best when the scars are ‘rolling’ or abnormally colored,” he says. “They are used as collaborative procedures for other types of scars, preferably after other procedures are performed.”

Indeed, lasers and energy-based devices can be used with volume correction via hyaluronic acid fillers or fat transfer, Dr. Goodman says. According to him, other combinations include botulinum toxin and fillers in lower facial scars and surgical procedures such as punch techniques and CROSS (TCA) for ice-pick scars followed by energy-based devices. Also, “subcision can be combined with almost all procedures except punch techniques in the same area.”

As for side effects, they’re “decreasing exponentially with fractionated therapies, and healing is much faster and simpler,” he says. However, he adds, “all energy-based devices have scarring and pigmentary abnormalities as potential issues. Fillers may cause allergies and infections. Surgical punch techniques such as subcision may form excessive collagen, and punch techniques may raise up and show edges of the punch for some time.”