Treatment for scarring

Patients need to have realistic advice about the likely success of treatment for acne scarring. They should be reassured that hyperpigmentation will gradually fade over time. Skin bleaching creams should be avoided as they are likely to cause hypopigmentation, leaving the patient with a more permanent problem than before. At the current time, there are no treatments for acne scarring that have a good research evidence base. Some options that patients may ask about are listed below.

Camouflage techniques: Special covercreams can be closely matched to skin tone and applied to the skin to even out colour differences. The creams are fixed with a spray or powder so that they can be left in place for up to a week (Davies, 2007). For patients with acne, this is most effective at covering hyper or hypopigmentation; it is not terrible successful at covering scars. It cannot be used on active inflammatory acne lesions.

Steroid injections for keloid scars: These can be helpful, but small injections should be given over a period of time to get the best results and avoid side effects.

Chemical peels or dermabrasion: These procedures are used for atrophic scarring and aim to remove layers of skin so that the whole skin surface is lowered to the level of the scar tissue. When the new skin grows back, it is smoother and less pitted. Patients should be warned that this can be extremely painful and lead to a prolonged period of sore and damaged facial skin as it heals. The extent of this depends on how severe the treatment is. Those facial peels which do not leave the face feeling sore are unlikely to have much long-term beneficial effect. ‘Fillers’ may be helpful in lifting shallow depressed scars. Treating scar tissue in these ways requires careful assessment and delivery of the various techniques to obtain the optimal response. In general these treatments are not available on the NHS.

Silicon sheets: These are worn in direct contact with the scar. A systematic review of the evidence for the efficacy of silicon sheets found that there were no good studies which made it difficult to make a judgement about their benefits (O’Brien and Pandit, 2006). They are, however, unlikely to cause any damage.

Lasers: A systematic review of the evidence for the use of lasers in treating acne scarring revealed that the evidence was not sufficiently robust as to determine the efficacy of different laser treatments or in comparison with other treatments. Whilst some case studies suggest there might be a positive effect, the authors of the review felt that the evidence was not strong enough to make recommendations for practice (Jordan et al., 2000).