Acne scarring is the sequence of acne which is a common skin condition affecting a large proportion of the population. The severity of acne can vary from person to person and in some cases no scarring will occur whereas in some others significant visible acne scars can develop which severely affect the quality of life of its sufferers. Risks for developing acne scars include delayed treatment for acne (or inadequate treatment), strong family history and manual manipulation of the acne lesions. It is therefore essential that acne is treated early and appropriately by a dermatologist.

Acne scars can present in different forms. Broadly speaking this can be excess of tissue (hypertrophic scars) or loss of tissue (atrophic scars). On the face the vast majority of acne scars tend to be from the atrophic type. Hypertrophic scars or even keloids tend to affect the chest, upper back and shoulders more than the face. Atrophic acne scars are further subdivided into different subtypes: rolling, ice pick, and boxcar scars. Rolling scars have uneven surface and appear with “hills and valleys” and shadows that are accentuated by the angle of light. There may be underlying volume loss at the base of the depressed scars. Ice pick scars have narrow openings and deep bases. Boxcar scars have flat bases and upright shoulders and can be small (2 mm in diameter) or large. Acne scar patients may have one or more of these subtypes and since each acne scar subtype has a preferential method of treatment it is common that combination treatment may be needed to effectively treat acne scars.

Treatments for acne scarring include microneedling, TCA CROSS, subcision, punch excision, fillers, and laser resurfacing or fractional laser treatment. Rolling scars are best treated with subcision whilst boxcars respond well to laser treatments. Ice pick scars can be treated with punch excision, TCA CROSS and/or laser resurfacing. Details on these treatments are available on the treatment section of the website.

Acne scars can present in different grades of severity ranging from mild to severe and treatment choice will take into consideration factors such as the subtype of acne scars, anatomic location, severity grade and other factors such as medication or background skin diseases. 

Professor Firas Al-Niaimi has huge experience in the management of acne scars and lectures on this topic internationally and has published several scientific articles in medical journals on this topic and these articles can be found in the publications section of the website.