Acne Scars

Acne Scar Treatment with Dermapen



Scars are areas of fibrous tissue (fibrosis) that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. With the exception of very minor lesions, every wound (e.g. after accident, disease, surgery) results in some degree of scarring. Scar tissue is the same protein (collagen) as the tissue that it replaces, but the fiber composition of the protein is different. Instead of a nice “basket weave” formation of fibers, the collagen in scar tissue is aligned in a single direction resulting in a pronounced and thicker appearance. Acne treatments for most are long term and can result in scarring. There are multiple causes of acne including hormone dysfunction, allergies, environmental factors and nutrition deficiencies. Acne scars result after skin follicles become blocked by excessive oils and the physiology of keratin and old skin cells trigger an inflammatory response reaction. The skin will attempt to heal and the scar tissue results as the collagen becomes deformed and thickens. Acne scars are categorized as being “ice- pick”, “rolling” or “boxcar .”
How to treat acne scars/ surgical scars.

The Dermapen® treatment can provide drastic results improving the appearances of the scars. The micro needles of the Dermapen® create new collagen and elastin to be generated and deposited called collagenesis, however the added benefit of new capillary growth is also a result which can improve blood supply to the area which helps create healthier existing skin as well as provide a healthy foundation for the new skin. The physical nature of “skin-needling” breaks up this fibrous and uneven scar tissue and stimulates the growth of new tissue. Currently there are ablative and non-ablative treatments offered which can damage the epidermis and evaporate the skin leading to thinner epidermis problems. The Dermapen® keeps the epidermis integrity full intact while treating the area which quickens healing time and causes less pain.
How many treatments?

Your medical professional should consult on medical treatment. While each patient is different and conditions will vary, the typical treatment regimen will consist of 5-6 treatments.

Acne Scars:  
  Acne scars are created by the wound healing process occurring after the acute process of inflammation, follicular rupture and perifollicular abscess formation.  
 The resulting acne scars may be atrophic or hypertrophic (Fabbrocini et al., 2010).  Approximately 80% of scars are atrophic associated with a net loss of collagen during the matrix remodeling process.  A minority of scars are hypertrophic or have keloid formation.  Atrophic scars are classified as:
Ice pick (70%) – These are the narrow < 2mm punctiform depressions with a “V” cross-section.  
Boxcar (20%) – These are round or oval scars with well-established vertical edges with a wide base and a “U” cross-section.
Rolling scars (10%) – These wide > 4 mm scars have an “M” cross-section and give an undulating appearance to the skin.
Grade of acne scarring Level of Disease Clinical Features
1 Macular Erythematous hyper- or hypo-pigmented flat marks.  These do not present a contour defect but rather color problem.
2 Mild Mild atrophy or hypertrophy scars that are not obvious at social distances of > 50 cm and may be covered by makeup or facial hair.
3 Moderate Moderate atrophic or hypertrophic scarring that is obvious at social distances of > 50 cm and is not covered by makeup or facial hair.  Scar will flatten by manual stretching of the skin.
4 Severe Severe atrophic or hypertrophic scarring that is obvious at social distances of > 50 cm and is not covered by makeup or facial hair.  Scar will not flatten by manual stretching of the skin.

Acne Scar Treatments There are many treatments for acne scars, each with characteristic side effects. For most treatments, the principle treatment side effect is postinflamatory hyperpigmentation (Fabbrocini et al., 2010) which is most pronounced in darker skin types (Shah and Alexis, 2010). Postinflammatory hyperpigmentation may result from dermabrasion, chemical peels and laser resurfacing.

Treatment Type Mechanism – Indication Side Effects
Chemical Peel Best results with macular scars.  Only variable results with icepick and rolling scars.   Temporary hyper-pigmentation or irritation.
Dermabrasion Completely removes the epidermis to the papillary or reticular dermis.  Will treat icepick and rolling scars.   General anesthesia and infection risks.  Significant patient downtime. Darker skin may become discolored and blotchy.
Microdermabrasion Removes outer layer of the epidermis.  Does not treat deep scars. Only rare complications.
Needle Dermabrasion Leaves epidermis largely intact.  Full effect seen after 6 weeks as mechanism of action is enhanced collagen production. Lowest risk of postinflammatory hyperpigmentation than the other procedures.
Fractional laser Treatment Ablative is more effective than nonablative.  Quantifiable improvement of 40 -80% in scar depth. Patient must stop isoretinoin.  Dark skin is at risk of postinflammatory hyperpigmentation.  Hyperpigmentation using conventional CO2 laser is 36% (Alster and West, 1996)

Dermapen Treatment of Acne Scars.  The Dermapen is a convenient and effective way of performing needle dermabrasion.  
The Dermapen adjustable needles penetrate a controlled depth into the dermis.  The dermis develops multiple microbruises, which start a cascade of growth factor release and collagen production.  Punch biopsy histology demonstrates thickening of the skin with dramatic increases in new collagen and elastin fibers (Fabbrocini et al., 2010).  As collagen is deposited, the skin texture improves.  Results are initially seen in six weeks and full effect will take three months to develop.  
Severity grade of rolling scars has been shown to be statistically reduced in a clinically meaningful fashion after two sessions of needle dermabrasion (Fabbrocini et al., 2009).  Importantly, there was no sign of hyperpigmentation in the 32 patients studied.

References
Alster TS, West TB (1996) Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser.  Dermatol Surg 22: 151-155.
Camirand A, Doucet J (1997) Needle dermabrasion.  Aesthetic Plast Surg 21: 48-51.
Fabbrocini G, Fardella N, Monfrecola A, Proietti I, Innocenzi D (2009) acne scarring treatment using skin needling.  Clin Exp Dermatol 34: 874-879.
Fabbrocini G, Annunziata MC, D’Arco V, De Vita V, Lodi G, Mauriello MC, Pastore F, Monfrecola G (2010) Acne scars:  Pathogenesis, classification, and treatment.  Dermatol Res Pract 2010: 893080.
Goodman G (2003) Post acne scarring: a review.  J Cosmet laser Ther 5: 77-95.
Goodman GJ, Baron JA (2006) Post acne scarring: a qualitative global scarring grading system.  Dermatol Surg 32: 1458-1466.
Graber EM, Tanzi EL, Alster TS (2008) Side effects and complications of fractional laser photothermolysis: experience with 961 treatments.  Dermatol Surg 34: 301-305.
Jacob CI, Dover JS, Kaminer MS (2001) acne scarring: a classification system and review of treatment options.  J Am Acad Dermatol 45: 109-117.
Levy LL, Zeichner JA (2012) Management of acne scarring, Part II:  A comparative review of non-laser based, minimally invasive approaches.  Am J Clin Dermatol 13:331-340.
Shah SK, Alexis AF (2010) Acne in skin of color:  practical approaches to treatment.  J Dermatolog Treat 21:206-211.