Dermapen Acne Scars
Dermapen acne 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.”
The Dermapen can provide results for improving the appearances of the acne scars. The physical nature of “skin-needling” can break up fibrous and uneven scar tissue and encourage 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 fully intact, which quickens healing time and causes less pain.
How many sessions
Your medical professional should consult you on best course of action for skin conditions. While each patient is different and conditions will vary, the typical regimen will consist of 5-6 sessions.
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 Modalities
There are many methods for improving the appearance of acne scars, each with characteristic side effects. For most modalities, the principal side effect is postinflammatory 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.
|Modality 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.|
|Fractional Dermal-needling||Leaves epidermis largely intact. Full effect seen after 6 weeks.||Lowest risk of postinflammatory hyperpigmentation than the other procedures.|
|Fractional laser Treatment||Ablative is more effective than non ablative. Quantifiable improvement of 40 -80% in scar depth.||Patient must stop isotretinoin. Dark skin is at risk of postinflammatory hyperpigmentation. Hyperpigmentation using conventional CO2 laser is 36% (Alster and West, 1996)|
Dermapen Acne Scars
The Dermapen is a convenient and effective way of performing fractional dermal-needling.
The Dermapen adjustable needles penetrate a controlled depth into the dermis. 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.
Dermapen Acne Scars Clinical 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.
Treatment OF ATROPHIC ACNE SCARRING – DERMAROLLER VS DERMAPEN. Professor Tony Chu, FRCP, Dermatology Department, Imperial College, Hammersmith Hospital, London, UK