Acne Scarring: Chemical Peels, Microneedling, Treatment Risks and Considerations

In this presentation, Nicole Gunasekera, MD, MBA, FAAD, discussed options for treatment of acne scarring and post-inflammatory hyperpigmentation—including chemical peels, microneedling, and laser resurfacing—as well as important safety and treatment considerations.

Gunasekera serves as a dermatologist for Brigham & Women's Hospital and as an instructor of dermatology at Harvard Medical School. She is also the Director of the Vitiligo Clinic and Director of the Skin of Color Clinic at the hospital.

In her presentation on acne scar treatment—given at the Society of Dermatology Physician Assistants (SDPA) 2023 Annual Summer Dermatology Conference—she described the 3 types of scars.

“The first step in procedural treatment of acne scars is really diagnosing the particular issue,” she stated. “Atrophic acne scarring, macular acne scarring, and hypertrophic acne scarring.”

Gunasekera explained that for atrophic scarring, there is a net loss of collagen, acne scars are found beneath the surface of the skin, and that there are 3 types: ice pick, boxcar, and rolling. She added that ice pick scars are by far the hardest to treat and the least responsive to many of the treatment options available.

“So things that tend to work better for these are either ablative or non-ablative fractional lasers, TCA cross, which we'll talk about in a second, and then punch excision,” she explained.

Gunasekera then noted that both of these types of lasers work well for boxcar acne scars, though microneedling and/or radiofrequency show some benefits as well for this type of scarring. Resurfacing lasers in general, she noted, involves less downtime compared to microneedling.

Rolling acne scars, she pointed out, can benefit from the same treatments that boxcar scars benefit from. In fact, Gunasekera explained that microneedling works best for rolling scars, though she cautioned that adverse events are always a possibility.

After discussing the 3 types of atrophic scars, she discussed macular acne scarring, noting that it involves issues of pigmentation rather than skin contours and adding that this type of scarring can be hyperpigmented, hypopigmented, or erythematous.

Gunasekera also brought up hypertrophic acne scarring, explaining that it involves excess collagen deposition, scars which are firm and raised, and that it can be keloidal.

“One thing to keep in mind is that there are several studies that show that there are several disparities regarding what patients are offered,” she said, noting that clinicians should make sure to understand and explore their own unconscious biases.

To find out more about discussions like these, view conference coverage and more here.

The quotes included in this description were edited for clarity.