Patients of African descent are at a disproportionately high risk for developing post-inflammatory hyperpigmentation following injury to the skin, whether it be through acne or acne scar treatments themselves. Therefore, additional safety measures must be put in place when approaching their acne scar treatments.
How does acne form?
Acne is a common inflammatory skin condition resulting from trapped excess sebum, dead skin cells, and bacteria in the hair follicle. Acne breakouts can manifest in multiple forms, including blackheads, whiteheads, pus-filled pimples, and nodules.
Below are common symptoms of acne:
- Formation of cysts
- Crusting of skin bumps
- Small red bumps with yellow or white pus at the tip
- Papules or small red bumps
- Scarring on the skin
- Whiteheads and blackheads
- Itchy, red flakes on the skin
- Redness and soreness around the eruptions
How do scars form differently on skin of color?
Acne scars can affect everyone. However, raised scars, also known as hypertrophic scars or keloid scars, disproportionately affect darker-skinned patients. In fact, darker-skinned individuals are 15% more likely to develop keloid scars than their lighter-skinned counterparts. There are a variety of factors that may contribute to this statistic, including differences in skin physiology, genetics, location of scarring, and the list goes on. More studies are needed to determine the exact causes for such disparities in risk for developing keloid scars among different ethnicities?
That’s why the experts at our scar revision clinic in California follow a person-centric approach to curing acne scars with utmost care.
What are the best acne scar treatments for skin of color?
There are a variety of acne scar treatments available for treating darker-skinned individuals. One common complication to look out for is post-inflammatory hyperpigmentation (PIH), or in simple terms, skin darkening. The following are treatments that are known to have a disproportionately high risk of hyperpigmentation.
Laser resurfacing is an energy-based acne scar therapy option. There are a variety of different laser options available at the Scar Healing Institute:
- Erbium:YAG
- Carbon-dioxide (CO2) laser
- Fractional laser
- Fully-ablative laser
Lasers are best suited for superficial acne scarring. Topical hydroquinone therapy can help ameliorate or even prevent post-laser hyperpigmentation or discoloration. Such risks are minimal if you adhere to strict sun avoidance and protection guidelines. But before going with laser, it is important to see if your acne scars will likely respond to treatments. Deeper acne scars, such as deep boxcar scars for instance, require more aggressive frontline treatments before we proceed with “skin-polishing” lasers.
CROSS stands for Chemical Reconstruction of Skin Scarring. This is a special technique in which a deep chemical peel is applied focally to each individual scar, as opposed to traditional field application. In the process, the healthy skin surrounding the scars are spared and rapidly heals the treated scars. There are a variety of deep chemical peels. The two most popular are:
- Trichloroacetic acid (TCA)
- Phenol
Studies have shown that TCA can potentially cause widening of scars in a split-face study comparing TCA and phenol. In the same study, it was shown that phenol produced similar results to TCA but with less complications. Therefore, the use of phenol in CROSS application has become increasingly popular.
At the Scar Healing Institute, we prepare our own proprietary deep chemical peel. Regardless, the risk of hyperpigmentation is still considerable. To prevent PIH, our team works with a special third-party pharmacy to compound a lightening cream for patients to use.
Other effective treatments for skin of color…
Surgical approaches to acne scars tend to have a lower risk of hyperpigmentation, as opposed to chemical- and laser-based treatments which have a higher tendency of activating melanocytes. Some treatment options that SHI might explore with you include:
Surgical approaches to acne scarring include the following:
- Subcision
- Dermabrasion
- Microdermabrasion
- Microneedling
- Punch excision
- Punch elevation
- Punch grafting
The Scar Healing Institute will examine your skin to see if you are an ideal candidate for scar tissue removal surgery using the techniques above. Typically, we have found that most patients require a combination of treatments to get the best results. Due to the unique facial characteristic of Asian patients, the Scar Healing Institute meticulously crafts the most effective surgical treatment plan for your skin type.
Injecting steroid injections in the scar areas makes the scar marks and dark spots less visible.
Steroid and peptide injections contain anti-inflammatory ingredients that are uniquely designed to calm the inflammatory and excessive tissue growth response in raised acne scars (hypertrophic acne scars). This is especially effective for Asian patients with large masseter, or “chewing,” muscles, which can lead to continually growing keloid scars on the jaw. Our proprietary cocktail is many times stronger than conventional steroid injections. Our team of expert dermatologists will examine your scars to determine what is the optimal therapeutic concentration.
Soft-tissue augmentation with dermal fillers is a common treatment approach for acne scars. There are different filler subclasses based on the length of clinical efficacy:
- Short-Lasting (Temporary): Hyaluranic Acid (HA), Bovine/Porcine-sourced collagen
- Semipermanent: Poly-L-lactic acid (PLLA), Calcium Hydroxylapatite (CaHA)
- Long-Lasting (Permanent): Polymethylmethacrylate (PMMA)
Choosing to inject filler is a delicate play between safety and duration of results. Safer fillers are shorter-lasting, whereas other fillers are riskier but provide longer-lasting results. When determining what filler to inject, safety is of utmost importance to the Scar Healing Institute.
What Is The Cost Of Acne Scar Treatment At The Scar Healing Institute?
The cost of acne scar treatment is dependent on a variety of factors, many of which will be determined at your first consultation. Factors include:
- Depth and distribution of scarring
- Type/Number of treatments required
- Expectation of improvement
The Scar Healing Institute is the most popular scar revision clinic in California, specializing in acne scar treatment for Asian skin. At your initial consultation, our expert dermatologists will create a customized plan for your acne scar treatment, with all associated costs and trips required to get the results you are looking for.
