Written for Scars1 by Michelle Alford
Dr. Robert McDonald, BSc, MMed, FACD, has treated acne scars for almost twenty years. He studied medicine at Newcastle University and became a Fellow at the Australasian College of Dermatologists in 1995. He established his private practice Sky Blue Dermatology in 2000. In addition, he is a visiting medical officer at St. Vincent Hospital, Darlinghurst.
Dr. McDonald grew up in a medical family. “I was exposed to medicine from a young age and it appealed to me,” he explains. However, he didn’t decide to specialize in dermatology until after he completed med school. “During my residency I came across the scientific dermatological literature and realized what a dynamic, exciting field it was.”
He often treats patients with acne scarring and urges those with more than just mild acne to seek the advice of a dermatologist. Acne scarring is caused by inflammation that originates in the pilosebaceous unit, a unit that consists of the hair follicle, hair shaft, and sebaceous gland. It causes the destruction of connective tissues, resulting in scarring. “By consulting a dermatologist early, patients can develop an optimal management approach and minimize the chance of scarring,” says Dr. McDonald.
Dr. McDonald recommends seeking treatment for acne scarring as early as possible. “As soon as scarring is suspect, treatment should be considered to lessen the impact of scars already evident,” he explains. “Medical treatment may also be necessary to reduce inflammatory foci and further scar development.”
He warns that patients with darker skin types require a more conservative scar treatment. “Patients with darker skin are more susceptible to post inflammatory hyperpigmentation,” he cautions. “However, PIH, or darkening of the skin, is usually transient and the potential benefits of treatment, such as reducing the long-term psychological impact of scars, often outweigh the risks.
|Dr. McDonald’s Advice
Consult a dermatologist if you have more than just mild acne.
Seek treatment as soon as scarring is suspected.
Do your best to control active acne before seeing a specialist.
If you have darker skin, you should be cautious but still consider scar treatment.
Prior to seeing a specialist, patients should keep active acne controlled. According to Dr. McDonald, this usually means a combination of prescription topical and systemic agents, e.g. antibiotics, anti-androgens, or isotretinoin. “Controlling inflammation takes precedence over scar treatments as this will lessen the severity of scarring,” he explains. “Furthermore, it is much simpler to prevent scars than to treat them.”
There are many good treatments for acne scarring, and each case should be considered independently. “Good treatments include laser resurfacing (using fractional non-ablative and ablative devices), chemical peeling techniques, punch excisions, and tissue augmentation with dermal fillers. The nature of scars and patient lifestyle factors determine what treatment or combination of treatments is best suited for the individual,” explains Dr. McDonald. “In my practice patients usually have busy schedules and little tolerance for downtime. For these patients I usually recommend a series of 1540nm fractional laser treatments and may combine this with hyaluronic fillers. Subcision is a useful adjunct for depressed scars where fibrosis is a factor. Ice pick scars are addressed by small punch excisions or with the TCA cross technique.”
Dr. McDonald is excited about the past and future advances in laser scar treatment. “Nonablative fractional resurfacing technology has been the greatest advance in recent years,” he explains. “This technology provides us with an effective way to stimulate dermal collagen synthesis and remodeling with the advantage of safety, comfort and fast recovery.” Going forward, he expects that “the popularity of non-ablative fractional resurfacing will continue as patients continue to request minimum downtime procedures. Perhaps future devices will incorporate imaging technology for objective evaluation of scar type and severity and guide treatment parameters accordingly.”
Discuss in the Scars1 forums