Mild and moderate cases of acne may clear up without scarring but more severe cases can cause permanent tissue damage. (Ref. 1) Some people are left with deep craters or depressions in the skin, called atrophic scars, that occur due to a loss of tissue. People with darker skin, including African Americans, tend to develop raised scars or keloids. Mild to moderate craters can be treated with chemicals, lasers and abrasion to resurface the skin. More severe scars may require one of several types of surgery to improve the appearance of the skin. Home remedies are not recommended.
A series of chemical peels at the dermatologist's office can help to resurface the skin and stimulate it to begin to fill in the craters with collagen. (Ref. 4) This procedure involves spreading one or more chemicals such as salicylic acid, pyruvic acid, glycolic acid or trichloroacetic acid on the face, then removing it along with a superficial layer of skin. (Ref. 4) Between office treatments, you may also be asked to apply chemicals to your skin at home. Depending on the substance used, you may experience side effects such as skin irritation, changes in skin color or sensitivity to light. (Ref. 4)
Two types of laser treatments are available to improve the appearance of acne craters. Ablative lasers resurface the skin but can cause unpleasant side effects. Non-ablative lasers can successfully treat some types of atrophic scars with fewer side-effects. (Ref. 2, 4) Another type of noninvasive treatment, called tretinoin-iontophoresis, utilizes special equipment that improves the way that tretinoin, a medication, penetrates the skin and treats atrophic scars. (Ref. 2, 4)
Two types of dermabrasion are available for the resurfacing of skin affected by atrophic scars. Microdermabrasion, the less invasive form, is a form of exfoliation that removes the outermost layer of the epidermis painlessly and without side effects. Dermabrasion, which must be done under general or local anesthesia, removes the epidermis layer and is more effective with deep craters. (Ref 2, 4) Both procedures are performed with specialized equipment in the dermatologist's office.
Depending on the type and depth of the craters, a surgical procedure may be warranted. Your doctor may decide that surgically removing the craters and closing the skin with sutures will be adequate. In the case of deeper craters, your doctor may elect to fill the opening with collagen, apply a skin graft or implant fat from another area of the body. (Ref. 5; ref. 6 p. 154 and other pages)