Nelson Lee Novick, M.D. is a Clinical Professor of Dermatology at Mount Sinai School of Medicine in New York City, an Attending Physician, and a former OPD Clinic Chief within the department of dermatology of the Medical Center. He is board-certified both in internal medicine and dermatology and is a Fellow of the American... more
In my previous blog, I discussed the various quick, simple and inexpensive ways to elevate and smooth sunken, indented boxcar, rolling and ice pick scars. However, not uncommonly, particularly when moderate to severe in nature, nodulocystic acne breakouts can give rise to several different kinds of disfiguring, raised, elevated above the surrounding skin scars. The three most common types of these unsightly raised scars are hypertrophic scars, keloid scars, and papular acne scars.
Hypertrophic scars, also known as "proud flesh" scars, as the name implies, are elevated scars caused by an overabundant production of fibrous tissue in response to intense acne inflammation at the site. This exuberant mound of fibrous scar tissue, despite rising up "proudly" above the skin surface, characteristically maintains the diameter of the inflamed acne process that gave rise to it. Keloid scars, like their hypertrophic relatives, are also elevated exuberant mounds of abnormal fibrous tissue, however, instead of remaining confined within the boundaries of the previously inflamed acne site, they instead rise up and spread out over and beyond the bounds of the original inflammation.
Keloids are more commonly seen in persons of skin of color, and there may even be a family trait in some cases for their tendency to develop. Both hypertrophic and keloid scars can appear reddish to reddish-brown and often turn to off-white or ivory-colored bumps with the passage of time. In general, the more intense and more prolonged the antecedent active acne inflammation, the more likely these kinds of scars are to develop in predisposed persons. Papular acne scars have only relatively recently been characterized in the dermatology literature. They appear as a cluster of small, flesh-colored, much more subtly raised bumps when compared to acne-related hypertrophic and keloid scars.
While these types of elevated scars are much less common than hypertrophic scars and keloids, since they typically appear on prominent places, such as the nose and chin, they can nonetheless be quite aesthetically and psychologically troubling. As with the treatment of depressed scars, treatment of their elevated cousins need not involve the use of the latest fancy and relatively expensive and heavily marketed "in" machines and devices. Both hypertrophic scars and keloid scars typically respond to a series of injections of certain proven antiinflammatory agents directly into the scar tissue (intralesional injections) to shrink and flatten the fibrotic tissue under the scars responsible for their elevation.
These agents may be used in varying concentrations and combinations to achieve the desired improvement, and the treatment ordinarily engenders little to no downtime. Papular acne scars may respond to these injections, as well, but often, in my experience, they also require some prior physical flattening, which is easily achieved with light electrodessication performed under local anesthesia in a matter of just a few minutes. Treated sites heal in only a few days. Treating raised acne scars does not require a host of expensive smoke and mirrors machines. Happily, they can be successfully treated by a few simple, quick, inexpensive, and time-tested, in-office techniques.