Acne scar revision

Question 1

Ice pick scars are less than 2mm in diameter

Answer 1

T

Question 2

Boxcar scars extend 1mm into dermis

Answer 2

F

0.1–0.5 mm

Question 3

The 3 methods for treating acne scars are to
Alter the colour
Induce or reduce collagen
Fill the scar

Answer 3

T

Question 4

Rolling scars may be >5mm in diameter

Answer 4

T

Question 5

Icepick scars do not extend into subcutaneous layer

Answer 5

F

can do

Question 6

Post inflammatory hyperpigmentation (PIH) can respond to bleaching agents, light chemical peels, pigment lasers, light sources and fractionated lasers

Answer 6

T

Question 7

Hyperpigmentation is more difficult to treat than hypopigmentation

Answer 7

F

Hypopigmentation is most difficult

Question 8

Erythematous scars may improve with time

Answer 8

T

also skincare and vascular laser or IPL

Question 9

altering the colour is the most common approach to acne scar teratment

Answer 9

F

altering the collagen is

Question 10

medium and deep chemical peels stimulate collagen while superficial peels reduce pigmentation

Answer 10

T

Question 11

There are 3 grades of acne scarring severity

Answer 11

F

4 grades

Question 12

If scars dissappear with stretching the skin is an important discriminator in assessinfg acne scar severity

Answer 12

T
important for atrophic scars especially
If they dissappear its grade 3 if not is grade 4

Question 13

Discolouration with no textural change is characteristic of Grade 2 acne scarring

Answer 13

F
Grade 1 =
Erythematous, hyper- or hypopigmented flat marks visible to patient or observer at any distance

Question 14

Grade 4 acne scarring includes atrophy or hypertrophy that is obvious at social distances of ≥50 cm and is not covered easily by make-up, the normal shadow of shaved beard hair in males or body hair, if extra-facial, but flattens by manual stretching of the skin

Answer 14

F
this is Grade 3
Grade 4 is the same but Manual skin stretching cannot flatten it

Question 15

Grade 1 acne scarring is Mild atrophy or hypertrophy that may not be obvious at social distances of ≥50 cm and may be adequately camouflaged with make-up, the normal shadow of a shaved beard in males or normal body hair if extra-facial

Answer 15

F

this is grade 2

Question 16

Hypeprigmented scars mainly seen in dark skin types

Answer 16

T

Must advise sun block

Question 17

Needling devices can penetrate up to 3mm

Answer 17

T

Question 18

shallow depth needle treatments can do at home without anaesthetic

Answer 18

T

Question 19

25g needles are used for acne scar needling treatments

Answer 19

F

30g

Question 20

Dermapen is a vibrating, stamping needle device

Answer 20

T

vibrations make it much less painful

Question 21

Prophylaxis for herpes simplex is not required for needling procedures

Answer 21

F

Prophylactic antivirals should be used for pts w/ Hx of herpes simplex (Acyclovir 400mg TDS for 5 days)

Question 22

Needling sessions can be repeated 2 weeks apart

Answer 22

T

Question 23

Chemica peels are 2nd line to laser techniques

Answer 23

T

Question 24

TCA CROSS stands for TCA Chemical Reconstruction Of Skin Scars

Answer 24

T
Use 60-100% TCA +/- other techniques (subcision etc) to raise depressed scars
Then often followed by CO2 or Er:YAG laser resurfacing

Question 25

1927nm non-ablative fractional thalium laser resurfacing can help hypopigmentation

Answer 25

T | or the 1550nm Fractionated non-ablative diode-pumped erbium laser (fraxel SR)

Question 26

bleaching agents cannot help hypopigmentation

Answer 26

F | use on the normal skin to reduce the contrast

Question 27

Pigment transfer procedures include minigrafting and epidermal suspensions

Answer 27

T

Question 28

1550nm Fractionated non-ablative diode-pumped erbium laser (fraxel SR) can be used for macular erythematou scars (grade 1 scarring)

Answer 28

T

Question 29

moderate (grade 3) rolling scars should be treated with non-ablative resurfacing, microdermabrasion or needling or Dermal or superficial dermal fillers

Answer 29

``` F this for grade 2 mild rolling scars For grade 3/4 rolling scars use; ablative or non-ablative resurfacing Medical skin rolling Plasma skin resurfacing Dermabrasion Chemical peel Focal dermal filler if localized If extensive- volumetric deeply placed HA, hydoxyapatite or stimulatory agents Subcision BoTox ```

Question 30

Fine wire diathermy can be used to treat small papular scars of grade 2 acne

Answer 30

T | also intralesional 5FU

Question 31

Vascular lasers are mainly used for erythematous scars but may have a positive effect on other atrophic and hypertrophic scar types if they are also present

Answer 31

T

Question 32

Options for mild-mod hypertrophy (papular) scars include ILCS and/or 5FU and/or silicon sheeting or vascular laser

Answer 32

T | same options for major hypertrophy/keloids

Question 33

Subcision is treatment of choice for Deep box car scars or Ice pick scars

Answer 33

F TCA CROSS Punch excision Punch elevation if base skin okay

Question 34

Bridge or tunnel dystrophic scars can be treated with ablative laser

Answer 34

F | excision

Question 35

Sagging and redundancy due to scar tissue can be treated with rhytidectomy

Answer 35

T

Question 36

BoTox + fillers are useful for grade 4 atrophic or hypertrophic scars esp in lower face

Answer 36

T

Question 37

Non-ablative lasers have a less pronounced healing phase at microscopic level

Answer 37

F | more pronounced than ablative lasers

Question 38

Non-ablative laser thermally denatures the treated skin – pronounced healing phase during which remodelling occurs

Answer 38

T 1540nm Er:glass 1550nm diode-pumped erbium laser (fraxel SR) 1927nm thallium

Question 39

Ablative lasers have higher risk of erythema and hyperpigmentation

Answer 39

T

Question 40

Non-ablative Non-fractional resurfacing is comonly used for acne scarring

Answer 40

F rarely used now Modest results Can be used for mild (grad II) rolling scars

Question 41

Fractional ablative resurfacing good for older pts esp if photodamage and tightening of skin also required – good for all scar types including hypertrophic/keloids

Answer 41

T

Question 42

Fractional non-ablative laser good for younger pts or where less downtime is required esp boxcar and rolling scars

Answer 42

T

Question 43

Fractional radiofrequency treatment is radiowaves delivered into skin

Answer 43

T

Question 44

Fractional radiofrequency treatment can be used for all hypertrophic scars

Answer 44

F | For all atrophic scars - ice pick, boxcar and rolling scars

Question 45

Fractional radiofrequency treatment has a similar Rx regime and response to fractional ablative (CO2) laser resurfacing

Answer 45

T | causes collagen and elastin formation and remodelling

Question 46

Microdermabrasion is the technique with the highest risk of hyperpigmentation

Answer 46

F | dermabrasion is

Question 47

Plasma skin resurfacing is thought to be similar to CO2 fractional resurfacing in efficacy and downtime

Answer 47

T

Question 48

Dermal Fillers restore volume, firmness, density, elasticity and shape to tissue

Answer 48

T

Question 49

antegrade injection is typically performed when injecting dermal fillers

Answer 49

F retrograde injection for isolated atrophic scars (boxcar or rolling) – insert needle at 90 degrees to skin and inject as you withdraw to lift the scar (can use after subcision)

Question 50

Autologous filler means injecting the patients own fat

Answer 50

T fat recommended for severely atrophic disease Cheap, readily available, no risk of rejection or allergy

Question 51

``` non-autologous fillers include Purified bovine dermal collagen Hyaluronic acid (HA) Freeze-dried irradiated human cadaveric fascia lata Polyacrylamide ```

Answer 51

T | Polyacrylamide not recommended as prone to biofilms and late infection

Question 52

Hyaluronic acid (HA) is a long term filler

Answer 52

F

Question 53

Hyaluronic acid (HA) causes more sensitization and foreign body reaction than collagen

Answer 53

F | Less

Question 54

Keloids on the face should be treated initially with kenacort A40

Answer 54

F | start with A10

Question 55

Intralesional 5FU for hypertrophic/Keloid scars is used at 50mg/ml used neat or diluted 80:20 w/ low strength steroid

Answer 55

T Use 1ml per session of 5FU and repeat every 2 weeks May only need 0.1-0.3mls per scar per Rx

Question 56

Botox is used for ‘movement quiesence’

Answer 56

T to relax puckered scars in areas subject to a lot of movement esp on forehead, glabella or chin/lower jaw area e.g. marionette lines, chin these can become more pronounced with age Temporary improvement Works well combined with dermal fillers

Question 57

Punch excision is used mainly for ice pick or boxcar type ‘punched out’ scars esp if white base, dystrophic or in bearded area

Answer 57

T

Question 58

For punch excision the punch size must be slightly smaller than scar

Answer 58

F | size must be slightly larger than scar

Question 59

Punch elevation of depressed scars is contraindicated if if the scar base is poor or the scar is in a bearded area

Answer 59

T

Question 60

Punch grafting involves replacing punched out scar with a slightly larger non scarred punch from good skin, usually postauricular

Answer 60

T usually perform laser resurfacing 4-8 wks later excellent result

Question 61

In Punch elevation/float – scar is punched but not removed and pts serum injected into base to float the scar up to the level of the surrounding skin

Answer 61

T | usually perform laser resurfacing 4-8 wks later (or dermabrasion)

Question 62

excision +/- flap repair may be considered for large areas of severely atrophic facial scars

Answer 62

T

Question 63

It is not necessary to completely remove all underlying cystic tissue when excising large areas of severely atrophic facial scars

Answer 63

F Be sure to completely remove all underlying cystic tissue which can have wide extensions Excision can cause cyst reactivation

Question 64

Subcision results in permanent improvement of rolling scars

Answer 64

T | Several treatments needed; 1-3 months in between sessions

Question 65

Overpromising results is a pitfall in acne scar treatment

Answer 65

T Tell pts scars are not removable only improvable Ensure pts are aware the multiple treatments are often needed and final results cannot be seen for many months

Question 66

Post op infection after resurfacing is a preventable and problematic pitfall

Answer 66

T Always think of HSV infection when swelling occurs Be liberal with antiviral prophylaxis

Question 67

Must do punch excision, graft and elevation just outside the scar or on the edge

Answer 67

F | Just outside the scar not inside or on the edge