Evidence-Based Treatment Approaches for Acne Scars in Ethnic Skin

Conclusions

• Acne scarring in ethnic skin can be managed safely and effectively, but treatment selection must be guided by scar type, skin type, downtime, and cost to minimize complications.
• For icepick scars, TCA CROSS is effective, but lower concentrations such as 50% may offer similar improvement to 80% with fewer adverse effects like post-inflammatory hyperpigmentation.
• For rolling scars, subcision appears more effective than 100% TCA CROSS and produces fewer pigmentary side effects.
• Microneedling is a safe, well-tolerated option for higher Fitzpatrick skin types and can be combined with other treatments to improve results while keeping the risk of dyspigmentation low.
• Nonablative fractional lasers improve boxcar and rolling scars better than icepick scars because their depth of penetration is insufficient for many deep icepick lesions.
• Microneedling and laser-based approaches can produce comparable scar improvement, but microneedling generally has a better safety profile with less erythema and post-inflammatory hyperpigmentation.
• Fractional radiofrequency microneedling is effective for moderate to severe atrophic acne scars, with most patients improving and many gaining at least two grades.
• Fractional CO2 laser and RF microneedling can achieve similar scar texture improvement, but CO2 tends to cause more erythema and skin barrier disruption while RF microneedling tends to be more painful.
• Fractional microplasma RF may produce greater scar improvement than RF microneedling, but it also appears to cause more pain, longer erythema, and occasional PIH.
• Combination therapy is often the best strategy for mixed acne scar patterns, because combining subcision with fillers or fractional CO2 can improve outcomes beyond subcision alone, albeit with greater downtime or treatment-related discomfort.