> Acne Scars

 

Acne Scars

 

 

 


Acne is a skin condition caused by overactivity of the glands that secrete oily substances on to the skin.


Causes of Acne

Around three-quarters of all teenagers and young adults suffer from acne. However, men and women in their 30s and 40s can also suffer. The blackheads and spots usually occur on the face, where the greatest numbers of these oil-producing “sebaceous” glands exist. The back, chest and shoulders can also be affected.

Central to the development of acne  are sex hormones, which are produced at puberty. The male hormone testosterone - found naturally in women as well as in men – triggers the sebaceous glands to produce more of an oily substance called sebum, making the skin more greasy. However, most acne sufferers don’t have a hormone problem and their hormones are at normal levels in their blood.

When there is an excess of sebum, the area around a hair follicle and the pore  can become clogged. A bug, a bacterium called Propionobacterium acnes, that normally lives on the skin , can thrive within the blocked pore. This infection causes inflammation, which is responsible for the redness and swelling of a spot.

In severe acne, the pocket of inflammation within the pore can rupture, causing scarring to the skin. Drugs such as certain steroid tablets and some beauty products that block the pores can contribute to acne. Contrary to popular belief, acne is not caused by eating fatty food or chocolate.

Types of Acne Scars

Ice pick scars are a common type of acne scarring. This type of scarring is characterized by deep pits that are usually less than 2 mm across. They extend into the skin, giving the surface appearance of having been punctured by an ice pick.

   

Boxcar scars are also a common type of acne scarring. They are angular scars with sharp vertical edges, and resemble the scars left by Chicken Pox. Boxcar scars may be shallow or deep, and are most often found on the cheeks and temples.

   

Rolling scars are caused by damage under the surface of the skin, and give the skin a wave-like appearance. They tend to be wide and shallow.

   

Hypertrophic scars are raised and lumpy. They tend to appear more commonly on the back and chest, but can also appear on the neck and face. They are often the result of more severe acne lesions, such as cysts or nodules. Hypertrophic scars generally stay within the boundary of the original wound, and may decrease in size as time goes on. Keloid Scars (a type of hypertrophic scarring), on the other hand, may scar beyond the original wound site.


Acne Treatment
Acne can be the source of considerable emotional distress. Before undergoing any acne scar treatments, you first need to treat any active acne. A visit to the dermatologist is strongly recommended.

It is important to keep spot-prone areas clean, by washing with an unperfumed cleanser. Antibacterial face washes and soaps specifically for greasy skins are available. However, the skin needs a certain amount of oil to maintain its natural condition, so avoid aggressive washing with strong soaps. Avoid the temptation to pick at spots as it can cause scarring. During summers acne tends to settle down due to the ensuing dryness.

For mild to moderate acne a preparation containing benzoyl peroxide is used which dries out the skin and encourages it to shed the surface layer of dead skin. Together, these effects make it harder for pores to become blocked and for infection to develop.  Benzoyl peroxide can cause redness and peeling, to start with, but this tends to settle down within a few days.

There are several topical treatments you may be prescribed, such as Azelaic acid, Topical retinoids, ( Vit A) and topical antibiotic lotions can be used to control the Propionobacterium acnes bacterial infection. Treatment needs to continue for at least six months. Preparations that combine an antibiotic with other acne medication are available.

Oral antibiotics (tablets), taken daily for around 3 months, can be prescribed for inflammatory acne. For women, a standard combined oral contraceptive pill (containing an oestrogen and a progestogen) can improve acne symptoms. Cyproterone acetate which limits the amount of circulating male hormone is also an effective treatment for acne. Isotretinoin an oral retinoid is a powerful medicine used in severe forms of acne that have proved resistant to other treatments.

Laser Treatment of Acne Scars
1. Fractional Laser - A “fractional” laser is one where the laser-light beam is not solid but rather broken up into a grid of thousands of microscopic beams. Unlike old resurfacing lasers that remove the entire top layer of skin, fractional resurfacing works by creating a grid of pinpoint laser beams that zap tiny spots on the skin. This produces thousands of tiny but deep columns of treatment in your skin, known as microthermal treatment zones. This method protects the skin from enduring too much damage at once and, because you have an 80 percent reservoir of normal skin surrounding these microthermal treatment zones, healing is fast.

By design, each treatment session targets about 15 to 20 percent of the skin's surface. In other words it treats a "fraction" of the skin surface each time and that is why the technique is called "fractional laser resurfacing" and one of the lasers uses the brand name “Fraxel”.

How does Fraxel laser treatment work?
The Fraxel laser treats a fraction of your skin’s tissue at a time to give you optimal results. The laser works by producing thousands of microscopic laser columns that penetrate deep into the layers of skin that stimulate your own natural healing process. The body then produces collagen to replace the damaged skin. The results are more youthful, smoother, and healthier appearing skin.

Is Fraxel laser safe?
With over half a million procedures already performed, Fraxel has an excellent safety record.

Is the Fraxel laser safe on darker skin types, like Asian, Indian and African-American skin?
Fraxel laser is safe and effective on all skin colors because it does not target melanin.

What should I expect during and after the treatment?
When you arrive, your skin will be cleansed thoroughly. Then a topical anesthetic will be applied to the surface of your skin. It will take about 60-90 minutes for the anesthetic to fully work and then your treatment will start. The anesthetic will then be removed. The actual laser treatment will only take about 20-25 minutes for the entire face. Your healing process will begin with some redness, swelling, or a sunburn sensation. Depending on your type of treatment, you can return to your regular routine in as little as a couple hours or up to a few days.

How many treatments will I require?
Most Patients require 3 to 5 treatments depending on the indication

2. Fractional CO2 Laser - The most safe and effective treatment for the majority of patients with acne scars is the Fractional CO2 Laser (the most popular laser in this class are the Fraxel Repair, Mixto laser, Active FX, Deep FX, This laser is a new, so called “fractional” laser. This means that the laser works by resurfacing only a “fraction” of the skin at a time, leaving the surrounding area intact for faster healing. This vastly reduces the incidence of side effects and has given us the ability to treat all skin types.

The usual trade-off dictates that the deeper you go with a resurfacing procedure, the more dramatic the results, but with added downtime and risk. So typically a light acid peel or a microdermabrasion has almost no risk of adverse effects and no downtime, but the results are modest.

What kind of results can I expect from this CO2 Laser treatment?
Most patients start to notice improvements in their skin as early as 1 week after the treatment. Continued improvements occur for the next 6 months and peak at  around month 6. Most patient notice between 50-70% improvement of the condition treated. However, results vary  by individual.

How many treatments will it take?
The vast majority of patients require only 1 treatment to achieve the desired results. Since the treated area continues to improve for 6 months following the laser treatment, we re-evaluate the need for any additional treatments at that time.

What is the downtime for this laser treatment?

The fractional CO2 laser causes a wound in the skin which means you will have three to four days of downtime when the skin is healing. During that time you have to apply an ointment frequently to your face keep the skin greasy, which makes healing faster.

What are the side effects of CO2 Laser resurfacing?
The main risks are temporary or long-lasting light or dark spots from treatment. Very rarely scarring can still result. For these reasons it is important to be treated by an experienced laser surgeon.
 

What is Demaroller induced CIT " Collagen Induction therapy?
A dermaroller is a cylindrical shaped drum studded with fine needles used in microneedling to stimulate skin cells to proliferate. This process induces collagen production which is responsible for more strength and elasticity and fills up the depth of pits and thereby reducing the scars.

Procedure is called Collagen-Induction-Therapy (CIT). Indications of dermaroller treatment :Anti aging, Anti Wrinkle, Cellulite treatment, Scar removal, Stretch mark treatment, Hair loss treatment.

Advantages of Derma Roller treatment  are Short healing period within days, Minimum risk and no side effects, Cost effective, Short treatment time with no aftercare and no downtime, Added bonus of Facial Rejuvenation, No sun sensitivity after the treatment, very safe in dark skin patients. It  gives amazing results in depressed scars caused by acne and chicken pox with good results in just 3-4 sessions.


Chemical Peels

Salicylic acid peels :

It is mainly used in:

  • Reducing severe recalcitrant acne.

  • Faster resolution of acne & spot clearance.


Glycolic acid peels :

  • Reduces acne & acne scars.

  • Decreases under eye circles.

  • Reduces pigmentation, decreases blemishes.

  • Improves complexion of skin & makes skin vibrant.

  • As it stimulates collagen synthesis, has an anti-aging role as well.


What are Dermal Filler Injections?
There are two categories of dermal fillers : Collagen and Hyaluronic Acid

How do Dermal Filler Injection help acne acars?
Hyaluronic Acid Fillers or Bovine or porcine collagen  can be injected under the pitted scar to help raise it to the level of the surrounding skin. It works in the same way as collagen/filler  injections that help plump lips and refine wrinkles.

For Collagen injection you will be tested for allergy to collagen prior to treatment, and the sterilized collagen will be injected using a fine needle. The risks for this treatment of acne scarring are minimal, and the after-effects are very mild. You may experience some tenderness and swelling around the area for the  following day, but you will be able to return to normal activity the same day as your treatment.

Autologous Fat Transfer
Autologous fat transfer, or fat grafting, uses your own fat drawn from an inconspicuous area on your body and reinserts it under a pitted acne scar to add volume. Also used in wrinkle treatment and to add volume to lips, this is a safe method to even out acne scars.

Because the filler is from your own fat, there is no chance of allergic reaction, and no pre-testing needed.