Untreated or non-responsive acne may results in scarring a scenario, more difficult to treat. Some forms of acne never cause development of scars, however, severe forms of acne such as cysts is very likely to be followed by acne scar. Also acne in some individuals is more prone to occurrence of scar, which suggest genetic factors as a predisposing factor. Mechanical stimulation of acne lesions is another mode of causing damage in sebaceous follicles in dermis level. Appropriate treatment early and adequately is the best preventive method for acne scar. Combination therapy for severe forms such as cystic form is considered.
Injury and consequent tissue repair mechanisms cause the formation of scarring. Migration of inflammatory molecules at the site of injury (acne also causes an inflammation and small inury at the sebaceous follicle level) and their repair may prevail on disordered site. This means when the job of these molecules is done they leave a repair site in the form of fibrous scar tissue, or eroded tissue. Pathology of acne scars is recognized by improper deposition of collagen and elastin and insufficient wound healing process. Epithelium lining scarring is not flat and atrophic but hyperplastic. Healing them involves stimulation of the skin’s healing process and rebuilding collagen and elastin tissue.
Scars are basically divided in two types. One with increased skin tissues and another with decreased skin tissue. Keloids and hypertrophic scarring is associated with increased skin tissue. Keloids are overgrowth of scar tissue and develop as a sequel of skin injury. They are more common in african-americans. They could be seen as thick, raised, lobulated fibrotic plaques. They are often red or darker (increased skin color) than the surrounding skin. Once body’s healing process continue to make collagen even after a wound has healed cause the occurrence of keloids. The periphery of keloids is more densely populated with fibroblasts than normal skin. Ice-pick scars are usually small, with a somewhat jagged edge and steep sides. They appear as superficial or deep, fairly linear but irregular and commonly occur on the cheeks. These subcategory of acne scar are more resistant to treatment and the deeper they are the longer it takes to be healed completely. Soft scar can be improved by stretching the skin; hard ice-pick scars cannot be stretched out
At the beginning a scar present more red and thicker, then gradually fade. In a few months they heal spontaneously without any treatment. It would be wise to wait a few months before considering any type of scar treatment. Most treatment or removal methods available for acne scar one way or another, rely on skin resurfacing. Among methods to treat acne scars, laser resurfacing, dermabrasion and chemical peels reach their ultimate goal through skin resurfacing and renewal. Types of acne scars as well as their depth are two important factors in determining the outcomes of any acne scar treatment. Severe forms of scars never completely disappear using these procedures. Collagen injections and fat transfer can temporarily improve the appearance of scars. Collagen injections typically need to be repeated every three to six months. The patient’s own fat or injectable donated fascia can be used in full-thickened deep depressed acne scars. Silicone gels, creams, and bandages have also been reported as helpful in reducing scar thickness and pain in scars with increased skin tissue such as keloids. They must also be used regularly and results are variable. Here we review a few of procedures that can help treat acne scars:
Scarring removal remains a relative term as scars can not be completely eliminated. Only pigmentation spots and superficial scarring is subject to total removal. Most forms of scarring treated with different procedures leaves some sequalea and only shows some degree of improvement in appearance and not a total removal. Dermabrasion can be performed in the dermatologic surgeon’s office or in an outpatient surgical facility. Anesthesia may be given prior to procedure. Cleansing and freezing of the skin is performed before using the abrasive device. A high-speed rotary instrument with an abrasive wheel or brush removes the upper layers of the skin and improves irregularities in the skin surface. Healing occurs within one to two weeks after procedure. Medications will be used to alleviate the pain associated with the treated skin. Pink to red skin will stay for as long as three to four weeks after dermabrasion. The skin will be smoother as a result, total eradication should not be expected.
The type of laser used is determined by the results that the laser treatment aims to accomplish. CO2 lasers can vaporize skin layer-by-layer, causing minimal damage to other skin tissue. Special scanning devices move the laser light across the skin in predetermined patterns, ensuring proper exposure. Scarring, lines around the eyes, mouth, and cheeks are the primary uses for laser resurfacing. Smile lines or those associated with other facial muscles tend to reappear after laser resurfacing. Post-treatment redness stays for several months. Laser for acne scars appears to achieve its best results as a spot treatment; patients expecting complete elimination of their scars will not be satisfied. Complete eradication of scarring is closely correlated with acne scars’ type.
Collagen or other fillers is injected under the skin to fill out certain types of superficial and deep acne scar. Collagen treatment usually does not work as well for ice-pick scars and keloids. Bovine collagen cannot be used in people with autoimmune diseases. Fat transfer is helpful for those allergic to bovine (cow-derived) collagen. The result usually lasts 3 to 6 months. Additional collagen injections to maintain the cosmetic benefit are done at additional cost. Fat injection may last somewhat longer. Treated areas remain lumpy for months.
This procedure involves the use of a chemical to remove epidermis , the most superficial layer of the skin, in order to smooth depressed scars and give the skin a more even color. It is most helpful for shallow superficial acne scars. Peels are divided into three types: superficial, medium-depth, and deep. The type of peel depends on the strength of the chemical used, and on how deeply it penetrates. Superficial peels are used for fine wrinkles, sun damage, acne, rosacea and superficial scars resurfacing. The medium-depth peel is used for more obvious wrinkles and sun damage, as well as for removal of precancerous lesions like actinic keratoses through skin resurfacing. Deep peels are used for the most severe wrinkling, sun damage and acne scars.
Preparation for the chemical peeling begins several weeks before the actual procedure. To promote turnover of skin cells, patients use a mild glycolic acid lotion or cream in the morning, and a tretinoin cream in the evening. They also use hydroquinone cream, a bleaching product that helps prevent later discoloration. To prevent reappearance of a herpes simplex virus infection, antiviral medicine is started a few days before the procedure and continues until the skin has healed.