| 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 cystic acne is very
likely to be followed by scarring. Also acne in some individuals
is more prone to occurence 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 of acne early and adequately is the
best preventive method for acne scar. Combination therapy for severe
forms of adult acne is considered.
Histologic
changes in acne scars
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.
Different
forms of acne scars
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 are more resistant to most treatments 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
Treat acne scars
At the begining 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
considerting any type of 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.
Type and depth of scars are two important factors in determining
the outcomes of any acne scar treatment. Severe forms of scars never complelely 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 afew
of procedures that can help treat acne scars:
Remove acne scars - an appropriate
term?
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 weekds after procedure. Medications will
be used to alleviate the pain assoicated 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.
Laser
for acne scars:
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.
Fat
or collagen injections:
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.
Peeling
for acne scars:
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.
|
