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ACNE SCARRING

What is acne scarring?
Treating early acne scars
 
Wednesday, 26 August 2009
Written by : DoctorNDTV Team
 
What is acne scarring?
What is acne scarring?Acne is a skin condition that affects up to 80% of people in their teens and twenties, and up to 5% of older adults. While many people recover from acne without any permanent effects, some people are left with disfiguring acne scars. There are some topical skin care products and medications that can improve mild scarring, but most acne scars are treated with a combination of procedures.

Early acne scars

After an acne lesion has healed, it can leave a red or hyperpigmented mark on the skin. This is actually not a scar, but a post-inflammatory change. The redness or hyperpigmentation is seen as the skin goes through its healing and remodeling process, which takes approximately 6-12 months. If no more acne lesions develop in that area, the skin can heal normally. Any colour change or skin defect still present after 1 year is considered to be a permanent defect or a scar.
Treating early acne scars
Treating early acne scarsThe post-inflammatory changes caused by acne are part of the skin's natural healing process. There are certain practices and medications that can help facilitate this healing process.

  • Unprotected exposure to the sun causes more skin damage and delays healing, therefore using a sunscreen is important.
  • Using tretinoin speeds up the skin's remodeling process and helps heal post-inflammatory changes.
  • Appropriate formulations of Alpha-Hydroxy Acids (AHAs) and Beta-Hydroxy Acid (BHA) that contain the correct concentrations and are at the appropriate pH also help the skin's remodeling process.
  • Picking at scabs should be avoided at all costs. Scabs form to protect the healing process that is going on underneath them. Pulling a scab off before it is ready interferes with the healing and remodeling process, prolonging the time that post-inflammatory changes will be visible.
Acne scars are stubborn, and no single treatment is best for everyone. Various procedures can help treat these from collagen injections, in which the results are temporary to microdermabrasion to remove the cells on the surface of the skin or dermabrasion to completely remove the top layer of skin. Various laser treatments can also be used to treat acne scars. However, in some cases, surgery may be needed to remove deeply indented acne scars. The best way of treating acne scars is to start early and continue for as long as is necessary. There are, however, a number of treatments available when suffering from scar formation:

Dermabrasion

Dermabrasion is a cosmetic medical procedure in, which the surface of the skin is removed by abrasion (sanding). It is used to remove sun-damaged skin and to remove or lessen scars and dark spots on the skin. The procedure is very painful and usually requires a general anaesthetic or twilight anaesthesia, in which the patient is still partly conscious. Afterward, the skin is very red and raw-looking, and it takes several months for the skin to regrow and heal. Dermabrasion is useful for scar removal when the scar is raised above the surrounding skin, but is less effective with sunken scars. Laser dermabrasion is much easier to control, much easier to gauge, and is practically bloodless compared to classic dermabrasion.

Microdermabrasion

Microdermabrasion comes from the above mentioned technique dermabrasion. Microdermabrasion is a more natural skin care that is a gentler, less invasive technology for doing an exfoliation on the skin. The goal of microdermabrasion is to eliminate the superficial layer of the skin called the epidermis. If the surface of the abraded skin is touched, a roughness of the skin will be noticed. The roughness is keratinocytes, which are better hydrated than the surface corneocytes. Keratinocytes appear in the basal layer from the proliferation of keratinocyte stem cells. They are pushed up through the cells of the epidermis, experiencing gradual specialisation until they reach the stratum corneum where they form a layer of dead, flattened, strongly keratinized cells called squamous cells. This layer creates an efficient barrier to the entry of foreign matter and infectious elements into the body and reduces moisture loss.

Keratinocytes are shed and restored continuously from the stratum corneum. The time of transit from basal layer to shedding is generally one month. Corneocytes are cells derived from keratinocytes in the late stages of terminal specialisation of squamous epithelia. Microdermabrasion is done to eliminate some of the corneocytes. These cells are responsible for the impermeability of the skin. The minimising or elimination of scars, skin lesions, blotchiness and stretch marks from the skin can be an easy process with the use of skin exfoliation. The result depends on how well the procedure known as skin remodeling works. Results are optimal and fewer treatments are needed with more recent and/or superficial scars. Still, microdermabrasion can be used on scars that showed up during puberty or many years later.

Laser therapy

Fractional laser resurfacing is a procedure, which wounds the skin using microscopic pulses of light. Over the course of several treatments scars are softened as the body regenerates the areas of microthermal wounding. Laser resurfacing is a technique used during laser surgery wherein molecular bonds of a material are dissolved by a laser. CO2 or erbium energy is used to treat the areas of discoloration closer to the surface and also penetrates deep into the dermis, eliminating damaged cells and stimulating the growth of new collagen. Collagen is stimulated for up to 6 months and this new collagen regeneration lifts and supports the skin's surface. The generation of the new skin cells in combination with collagen stimulation dramatically improves the appearance of acne scars. Depending on the depth of the scars, some patients may require anywhere from 1 to 3 treatments for acne scar removal.

Chemical therapy

Chemical peels improve and smoothen the texture of the facial skin using a chemical solution that causes the skin to blister and eventually peel off. The regenerated skin is usually smoother and less wrinkled and scarred than the old skin.

Surgical therapy

Subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as laser resurfacing, microdermabrasion or chemical peels can be used to smooth out the scarred tissue.
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