About Acne and Scars
Acne and scars are a common skin disorder that involves outbreaks of skin lesions (pimples) that may scar the skin. Acne and scars are so common that they are sometimes not treated as a disorder but as a normal symptom of adolescence or puberty. Acne is a general term to define skin breakouts but it can be divided into many types of sub groups, the most common type is acne vulgaris (common acne) often interchanged with the term “acne”. Acne and scars occur mostly on the face they also can be present on the, neck, back, chest, and shoulders. The main concern about acne and scars is the fact they can lead to disfiguration and to psychological problems like reduced self esteem or depression.
The cause of acne is clogged pores (hair follicle ducts) caused by sebum and natural accruing dead cells. Sebum is an oily/waxy substance produced by the sebaceous glands for lubricating the skin and hair. The sebaceous glands are small glands that can be found on all skin areas except on the palms and souls of feet. Their number is higher on the skin of the face and scalp, hence, acne and scars are more common on the face.
The production of sebum fluctuates and depends on the levels of male sex hormones. This is why adolescences are more prone to acne and scars during puberty and females often breakout before their periods. Since hormone levels fluctuate in the years prior to menopause too, some women in their 40s and 50s can suffer from acne and scars too.
Acne scars are created following severe infected acne breakouts and as a result of incorrect treatment of acne outbreaks, e.g. scratching, squeezing or picking of acne lesions.
Types of acne outbreaks:
As mentioned above, acne is caused by excessive sebum production and clogged pores. In addition, most skin hosts the bacteria Propionibacterium acnes (P acnes) which thrives in anaerobic surroundings and excessive sebum conditions. The P acne bacteria may cause an inflammation in the clogged pores which results in puss infested pores and large infected acne lesions.
A patient suffering from acne can display all the different types of acne on their skin. The degree of inflammation determines the type of acne outbreak:
Comedones (whiteheads and blackheads): is a type of acne breakout created when the openings of hair follicles become clogged by sebum, dead skin cells and sometimes with P acnes bacteria. Blackheads are comedones that are open at the skin surface, balckheads have a dark appearance because of the darkness of the plug in the hair follicles. Whiteheads are closed comedones which are slightly raised, skin-colored bumps.
Papules consist of small raised bumps caused by inflammation or infection in the hair follicles. Papules may be red and tender.
Pustules are red and tender bumps with white pus at their tips.
Nodules are large and solid, painful lumps beneath the surface of the skin formed by the accumulation of secretions deep within hair follicles.
Cysts are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.
Treatment of acne:
Treatment of acne should not be taken lightly. Untreated acne can result in permanent scarring, low self esteem, depression (even suicide), and anxiety. The treatment of acne should continue for as long as needed to prevent the acne from recurring.
Unfortunately there are no magic cures for acne and not one treatment protocol for all. There is no quick fix or overnight cure; treatment may take four to eight weeks, if you do not see an improvement after this period, it is advised to re evaluate the treatment program with a dermatologist. In addition, once the symptoms have dissipated, the treatment of acne must continue and should be ongoing in order to be effective as the goal of the treatment is to prevent further breakouts. The treatment of acne does not target the existing blemishes; therefore it is tempting to squeeze the existing clogged pores to try to “unclog” them. However, picking, popping, and squeezing can make acne worse, cause infections and can cause permanent damage to skin leading to scars.
There are many methods and combinations for treatment of acne and scars. In cases of moderate and severe acne it is advised to select a treatment plan that considers many factors including gender, age, and acne severity. For women, other considerations include pregnancy, nursing, or trying to become pregnant.
The treatment of acne may include a combination of topical (applied to the skin) or systemic (consumed, internal) medications or a combination of both topical and systemic. Other types of treatment include laser and light-based technologies along with Radio Frequency (RF).
Topical treatment is the standard treatment for mild to light acne. The medications include benzoyl peroxide, topical antibiotic creams, retinoids, and salicylic acid.
Systemic acne treatment is often deployed for managing moderate to severe acne or acne that resists topical treatment therapy, and covers large body surface areas. Systemic acne treatment involves oral antibiotics such as tetracycline, doxycycline, minocycline, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim, and azithromycin.
Combination therapy is often used to treat moderate to severe acne, it involves oral antibiotics along with topical medication.
Birth control pills are an option for treating females with moderate to severe acne. Birth control pills contain estrogen or other medications that reduce the effects of male hormones, hence reducing acne outbreaks. There are birth control pills that have been approved for the treatment of acne.
Corticosteroid injections may be deployed in cases of sever large painful acne lesions. These injections can reduce the pain and help clear large lesions more effectively therefore reducing the probability of acne scars that often follow large acne lesions.
Isotretinoin (Accutane , Roaccutane and others) is a systemic treatment approved by the U.S. Food and Drug Administration (FDA) to treat the most severe form of acne: severe resistant nodular cystic acne. Isotretinoin cannot be prescribed to pregnant or soon to become pregnant women and men, due to the high risk of birth defects associated with it. Men and women considering pregnancy should consult with their physician to evaluate the risk and to join a special risk evaluation program. While being treated by Isotretinoin it is important to be under a strict physical and psychological monitoring protocol by a physician.
Treatment of Acne Scars:
Acne and scars do not have to be a definite combination, some acne scars can be avoided through proper care. Scars are a result of the skin repairing wounds; they are a natural part of the healing process. In general, the more the skin is damaged and the longer it takes to heal, the greater the chance of a scar formation.
Acne scar formation and appearance depends on the individual’s age and the location on the body or face, younger skin tends to create large thick scars due to “over healing”. Location of a scar will also affect its’ visible, e.g. a scar over tight skin (the nose) is easier to see than a scar on softer loser skin (cheek). The shape and texture of the scar will also determine its visibility because the shadows created by the scar on the skin produce an uneven appearance. In addition, a scar that crosses facial expression lines will be more noticeable because it interrupts a naturally occurring line. At first a scar may appear red and thick and gradually fade, some acne scars may improve over time without treatment; this can take 6-18 months.
Quite a few methods are available to treat acne scars, however the patient’s expectations regarding the results of the treatment should be clarified as the appearance of the scars can improve but most scars will not diminish completely. Acne scar treatments include: laser resurfacing, dermabrasion, chemical peels, surgery, skin fillers, and Radio Frequency (RF). Some of the listed treatments improve acne scars by removing and/or injuring the upper layer of the skin. This induced surface injury helps reduce the appearance of acne scars due to a more even outer skin layer and activation of the natural healing of the skin following the surface injury. The natural healing process involves stimulation of new collagen and elastin production in the dermis and tightening of existing collagen, hence, reducing the depth of the scar and tightening it.
Treatment of acne scars requires an individual treatment protocol as not all scars are identical, the best results will be achieved following a professional consultation and assessment with a dermatologist that should take into consideration the different types of acne scars, their location and the patient’s particular sensitivities to the scaring. Below is a list of several methods for treatment of acne scars:
Dermabrasion is a method for treating acne scars by removing the top layers of the skin mechanically through sanding it off or by laser. Removing the top layer of the skin enables a more even contour to the skin surface. Complete healing from this procedure can take months but patients can return to work after a week. While it can offer improvement for certain scars, it cannot get rid of the scar entirely. The number of sessions required depends on the scar conditions, minor scars, will require only one session but several sessions may be required if the scars are deep and extensive.
Laser therapy is actually dermabration mention above. Several different lasers are available for treatment of acne scars. The type of laser selected depends on the type of acne scar. A pulsed dye laser, for example, uses yellow light to remove scar redness and to flatten raised scars. Acne scars can also be improved with laser skin resurfacing. In laser skin resurfacing high-energy light is used to remove unwanted, damaged skin. Patients can usually return to work or regular activity within one week, but the skin may stay sensitive and pink for several weeks or months, particularly after skin resurfacing with a carbon dioxide laser.
This method uses tiny particles (crystals: e.g. Zinc Oxide) to gently scrape away the top layer of dead skin and scarred skin. This is a painless superficial peeling (not to be confused with dermabration mentioned above), usually performed with a rough wand over the skin. The results of the treatment are highly correlated to the skills of the practitioner. Microdermabrasion is suitable for patients with very mild scarring. This method usually requires several treatments to demonstrate mild results it is more of a cosmetic procedure and the results are not dramatic.
This method uses a small piece of normal skin – Punch graft – to replace scarred skin. The scar is removed by a tiny circular “cookie cutter, the tiny punch hole is then filled in with a matching piece of unscarred skin, usually taken from the skin behind the ear. The “plugs” are secured into place for about a week as they heal. This method is particularly helpful for deep scars.
Depressed acne scars can be corrected by injecting fillers into the scar. These include: bovine collagen, hyaluronic acid, synthetic fillers or a patient’s own fat (taken from another part of the body).
This procedure involves the use of a chemical to remove the top layer of the skin. Different chemicals are used for different depth peels. Light peels require no healing time while deeper peels can require up to two weeks to heal. The amount of scarring and color change determines the type of peel deployed.
Some new studies have merged demonstrating improvement of acne scars following radio frequency (RF) facial treatments. Radio frequency in medicine is a common procedure. RF facial treatments create a thermal effect- the skin heats up. The thermal effect triggers the natural process of collagen re-generation and skin tightening. This will improve appearance of scars. RF has also been reported to aid in the treatment of existing acne outbreaks by reducing the duration of the outbreak.
The bottom line to acne and scars treatments is to consult with a dermatologist regarding your treatment protocol, he/she will help you sort out the suitable topical or systemic treatment suitable for your type of acne and can save you money and time by directing you to the right products for you.