b. Prevention of Acne Scars
Nevertheless, the only sure method of preventing or limiting the extent of scars is to treat acne early in its course, and as long as necessary. The more that inflammation can be prevented or moderated, the more likely it is that scars can be prevented. (Click on Acne Treatments for more information about treatment of mild, moderate and severe acne). c. Types of Acne Scars
There are two general types of acne scars, defined by tissue response to inflammation: (1) scars caused by loss of tissue(2) scars caused by increased tissue formation,
Scars Caused by Loss of Tissue
Acne scars associated with loss of tissue—similar to scars that result from chicken pox—are more common than keloids and hypertrophic scars. Scars associated with loss of tissue are:
Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out.
Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time.
Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.
Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious.
Scars Caused by Increased Tissue Formation
The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar.
d. Treatments for Acne Scars
The number of treatments are available for acne scars through dermatologic surgery . The type of treatment selected should be the one that is best for you in terms of your type of skin, the cost, what you want the treatment to accomplish, and the possibility that some types of treatment may result in more scarring if you are very susceptible to scar formation.
A dermatologist's expert opinion as to whether scar treatment is justified in your particular case, and what scar treatment will be most effective for you.
The objective of scar treatment is to give the skin a more acceptable physical appearance.
Total restoration of the skin, to the way it looked before you had acne, is often not possible, but scar treatment does usually improve the appearance of your skin.
The scar treatments that are currently available include:
1.Collagen injection. (Click for more information)
Collagen, a normal substance of the body, is injected under the skin to "stretch" and "fill out" certain types of superficial and deep soft scars.
Cosmetic benefit from collagen injection usually lasts 3 to 6 months. Additional collagen injections to maintain the cosmetic benefit are done at additional cost.
2. Autologous fat transfer. (Click for more information)
Fat is taken from another site on your own body and prepared for injection into your skin. The fat is injected beneath the surface of the skin to elevate depressed scars.
Because the fat is reabsorbed into the skin over a period of 6 to 18 months, the procedure usually must be repeated. Longer lasting results may be achieved with multiple fat-transfer procedures.
3.Dermabrasion. (Click for more information)
This is thought to be the most effective treatment for acne scars. Under local anesthetic, a high-speed brush or fraise used to remove surface skin and alter the contour of scars. Superficial scars may be removed altogether, and deeper scars may be reduced in depth. Dermabrasion does not work for all kinds of scars.
4. Microdermabrasion (Click for more information)
This new technique is a surface form of dermabrasion. Rather than a high-speed brush, microdermabrasion uses aluminum oxide crystals passing through a vacuum tube to remove surface skin. Only the very surface cells of the skin are removed, so no additional wound is created. Multiple procedures are often required but scars may not be significantly improved.
5. Laser Treatment. (Click for more information)
Lasers of various wavelength and intensity may be used to recontour scar tissue and reduce the redness of skin around healed acne lesions. The type of laser used is determined by the results that the laser treatment aims to accomplish.
Tissue may actually be removed with more powerful instruments such as the carbon dioxide laser. In some cases, a single treatment is all that will be necessary to achieve permanent results. Because the skin absorbs powerful bursts of energy from the laser, there may be post-treatment redness for several months Skin Surgery
Some ice-pick scars may be removed by "punch" excision of each individual scar. In this procedure each scar is excised down to the layer of subcutaneous fat; the resulting hole in the skin may be repaired with sutures or with a small skin graft. Subcision is a technique in which a surgical probe is used to lift the scar tissue away from unscarred skin, thus elevating a depressed scar.
Skin grafting
This treatment may be necessary under certain conditions—for example, sometimes dermabrasion unroofs massive and extensive tunnels (also called sinus tracts) caused by inflammatory reaction to sebum and bacteria in sebaceous follicles. Skin grafting may be needed to close the defect of the unroofed sinus tracts.
Treatment of keloids
Surgical removal is seldom if ever used to treat keloids. A person whose skin has a tendency to form keloids from acne damage may also form keloids in response to skin surgery. In some cases the best treatment for keloids in a highly susceptible person is no treatment at all.
In summary, acne scars are caused by the body's inflammatory response to acne lesions. The best way to prevent scars is to treat acne early, and as long as necessary.
If scars form, a number of effective treatments are available. Dermatologic surgery treatments should be discussed with a dermatologist. |
