acne continues to affect both men and women from adolescence through to adulthood worldwide. this skin condition commonly affects 80% of people during their teen years and in their twenties, with older adults making up 3% of this population. while acne can be permanently cleared with appropriate treatment, care and knowledge, acne may however, also lead to scarring and in some cases, disfigurement and physical and psychological discomfort. this results in a loss of self confidence and low self esteem.
early acne scars
as the skin begins to heal after experiencing acne lesions, you will notice a red or hyperpigmented mark on the skin indicative of a post-inflammatory change. this is not a scar and instead marks the beginning of a 6 -12 month period of the skin’s healing process. despite the redness (hyperpigmentation) observed in the skin during this remodeling process, complete and normal healing of the skin occurs when acne lesions cease to develop in the area. permanent defects or acne scars occur only when the skin continues to show signs of colour defects or changes in colour after this period of time.
preventing early acne scars
acne lesions lead to acne scars. thus, preventing the occurrence of acne lesions which result in post-inflammatory changes is one sure way of avoiding early acne scars. acquiring knowledge of factors surrounding the development of acne and the best treatment suited to various acne types is also essential in preventing acne scarring.
treating early acne scars
as the skin heals and recovers from the post inflammatory changes caused by acne, it is handy to know that this healing process is facilitated by available practices and medications which help prevent acne scars.
wearing a good sunscreen is one way of treating acne scars as the healing process is further delayed by skin prone to sun exposure and lack of appropriate protection. thus, the skin’s remodeling process can be helped in two ways; alpha-hydroxy acids speed up this remodeling process as well as aid in healing post-inflammatory changes, while a combination formulae in the right proportions of alpha-hydroxy acids (ahas) and beta-hydroxy acid (bha) when administered in accurate concentrations and ph levels also aid in healing acne scars.
during the skin’s remodeling process, scabs may form which function to protect the healing process beneath. these scabs should never be picked as premature exposure of the skin during the healing process prevents complete healing of the acne, and also inhibits the development of post-inflammatory changes.
skin rejuvenation through the topical or oral application of antioxidants is thought to heal as well as prevent skin damage. however, there is no proven scientific studies on this and therefore, skin rejuvenation through antioxidants still remains a hype until further research can be done. incidentally, it has been discovered that vitamin e applied to wounds undergoing healing has not proven as successful as hoped in healing acne scars.
types of acne scars
ice pick scars
as the name suggests, this variety of scars appear on the skin in the form of a deep “hole” or piercing, as if made by an ice pick or sharp instrument. typically, ic scars are characterized by long, narrow scars that extend deep into the dermis and to the naked eye, appear as e pick a large open pore.
how does it form?
when a cyst becomes infected or when a deep inflamed blemish erupts on the skin’s surface, skin tissue is destroyed. a long column like scar develops due to this which is then known as an ice pick scar.
punch excision or punch grafting can be used to treat ice pick scars.
characterized by round or oval depressions with steep vertical sides, boxcar scars contribute to the skin’s uneven or concave-ridden appearance. they are also generally wider than ice pick scars.
how does it form?
the loss of tissue is the main factor in boxcar scars developing. during an inflammatory breakout, collagen is destroyed resulting in the loss of tissue. this loss of tissue support leads to a depression in the skin over time and creates what we call boxcar scars. the severity of these scars is also dependent on the amount of tissue lost.
punch excision or elevation, dermal fillers, and laser resurfacing are some of the available treatments for boxcar scars.
when ‘normal’ skin appears bumpy with “wave-like” undulations, this type of scarring is known as rolling scars.
how does it form?
the characteristic rolling appearance of the skin is caused by the direct pulling of the epidermis on the skin from within. fibrous bands of tissue develop between the skin and subcutaneous tissue below and proceed to bind the epidermis to deeper skin structures by pulling on the skin.
subcision is the recommended treatment for rolling scars.
hypertrophic or keloid scars
raised, firm bumps which are actually a mass of tissue, is typical of hypertrophic scars. they tend to grow larger than the original wound and are commonly found on the torso in men.
how does it form?
hypertrophic scars are a result of an overproduction of collagen and not a loss of tissue. this is how they differ from ice pick or boxcar scars.
there are treatments that help shrink and flatten hypertrophic scars such as the use of steroid (cortisone) creams, tapes, or injections. in addition, scar tissue can also be softened by administering interferon injections.
what option should i take?
deciding on a treatments for acne scars is not always straightforward. the medical treatments and surgical procedures available and mentioned above all work to effectively treat acne scars. as always, there are pros and cons to every procedure, and in some cases, procedures may be combined to provide the most effective tool in dealing with the acne scar. however, it is important to note that sound knowledge in carrying out these procedures safely and smoothly will result in the anticipated outcome without any known pigmentation or hypo pigmentation developing
ultimately, when considering your acne scar treatment options, always look for non-invasive treatments that have no side effects post treatment. using glycolic acid (aha acid) with a combination of ipl treatments or introducing dermal growth factors can greatly improve the scars though treatment results will vary from individual to individual depending on ones age ie. skin on younger individuals have a higher probability of healing.