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Acne Scarring
A detailed and comprehensive discussion of acne scars starts with causes of scarring, prevention of scarring, kinds of scars, and treatments for scars.
Just before speaking about scars, a word about spots that may appear like scars but are not scars in the sense that a permanent change has occurred. Even although they are not true scars and disappear in time, they are visible and can trigger embarrassment.
Macules or "pseudo-scars" are flat, red or reddish spots that are the final stage of most inflamed acne lesions. Following an inflamed acne lesion flattens, a macule may possibly remain to "mark the spot" for up to 6 months. When the macule sooner or later disappears, no trace of it will remainunlike a scar.
Post-inflammatory pigmentation is discoloration of the skin at the website of a healed or healing inflamed acne lesion. It happens more regularly in darker-skinned individuals, but sometimes is observed in people with white skin. Early remedy by a dermatologist might decrease the development of post-inflammatory pigmentation. Some post-inflammatory pigmentation could persist for up to 18 months, specifically with excessive sun exposure. Chemical peeling might hasten the disappearance of post-inflammatory pigmentation.
Causes of Acne Scars
In the easiest terms, scars kind at the website of an injury to tissue. They are the visible reminders of injury and tissue repair. In the case of acne, the injury is induced by the bodys inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle. Two types of correct scars exist, as discussed later: (1) depressed locations such as ice-choose scars, and (two) raised thickened tissue such as keloids.
When tissue suffers an injury, the body rushes its repair kit to the injury internet site. Amongst the elements of the repair kit are white blood cells and an array of inflammatory molecules that have the task of repairing tissue and fighting infection. Nevertheless, when their job is completed they may leave a somewhat messy repair web site in the kind of fibrous scar tissue, or eroded tissue.
White blood cells and inflammatory molecules might remain at the website of an active acne lesion for days or even weeks. In men and women who are susceptible to scarring, the result might be an acne scar. The occurrence and incidence of scarring is nonetheless not nicely understood, however. There is considerable variation in scarring amongst 1 particular person and one more, indicating that some folks are a lot more prone to scarring than other people. Scarring frequently final results from serious inflammatory nodulocystic acne that happens deep in the skin. But, scarring also could arise from much more superficial inflamed lesions. Nodulocystic acne that is most likely to outcome in scars is noticed in these pictures:
(Pictures utilised with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides)
The life history of scars also is not properly understood. Some people bear their acne scars for a lifetime with little adjust in the scars, but in other folks the skin undergoes some degree of remodeling and acne scars diminish in size.
Folks also have differing feelings about acne scars. Scars of a lot more or less the same size that may possibly be psychologically distressing to 1 particular person could be accepted by another individual as "not too negative." The person who is distressed by scars is a lot more probably to seek treatment to moderate or eliminate the scars.
Prevention of Acne Scars
As discussed in the preceding section on Causes of Acne Scars, the occurrence of scarring is different in diverse men and women. It is hard to predict who will scar, how comprehensive or deep scars will be, and how lengthy scars will persist. It is also hard to predict how effectively scars can be prevented by effective acne therapy.
Nevertheless, the only certain technique of preventing or limiting the extent of scars is to treat acne early in its course, and as extended as required. The far more that inflammation can be prevented or moderated, the more likely it is that scars can be prevented. (Click on Acne Remedies for much more information about therapy of mild, moderate and extreme acne). Any particular person with acne who has a known tendency to scar must be below the care of a dermatologist. (Click on Locate a Dermatologist to find a dermatologist in your geographic area).
Varieties of Acne Scars
There are two common types of acne scars, defined by tissue response to inflammation: (1) scars caused by enhanced tissue formation, and (2) scars triggered by loss of tissue.
Scars Caused by Increased Tissue Formation
The scars brought on by elevated tissue formation are called keloids or hypertrophic scars. The word hypertrophy indicates "enlargement" or "overgrowth." Each hypertrophic and keloid scars are related 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, normally irregularly-shaped scar. The photo shows a common extreme acne keloid:
(Photo utilised with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides)
The standard keloid or hypertrophic scar is 1 to two millimeters in diameter, but some may possibly be 1 centimeter or more substantial. Keloid scars tend to "run in households"that is, abnormal development of scar tissue is more most likely to take place in susceptible men and women, who frequently are individuals with relatives who have equivalent sorts of scars.
Hypertrophic and keloid scars persist for years, but may possibly diminish in size more than time.
Scars Brought on by Loss of Tissue
Acne scars linked with loss of tissuesimilar to scars that outcome from chicken poxare much more common than keloids and hypertrophic scars. Scars associated with loss of tissue are:
Ice-choose scars usually occur on the cheek. They are generally little, with a somewhat jagged edge and steep sideslike wounds from an ice choose. Ice-pick scars may possibly be shallow or deep, and could be tough or soft to the touch. Soft scars can be improved by stretching the skin difficult ice-choose scars cannot be stretched out.
Depressed fibrotic scars are usually quite big, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-choose scars may possibly 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 typical skin. They are typically little, and either circular or linear in shape.
Atrophic macules are normally fairly little when they take place on the face, but may possibly be a centimeter or bigger on the body. They are soft, typically with a slightly wrinkled base, and might be bluish in appearance due to blood vessels lying just below the scar. More than time, these scars change from bluish to ivory white in color in white-skinned people, and turn out to be considerably much less clear.
Follicular macular atrophy is much more likely to occur on the chest or back of a particular person with acne. These are modest, white, soft lesions, frequently barely raised above the surface of the skinsomewhat like whiteheads that didnt totally create. This situation is sometimes also called "perifollicular elastolysis." The lesions could persist for months to years.
Remedies for Acne Scars
A quantity of remedies are obtainable for acne scars via dermatologic surgery. The type of therapy selected ought to be the one particular that is best for you in terms of your kind of skin, the cost, what you want the treatment to accomplish, and the possibility that some sorts of remedy might outcome in much more scarring if you are quite susceptible to scar formation. stretch marks removal
A selection to seek dermatologic surgical remedy for acne scars also depends on:
- The way you really feel about scars. Do acne scars psychologically or emotionally impact your life? Are you willing to "reside with your scars" and wait for them to fade over time? These are personal decisions only you can make.
- The severity of your scars. Is scarring substantially disfiguring, even by objective assessment?
- A dermatologists professional opinion as to no matter whether scar remedy is justified in your certain case, and what scar remedy will be most productive for you.
Ahead of committing to remedy of acne scars, you should have a frank discussion with your dermatologist concerning these questions, and any other individuals you really feel are important. You want to tell the dermatologist how you feel about your scars. The dermatologist demands to conduct a full examination and figure out regardless of whether remedy can, or really should, be undertaken.
The goal of scar remedy is to give the skin a more acceptable physical appearance. Total restoration of the skin, to the way it looked just before you had acne, is often not achievable, but scar therapy does usually enhance the look of your skin.
The scar treatments that are currently available contain:
Collagen injection. Collagen, a regular substance of the body, is injected beneath the skin to "stretch" and "fill out" certain types of superficial and deep soft scars. Collagen treatment generally does not function as nicely for ice-pick scars and keloids. Collagen derived from cows or other non-human sources can not be utilized in people with autoimmune ailments. Human collagen or fascia is valuable for these allergic to cow-derived collagen. Cosmetic advantage from collagen injection normally lasts three to 6 months. Extra collagen injections to sustain the cosmetic advantage are accomplished at additional price.
Autologous fat transfer. Fat is taken from another web site on your personal physique and ready for injection into your skin. The fat is injected beneath the surface of the skin to elevate depressed scars. This approach of autologous (from your personal physique) fat transfer is typically utilised to proper deep contour defects brought on by scarring from nodulocystic acne. Since the fat is reabsorbed into the skin more than a period of 6 to 18 months, the procedure generally should be repeated. Longer lasting final results may possibly be attained with a number of fat-transfer procedures.
Dermabrasion. This is believed to be the most successful treatment for acne scars. Under nearby anesthetic, a high-speed brush or fraise utilised to get rid of surface skin and alter the contour of scars. Superficial scars may be removed altogether, and deeper scars may possibly be decreased in depth. Dermabrasion does not function for all kinds of scars for instance, it may possibly make ice-choose scars more noticeable if the scars are wider under the skin than at the surface. In darker-skinned individuals, dermabrasion may cause adjustments in pigmentation that require added treatment.
Microdermabrasion. This new method is a surface kind of dermabrasion. Rather than a higher-speed brush, microdermabrasion makes use of aluminum oxide crystals passing by way of a vacuum tube to eliminate surface skin. Only the very surface cells of the skin are removed, so no additional wound is developed. Several procedures are usually essential but scars could not be drastically enhanced.
Laser Therapy. Lasers of different wavelength and intensity could be used to recontour scar tissue and decrease the redness of skin about healed acne lesions. The kind of laser utilised is determined by the results that the laser therapy aims to achieve. Tissue may possibly actually be removed with far more potent instruments such as the carbon dioxide laser. In some instances, a single therapy is all that will be needed to attain permanent outcomes. Due to the fact the skin absorbs strong bursts of power from the laser, there could be post-therapy redness for numerous months.
Skin Surgery. Some ice-pick scars may possibly be removed by "punch" excision of each person scar. In this procedure each and every scar is excised down to the layer of subcutaneous fat the resulting hole in the skin may be repaired with sutures or with a tiny skin graft. Subcision is a approach in which a surgical probe is utilized to lift the scar tissue away from unscarred skin, hence elevating a depressed scar.
Skin grafting might be essential beneath certain conditionsfor example, at times dermabrasion unroofs enormous and substantial tunnels (also named sinus tracts) induced by inflammatory reaction to sebum and bacteria in sebaceous follicles. Skin grafting might be needed to close the defect of the unroofed sinus tracts.
Therapy of keloids. Surgical removal is seldom if ever utilised to treat keloids. A particular person whose skin has a tendency to type keloids from acne harm might also kind keloids in response to skin surgery. Sometimes keloids are treated by injecting steroid drugs into the skin around the keloid. Topical retinoic acid could be applied straight on the keloid. In some situations the greatest remedy for keloids in a highly susceptible person is no remedy at all.
In summary, acne scars are triggered by the bodys inflammatory response to acne lesions. The finest way to stop scars is to treat acne early, and as long as needed. If scars type, a number of successful treatments are obtainable. Dermatologic surgery remedies ought to be discussed with a dermatologist.
