Acne scaring occurs in over 95% of people with Acne.  For those with severe scaring, this condition affects self-esteem because people think this condition is permanent. Genetics do influence the severity of acne scaring with Asian people more likely to have hypertrophic (abnormal enlargement) and keloid a thick raised scar that is larger than the original acne outbreak.  African, African-Caribbean and people from the southern region of Indian also are prone to keloid scaring. Studies have shown Laser Acne Scar removal provides longer results.  Non-ablative Acne Scar Removal treats all skin tones. 

Types of Acne Scaring

Atrophic and Rolling Atrophic Scars

Atrophic scars are flat indentations just below the skin surface often in the cheek area.  Rolling Atrophic Scars have sloped wavy edges.  Chemical peels are used to reduce this type of Acne Scar.  A mild chemical peel uses glycolic acid which is an antioxidant exfoliate that takes off the top layers of skin.  A concentration of below 10% with a Ph of 5 is recommended for sensitive skin.  This procedure lessens the appearance of acne scaring, fine lines and wrinkles.  If a deeper level of skin needs to be reached, Phenol (Carbolic acid) may be used with a local anesthetic.  Dermal Fillers and Ablative Resurfacing are also used for this type of acne scar depending on its severity.  A Subcision procedure loosens skin around the treatment area causing new scar tissue to form that will match skin may be done.

Boxcar Scars

Boxcar Scars are treated singularly by laser treatment to diminish the edge of the scar and then fractional ablative or nonablative treatments are used.   Skin that is prone to scaring is more at risk for this type of Acne scars.  Asian and Spanish clients may need to have dermal filler under the scar tissue to keep it from collapsing.  They may also develop transient (temporary) hyperpigmentation so testing behind the ears is done before the full procedure. This test will give an indication if the procedure will have the desired results without causing skin discoloration.  

Preventing Hyperpigmentation

Sun exposure can cause hyperpigmentation sunspots to the face and hands.  It is recommended to use sun block with zinc, with a SPF (Sun Protection Factor) between 30 SPF to 50 SPF rating. Visible light can also cause hyperpigmentation so using a sun screen with mineral iron oxide in it is recommended for these conditions.  It is also advised to wear SPF wear clothes.  Washing clothes in SPF 30 infused sunguard treatment will help SPF treat clothes for up to 20 washes.

Icepick Scars

Icepick Scars are when the scar lesion is up and down.  Fanning out patterns of scarring may also occur with this type of scaring.  This type of scarring may require surgery.  A technique called punch incisions cuts away the scar.  Punch elevation uses the scar tissue by reattaching it at skin level.  Punch grafting is done for bigger and for deeper scars.  Skin from behind the ear may be used to level out the indentation caused from the procedure.  Recovery time includes 10 days for the stitches to hold and heal.  If the stitches used cause scaring, this can be treated with ablation.  

Treating and Preventing Acne

Treating Acne at the time of occurrence helps to prevent scaring by reducing the amount and how deep the inflammation reaches.  Post Inflammatory Hyperpigmentation (PIH) can happen also during Acne outbreaks due to injury and swelling of the skin.  Lifestyle changes such as reducing stress, not touching acne and limiting carbohydrates which causes oily skin reduces triggering Acne conditions.   Tweezing the eyebrows and eye brow waxing can cause ingrown hairs that can cause Acne to develop.  OTC (Over the Counter) drugs for Acne include Retinoids, which contain Vitamin A; Salicylic Acid is used to treat blackheads (closed pores open to the air that turn brown) and whiteheads (small white bumps of closed pores).  Any cosmetics that clog the pores and unclean makeup brushes that hold bacteria can cause acne.  Cigarette smoking is also associated with Comedonal Acne conditions in Women ages 25 to 50. This type of Acne has bumpy skin, blackheads and non-inflamed types of Acne (papules).  Large Comedones may occur in older adults.   Solar comedones due to large amounts of sun exposure may start to develop from age 40.  

Hormonal changes during Pregnancy and Menstruation can bring about Acne.  Acne in Menopause is caused by decreasing levels of Estrogen and androgen imbalances in the skin.  A study in the Journal of Clinical and Aesthetic Dermatology in January 2017 showed Polycystic Ovary Syndrome (PCOS) is also a hormone condition that can cause increased episodes of Acne.   The OTC Benzoyl Peroxide is used for limiting bacteria that causes Acne and helps reduce Acne caused by excess oil production.   All Acne is caused by hormones so the phrase “Hormonal Acne” is misleading and is not used in scientific journals as a term for a type of Acne it is explained.   Androgen hormones increase Acne in both men and women.  

Medical treatments for acne may include a course of antibiotics for acute Acne.  Prescription strength Retinoids may also be used.  Cortisteroids are used to reduce Acne inflammation.  Light therapy Phototherapy has been proved to help bacteria caused Acne lesions.  In the clinical trials published in Dermatologic Surgery in February 2004 85% of trial patients showed a 50% reduction in Acne lesions after four weeks of twice a week treatments.  In 20% of patients 90% of Acne lesions were cleared.  After 3 months of the clinical trial treatment the Acne lesion clearance was between 70% and 80%. In another study published in Lasers in Surgery and Medicine in February 2007 red and blue LED lights phototherapy given two times a week for a month was shown an effective treatment for mild to moderately severe Acne lesions (Acne vulgaris) especially with Papulopustular Acne lesions.  These types of lesions contain a papule (area of raised skin) and pustules (small raised skin with pus inside).  This combined course of red and blue light treatment cleared the bacteria, lessened oil production, and reduced inflammation.

Finding a Dermatologist

The American Academy of Dermatology (AAD) has a Find a Dermatologist online locater for finding a Dermatologist who does Laser Acne Scar Removal.  Dermatology studies have shown that people prefer to have all laser acne scar treatments done in the same place so this is becoming the industry norm.  

Laser Treatments for Acne Scar Removal

Ablative laser therapy uses an intense energy light to take off the outer skin layers.  This stimulates collagen production and decreases the scar depth.  A study in the Journal of Clinical and Aesthetic Dermatology in July 2010 found with Acne conditions of Papules, pustules, and nodules with using laser treatment the sebaceous gland size diminished which caused the condition to be cleared up for a much longer time than other treatments.  It was because of the removal of the bacteria using the 1,5550-nm Erbium- Glass laser and the ablation of sebaceous glands that the client had a longer symptom free  condition. Laser therapy was deemed a less painful and longer term Acne treatment.  This type of laser is also used in Laser Hair Loss Treatments.  Acne is a chronic inflammation of the pilo sebaceous follicles.  This term means related to hair follicles and their sebaceous glands.  Bacteria present in the skin and that caused by touching the acne area can cause severe Acne scarring.

Nonablative laser therapy for Acne Scar removal uses heat for increasing collagen production without damaging the outer skin layers.  This type of Laser therapy is especially suited for darker skin tones which are more prone to Acne scaring.  A Study in Lasers and Surgery Journal in February 2011 showed non-ablative treatment in darker skin tones with the Nd:YAG 1,064 nm laser was used to treat difficult Atrophic Acne scarring because of hyperpigmentation issues.  The study used unknown to reviewer (blind) photos of the clinical results.  The study concluded this laser treatment was a safe clinical procedure that produced desired results in harder to treat darker skin tones without hyperpigmentation issues and there was less discomfort pain than other treatments available.  After the procedure staying out of the sun, not touching the skin and gentle cleaning and moisturizing the skin is needed.

Acne is a condition that needs to be continually treated and as soon as the symptoms develop to prevent severe scaring.  Lifestyle changes of diet, not touching the Acne and treating the Acne with appropriate measures, whether with OTC or prescribed treatments is vital to help reduce Acne scaring.  Once Acne scaring has happened a Dermatologist Acne consultation can help with deciding the best of course of treatment or combinations of treatments to give longer lasting results to reduce and prevent Acne scarring.  Before the nonablative laser treatments darker skin tone Acne clients risked hyperpigmentation and scaring from the procedure that also had to be treated. This is no longer the case and all skin tones benefit from the less painful procedures that produce improved appearance with longer results. 

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