Acne vulgaris or pimple is a common problem, affecting about 80 percent of people in the age group between 11–30 years. This is an inflammatory skin disorder of the pilosebaceous units of the face, chest, upper arms, and back.
1.When do you call it Acne ?
Acne lesions can be primary like papules, pustules (Boils), comedone (Blackheads & Whiteheads)which may lead to secondary lesions including erythema(Red Spots), dispigmentation(Black Spots) and scars.
2.What is cause of Acne ?
The presence of acne is currently attributed to increased sebum(Oil) production which stimulates the inflammatory process and lead to skin damage.
3.Why do Pimples Leaves Scars ?
Acne scars result from an altered wound healing response to skin inflammation and are determined by the depth and duration of the lesions.
4.What are the Types of Scars Caused ?
Acne scars can be atrophic (pitted) –associated with loss of collagen and hypertrophic scars (thickened)- associated with gain of collagen.
90% of people with acne scars show atrophic scars. Further, atrophic acne scars have been classified as ice-pick (V-shaped), rolling (W-shaped), and boxcar (U-shaped).
5.How can one Avoid Scars ?
Primarily, it is vital to reduce the intensity of the inflammation in acne to prevent acne scars by the use of topical Retinoids and chemical peeling.
Oral Medications are usually reserved for severe acne lesions.
Physical treatments for acne include comedone extraction, chemical peels, intralesional corticosteroid injection for acne cysts.
6.What are the other Treatments Available for Acne Scars ?
Multimodal approaches are effective in treating acne scars. Usually the procedures may need to be repeated at certain intervals to maintain the improvement. These include skin resurfacing, filling, lifting with PRP, needling and grafting. Resurfacing procedures are the common interventions done for acne scars and include chemical peels, dermabrasion, microdermabrasion, laser resurfacing and radiofrequency. The size, type, and severity of the scar are the basic considerations in acne scar management
What are Chemical Peels and do they help in Acne ?
Chemical peels: Chemical peeling is a skin resurfacing procedure commonly used for facial rejuvenation.
Superficial peels such as lactic acid, salicylic acid, glycolic acid, Jessner solution, and 10 to 25% trichloroacetic acid affect the superficial layer of the skin Medium depth peels like 35 to 50% trichloroacetic acid affect the epidermis and papillary dermis.
The choice of chemical peels should be individualised, based upon the patient’s skin type, colour, history of acne or other skin diseases and relevant treatments, and expectations.
Are Dermabrasion and Microdermabrasion mean the Same ?
Dermabrasion completely removes the epidermis and penetrates to the dermis, to induce remodeling of the skin's structural proteins. Microdermabrasion is a more superficial variation of dermabrasion and only removes the outer layer of the epidermis and accelerates the natural process of exfoliation. Both these techniques are effective in the treatment of acne scars and produce clinically significant improvements in skin appearance.
Are Laser Resurfacing Safe ?
Laser resurfacing helps a lot to improve the tone, texture, and pigmentation of the skin. Fractional CO2 laser penetrates into the skin and promotes new collagen formation within the dermal defects. Fractional erbium-doped yttrium aluminium garnet (Erbium or pixel) laser has a more precise ablation of skin with even less damage to surrounding tissue. The number of sittings is subjective and depends on the depth and type of scar.
Is there any other Laser which can Treat Acne Scars?
Intense Pulse Light (IPL) acts by heating the dermis and stimulates new collagen formation. With the use of filters, we can manipulate the pulse duration and energy levels in IPL to achieve preferred effect for treating various conditions like acne pigmentation (dark spots), post acne erythema(redness) and shallow acne scars.
Do Radio Frequency can play any Role in scar Treatment?
Radio frequency delivers a current through the dermis that stimulates dermal remodelling. Microneedle bipolar RF and fractional bipolar RF treatments offer good results for icepick and boxcar scars.
Can deep acne scar be Smooth Ened?
Depression caused by scars can be lifted by injecting a Fillers underneath. There are several types of fillers. Resorbable filler such as hyaluronic acid are safe and lasts for 6-12 months. Nonresorbable fillers and Autologous fat transfer are other options.
What are new Treatments Available for Pimple Scars?
Autologous Platelet rich plasma (PRP) enhances wound healing by accelerating tissue repair. Platelets are the first cells to arrive at the sites of tissue damage and they mediate tissue repair by the release of growth factors. Intradermal injections of PRP improve acne scarring and also used for skin rejuvenation.
Acne and scarring may lead to low self-esteem, reduced quality of life and negative psychological impact on the individual. Prevention of acne scarring is the primary aim of treating any acne lesion. Early treatment of acne lesions is the best approach to prevent acne scarring.
A patient-centered, multi-step approach taking into account the acne scar type and patient’s need will give the best cosmetic results.