Acne Scarring - Acne Scars

Acne scarring occurs when the visible remnants of acne are permanently left on the skin after the acne itself subsides. True scarring is to be distinguished from macules, or reddish spots that mark the site of prior acne.
Causes

Acne scarring is caused by a variety of factors. When acne is produced on the skin as a response to sebum, the body may attempt to target the inflammation with white blood cells. Once the inflammation has subsided, however, the tissue may have yet to be fully repaired, and as such, scar tissue will show. It is important, however, to note that marks on the skin are not necessarily scars; simple marks will usually disappear within seven months.

Types

There are two types of acne scarring. They are:

1. Hypertrophic scarring, which results in a growth of tissue. Excess collagen is produced, and in severe cases, large outgrowths may result.
2. Atrophic scarring, which results in a loss of tissue. This type of scarring is much more common than hypertrophic scarring. There are several types:
1. Atrophic macules. These are small, bluish-whitish skin colorations, and are usually less visible than other types of scarring.
2. Depressed fibrotic scars. These are large, depressed valleys on the surface of the skin. They are usually jagged.
3. Follicular macular atrophy, or perifollicular elastolysis. This consists in small, slightly raised lesions, similar in appearance to whiteheads.
4. Ice-pick scars. These less severe versions of depressed fibrotic scars.
5. Soft scars. These are gentle, scar-like depressions in the skin. They are usually small, and either circular or linear.

Prevention and treatment

Some people are more prone to acne scars than others. Acne scars should be treated early, with dermatological consultation, to reduce their visibility and size later in life.

There are several forms of treatment for acne scars in current usage:

Dermabrasion

Dermabrasion is a cosmetic medical procedure in which the surface of the skin is removed by abrasion (sanding). It is used to remove sun-damaged skin and to remove or lessen scars and dark spots on the skin. The procedure is very painful and usually requires a general anaesthetic or "twilight anaesthesia", in which the patient is still partly conscious[1] Afterward, the skin is very red and raw-looking, and it takes several months for the skin to regrow and heal. Dermabrasion is useful for scar removal when the scar is raised above the surrounding skin, but is less effective with sunken scars.

In the past, dermabrasion was done using a small, sterilized, electric sander. In the past decade, it has become more common to use a CO2 or Er:YAG laser. Laser dermabrasion is much easier to control, much easier to gauge, and is practically bloodless compared to classic dermabrasion.

Microdermabrasion

Microdermabrasion comes from the above mentioned technique dermabrasion. Microdermabrasion is a more natural skin care that is a gentler, less invasive technology for doing an exfoliation on the skin. The goal of the microdermabrasion is to eliminate the superficial layer of the skin called the epidermis. If the surface of the abraded skin is touched, a roughness of the skin will be noticed. The roughness is keratinocytes, which are better hydrated than the surface corneocytes. Keratinocytes appear in the basal layer from the proliferation of keratinocyte stem cells. They are pushed up through the cells of the epidermis, experiencing gradual specialization until they reach the stratum corneum where they form a layer of dead, flattened, strongly keratinized cells called squamous cells. This layer creates an efficient barrier to the entry of foreign matter and infectious elements into the body and reduces moisture loss. Keratinocytes are shed and restored continuously from the stratum corneum. The time of transit from basal layer to shedding is generally one month. Corneocytes are cells derived from keratinocytes in the late stages of terminal specialization of squamous epithelia. The microdermabrasion is done to eliminate some of the corneocytes. These cells are responsible for the impermeability of the skin. The minimizing or elimination of scars, skin lesions, blotchiness and stretch marks from the skin can be an easy process with the use of skin exfoliation. The result depends on how well the procedure known as "skin remodeling" works. Results are optimal and fewer treatments are needed with more recent and/or superficial scars. Still, microdermabrasion can be used on scars that showed up during puberty or many years later.

Laser therapy

Fractional laser resurfacing is a procedure which wounds the skin using microscopic pulses of light. Over the course of several treatments scars are softened as the body regenerates the areas of microthermal wounding. Several lasers are now on the market such as the Matrix RF, Affirm Laser, Fraxel Laser, Pixel Laser, and Sciton Profractional. Laser resurfacing is a technique used during laser surgery wherein molecular bonds of a material are dissolved by a laser. CO2 or erbium energy is used to treat the areas of discoloration closer to the surface and also penetrates deep into the dermis, eliminating damaged cells and stimulating the growth of new collagen. Collagen is stimulated for up to 4 months and this new collagen regeneration lifts and supports the skin's surface. The generation of the new skin cells in combination with collagen stimulation will dramatically improve the appearance of acne scars. Depending on the depth of the scars, some patients may require anywhere from 1 to 3 treatments for acne scar removal.

Chemical therapy

Chemical peels improve and smooth the texture of the facial skin using a chemical solution that causes the skin to blister and eventually peel off. The regenerated skin is usually smoother and less wrinkled and scarred than the old skin.

Subcision

Subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as laser resurfacing, microdermabrasion or chemical peels can be used to smooth out the scarred tissue.
Biological treatment

The best way to treat acne scarring is to start early and continue for as long as is necessary. There are, however, a number of treatments available when suffering from scar formation. The idea behind biological treatment of acne scarring is that old, damaged tissues and scars are replaced by new cells. Mucin, from the snail Helix Aspersa Müller, is used in topical creams. The secretion from the Helix Aspersa Müller regulates the skin healing and scar formation process. These topical treatments focus on the creation of healthy skin cells instead of aggravating the body's inflammatory immune system response. The natural ingredients can saturate deep into the skin and promote cellular turnover. Damaged tissues and acne scars are diffused into their own amino acid components and released back into the body as the basis of new cellular growth. One step in the healing process involves an enzyme that starts a metabolic effect and a signal transduction that triggers the process of skin repair and skin remodeling. This metabolism works with extremely complex sequences of controlled biochemical modification of chemical compounds in living organisms and cells. Through these metabolic processes the enzymes can affect how fast a swelling or an edema of injured tissue is reduced. They do this by "digesting" or breaking down the damaged tissue. The waste material is thereby removed from the skin lesions so as to reduce inflammation, speed up the healing process and encourage regeneration of new tissue. In biology, signal transduction is any process by which a cell converts one kind of signal or stimulus into another. These processes often involve a sequence of biochemical reactions inside the cell. These reactions are carried out by enzymes and linked through second messengers. The processes can last a millisecond or as long as a few seconds. In transduction processes, an increasing number of enzymes and other molecules become engaged in the events that proceed from the initial stimulus. In such cases the chain of steps is referred to as a "signaling cascade" and often results in a small stimulus eliciting a large response. So, biological ingredients with active parts like antioxidants, anti-inflammatory, proteins, peptides, and enzymes can with rather little effort stimulate the speed in which the body heals itself.

Improved exchange between cells promotes proliferation which improves collagen and elastin levels in the skin. Biological ingredients will fuse with the skin cells and stimulate the production of fibroblasts which provide the structural framework for the skin. It dissolves existing post inflammatory scars and also fills in depressed scarring. The biological ingredients do this by stimulating the replacement of damaged skin cells, getting rid of scarring and necrotic tissues. They also stimulate the formation of the extra cellular binding between cells, thus improving skin strength, cutting down on fragility, and inhibit microbiological activity of dangerous, pathogenic skin bacteria, including acne.

References

1. ^ Anderson, Laurence. 2006. Looking Good, the Australian guide to skin care, cosmetic medicine and cosmetic surgery. AMPCo. Sydney. ISBN 0-85557-044-X.