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Acne scar types

Acne Scarring

Introduction

Acne is a condition that is amenable to treatment at all stages of the disease. Remember that you know all your scars in intimate detail. You see them in the same mirror, with the same lighting at the same time of day. Other people do not see you the same way, and what may surprise you is that infact they often don't care about your scars. People connect by eye contact and facial shape, not the type of skin you have.

If your skin still has active disease then this should be first be brought under control. Treatment recommended would be topical Retin-A. The recommendation would be to start with the lower concentration of 0.025% every night, and then move to the 0.01% if it is tollerated. Daily use can produce flaking in the first six weeks, and be positive about the rosey glow! Once you get through this you will be down to softer healthier skin.

If the skin becomes sore, then Retin-A may need to be used on alternate nights until the skin becomes tollerant. This is likely to dry the greasy skin and improve the texture. This will result in fewer spots and also lighten some of the Post Inflammatory Hyperpigmentation. It is important that the gel is applied to all the involved skin and not just the active spots. A number of lesions will be "brewing" below the surface, and these have to be treated before the erruption occurs. Retin-A is targeted at skin health, not the spots. Better skin health means less spots!

Morning treatment with Benxyl Peroxide will help in the contol of bacteria on the skin and reduce the number of infections. This is often used in the form of DUAC, that also contains a topical antibiotic.

If this is insufficient to control the active disease then Lymecycline 408 mg can be added in as a once a day treatment, and I would consider starting this at the same time as the retin-A. This should be continued for at least six months. After that, you can consider stopping one of the treatments if they are of concern, and continue on monotherapy. If this settles the skin then you may be happy with the result. If not then we can offer CO2  laser resurfacing with an expectation of some improvemnt in the scarring.

Obagi Nu Derm

This system is prescription only cosmetic treatment in a simple twice a day formulation. For more information check the link or take a look at the video.

Smoking

There are 400 poisons, including cyanide in cigarette smoke that interfere with would healing. Smokers get more infections and worse scars. Any treatment for acne should include cessation of smoking.

Antibiotics

Slow release antibiotics are useful in the treatment of active acne. These can be taken long term and often have to be taken for over three months before any benefit can be seen. A commonly used preparation is Lymecycline 408mg taken once a day or Minocin MR taken once a day.

Topical Preparations

Isotrex Gel, Retin A, Tretinoin

These are a derivative of Vitamin A and should be applied at night. They reduce the number of cysts and skin eruptions. They may cause temporary irritation and redness.

Metrogel, Rozex Gel

This is a topical antibiotic and is not usually sufficient alone to combat active acne.

Adapaleine

This is a newer generation topical gel that is applied at night time. It works by reducing the bacterial count in the skin to produce fewer infections, but also improves the skin texture and scarring. This must be used for at least six months and is applied at night.

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Laser Treatment

This has benefits for active acne as well as for soft scars.

Active Acne

The NLite laser is used in active acne to decrease the bacteria that cause the infection. The treatment is almost painless and it has been shown that the treatment reduces the number of eruptions for at least six months. We recommend an initial three treatments followed by one small treatment each time a spot appears.

Acne Scars

The NLite laser works by gently stimulating the skin to produce collagen. The treatment is almost painless and there are no side effects. The collagen produced is your own and so does not degrade like injected collagen. This is indicated to fill out scars that flatten when you stretch the skin. A minimum of two treatments are required.

Fillers

These are indicated to fill out scars that flatten when you stretch the skin.

Restylane, Perlane, Restylane Touch

This is a polymer of Hyaluronic (a naturally occurring inert substance present in all animals) and resorbs completely by 12 months. Often used initially to gauge the potential benefit of other materials and can be topped up at any stage. Most people request further treatment at nine months.

Excision of scars

If the ice pick scar is smaller than 2 mm diameter then it can be excised and left to heal. A small flat white scar is usually more acceptable than the ice pick scar. Results are improved if laser resurfacing is done at the same time. Larger scars sometimes benefit from excision, and a test area can be done first to confirm that the proceudre is right for you.

Punch Graft and elevation

This is a technique reserved for deeply pitted scars. The scar is elevated under local anaesthetic and then resurfaced with the CO2 laser no earlier than two weeks later.

Punch Transplantation

This is where the ice pick scars are excised with a circle and replaced with skin taken from behind the ear. This is suitable for scars 3 mm to 5 mm diameter. This leaves a circular white scar that must be taken into account. This can be blended in to some degree with laser resurfacing.

CO2 Laser

This is a technique whereby the outer layers of skin are evaporated to achieve smoothing of the contours and tightening of the skin. Please see the leaflet on laser resurfacing for more information.

 

Conclusion

Please note that this is only a guide and appropriateness of any specific treatment can only be assessed following a consultation with a practitioner.