This month we’ll be discussing scars. A difficult but treatable condition. People with acne or trauma scars may be very self conscious, shy or suffer from a low self-esteem. Acne scarring in particular has devastating psychological effects on teenagers especially
Treating a scar takes a very long time to treat but the rewards are worth the effort. Unfortunately it is very difficult to totally eradicate them; however they can be made to be much less visible to the naked eye.
Inflamed acne must be treated as soon as possible otherwise scar damage may be severe and difficult to treat. The old adage always applies that prevention is better than cure. A dermatologist should be sought out at this stage and treatment started without delay. If this is not possible, a visit to your local gp will help with prescription antibiotics until the dermatologist can be seen.
A good skin care regimen aimed particularly to acne prone oily skins is recommended to be incorporated into your daily regimen. Examples of such products are excuvience/neostrata, cetaphil, eucerin and most of the big cosmetic houses carry a range for acne prone skin.
How does a scar form?
The wound healing process goes through 3 stages:
2) Granulation/scar formation
3) Matrix remodelling – where the outer surface of the skin is broken down, into the outer surface of the scar. The skin has a decrease in elasticity which is why the scar is tight. There is also a decrease in blood flow hence the white colour of a scar towards the end of the healing period.
Some acne patients are predisposed to scar formation due to a stronger inflammatory reaction at the gland that produces the acne, while other patients may never develop a scar at all. It has also been shown that the inflammatory process is slower in those that don’t develop scars. It is so important for early intervention to be implemented and treatment initiated to stop the inflammatory process.
Scars can be pitted and shallow or stick out like a keloid scar.
Pitted scars are classified into:
1) Ice pick – majority of patients, looks like a tooth pick piercing hole.
2) Box car – 20 -30% of acne scars. Occurs on temple area as an oval angular depression and is muh wider than an ice pick scar
3) Rolling scars – uncommon – seen as a shallow depression with change of light
Hypertrophic or raised scars:Typically pink, raised and firm and is thick with collagen and are within the border of the original injury.
Keloid scarring: very large and extend beyond the border of the original wound. These scars are unfortunately more common in darker skins.
Treatment is a multi approach embodying various methods.
Firstly : Prevention , prevention prevention.
At this stage usually ruaccutane, antibiotics and topical retinoids are used to prevent scarring. Use of silicone gel has proven effective for prevention of scars, especially hypertrophic or keloid.
Treatment options include:
• Chemical peels
• Dermal fillers
• Laser treatment – ablative and non-ablative
• Dermal grafting
Combination treatments are generally used. In my practice I use a very effective combination of chemical peels, microneedling, subcision and dermal fillers especially with ice pick scars with very effective results. Treatment can take from 6 to 10 appointments for scarring but usually after the third appointment patients start to see visible results and leave the rooms feeling more confident and satisfied with their skins. Call my rooms for a free consultation 011 616 4040
1)Glycolic acid: for mild acne scars. Approximtely 6 treatments every 2 weeks increasing from 20 – 70%
2) Salicylic acid: best for Indian and African skins. Excellent for blemishes and macular scarring. 5-6 treatments very 3 – 4 weeks
3) Tca: medium depth peel, 6 treatments 4 weeks apartand can only be used in lighter skin types
Subcision for acne scar treatment:
This involves using a needle or cannula to break the fibrous bands that holds down the scar to the deeper layers of the tissue so the scar literally pops up. We use this technique with wrinkles too!! We break the band that holds down the wrinkle so it is released thus giving it a soft appearance.The depression is lifted and normal collagen is formed from underneath.
This needs to be repeated until the scar has relevelled. Once this occurs resurfacing treatments such as microneedling/ lasers can be used to improve skin texture.
Very useful for depressed scars. They attract water into the collagen cells and raise the skin of the scar to the surface and give a smoother look. My preference is to use hyaluronic acid fillers. The procedure needs to be repeated yearly
A handheld handpiece that vibrates with needles which make puncture wounds. This stimulates the healing process that finally results in new collagen production. This is a superb treatment for scarring and anti-ageing as thickening of skin and a dramatic increase in new collagen and elastin fibres are seen. This procedure actually produces new fibroblasts which are the small cells that produce collagen. Remarkable – a treatment that uses your own body to produce new skin… Like? The full effects are seen at 3 months due to deposit of new collagen.
Microneedling creates a natural response to wound healing and making of new skin. A microscopic injury is created to initiate the wound healing cascade. The skin becomes tighter, firmer and smoother with natural colour formation. As a very narrow channel is created approximately 4 cell width thick a closed wound is produced and not a scar.
For very severe scarring, laser CO2 abaltion is required. This is an expensive procedure and may require more than one treatment. Be careful when choosing your laser clinic carefully to ensure that they are reputable.
Hope you enjoyed this month’s topic. xx