Acne and acne scarring treatment has developed tremendously over the last 20 years, even though the pathogenesis of acne scarring is still not fully understood.
The National Library of Medicine and Health published a paper in 2010 on acne scar pathogenesis. The report details that the pathogenesis of acne scarring arises from multiple factors such as testosterone levels, increased production of sebum oils from the sebum glands and “proliferation of Propionibacterium acnes (P. acnes) within the follicle and follicular hyperkeratinization” to name but a few.
We know that acne scarring is a result of acne – a byproduct of the initial skin condition. The biological process of healing from acne scarring takes into account, lipids produced by the sebaceous glands, along with hormone management of the size of the glands, as well as other events such as “P. acnes inducing IL-8 and IL-12 release from TLR2 positive monocytes”.
All of which can stimulate the “infrainfundibular inflammatory process, follicular rupture, and perifollicular abscess formation, which stimulate the wound healing process” – causing acne scarring to occur.
THE TWO TYPES OF ACNE SCARRING
There are two types of acne scarring that occur. These are:
Atrophic Acne Scarring
Atrophic acne scars are the most common of the two acne scar types. Typically an atrophic scar appears when the damaged skin heals below the outer layer of skin tissue causing imbalanced scarring. Typically, this creates ice pick, boxcar and rolling acne scars. Mainly, ice pick acne scarring is the result of atrophic acne scarring.
Hypertrophic and Keloidal Scars
Hypertrophic acne scars are the result of excess collagen production during the wound healing process. The outcome is typically the red blemishes and raised skin profile that causes patches of red bumps around the skin.
MODERN TREATMENTS FOR ACNE SCARS
Acne scarring treatments continue to look into how the damaged skin can be treated in the least invasive way possible. In truth, dermatology strives to find a way to help identify a solution for acne before scarring occurs. However, modern advancements in the technology used by dermatologists to treat acne scarring have resulted in effective ways of treating acne scarring over the course of a 6-8 week treatment programme.
Microneedling is often confused with punch excisions, due to microneedling similarly excising the skin to break up scar tissue and trigger collagen regrowth. Ice pick scarring typically requires microneedling as a form of treatment due to the technique damaging the skin to promote collagen production.
This acne scar treatment penetrates the scar with hundreds of tiny needles all at once creating multiple ‘channels’ within the acne scar that allow the collagen regeneration to be spread evenly across the scar tissue, allowing the skin to raise to smooth and even levels.
Laser Acne Treatments
Laser acne treatments are often used in more severe cases of acne scarring. Dermatologists will often refer to punch techniques, chemical peeling and medical retinoids before looking to use laser acne treatments.
Laser acne treatments are often used more frequently with atrophic acne scarring. Deep tissue acne scarring such as boxcar and rolling acne scars are more likely to require laser acne treatments than ice pick scarring.
Two forms of acne lasering treatment can be used on atrophic acne scarring. These are:
Ablative Acne Laser Treatment
Ablative laser treatment removes damaged scar tissue by melting the layers of the skin showing scarring tissue. Typically, this laser treatment abrades the outer skin layers to help tighten collagen fibres in the deeper layers of the skin. This flattens and smooths out the acne scarring, creating a much more flatter skin layer in the process.
Non-Ablative Acne Laser Treatment
Non-Ablative lasers stimulate new collagen formation. This does not melt or remove any skin tissue and is a less invasive acne laser treatment. The reformation of new collagen helps to tighten the skin, raising the scar to the skin surface in the process, again smoothing out the skin layer.
Chemical Peels as Acne Scar Treatments
Chemical peels use Glycolic acid to help exfoliate the skin and are used for skin types that are high in bacteria. This acne scar treatment removes the outer layer of your skin and is typically used for Hypertrophic and Keloidal Scars which again encourages collagen to the surface layers, helping to tighten the outer layer and even out the skin, producing a flatter skin layer with less redness and soreness.
Microdermabrasion for Acne Scarring
Used as a form of aesthetic skin services, Microdermabrasion is often used to help treat acne scarring over the course of an acne scar programme. Microdermabrasion works by abrading the skin and sucking out the dead skin cages within the hair follicles. The removal of dead skin cells in the outer layers of the skin where the acne scarring has occurred reduces blockages in the pores as well as bacteria on the skin, allowing for a much cleaner/smoother skin profile.
Punch Techniques for Acne Scarring
Punch techniques are often used for icepick and boxcar acne scarring.
Specifically for ice pick acne scars, Punch excision works by surgically removing the scar and sealing the remaining wound. This smooths out and evens the outer layers of the skin.
Specifically for boxcar acne scars, Punch elevation tackles the base of the scar, surgically removing it and allowing the sides of the scar to remain where they are. The base of the scar is reattached to
the side scarring, however, it is ‘lifted’ which levels out the skin surface.
Punch grafting is used in cases of severe ice pick acne scarring. The wound is removed and then plugged with skin taken from elsewhere on the body.
KNOWING WHICH ACNE SCARRING TREATMENT IS BEST FOR YOU
If you feel your acne scarring is unbearable and hasn’t been treated by home remedies, visiting an acne dermatologist is the first course of action we would suggest taking.
Acne clinics have spent decades researching and treating this skin condition, which gives them the credibility, knowledge and experience in knowing which acne scar treatment is most suitable for the type of acne that you have.
For more information, please feel free to contact us and book an appointment to learn more about how we can support you with your acne.
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