Acne is an inflammatory disease of the skin, caused by changes in the pilosebaceous units (skin the hair follicle and sebaceous gland).
- The typical acne lesions are: comedones, papules, pustules, nodules and inflammatory cysts.
- After resolution of acne lesions, prominent (but temporary) hyperpigmentation is common and permanent scarring may also occur.
- Several factors occur in combination to cause acne, including hormonal changes, plugged pores and secondary bacterial overgrowth in the hair follicle and sebaceous gland units.
- Further research is necessary to establish whether reducing the consumption of high-glycemic foods (such as soft drinks, sweets, white bread) can significantly alleviate acne.
- There is no way to predict how long it will take for acne to disappear entirely.
- Current treatments for acne (these are often used in combination for best results):
- Exfoliation therpies (creams, toners, masks)
- Topical antibacterial medications
- Oral antibiotics
- Hormonal therapies (oral contraceptive pills, spironolactone, cyproterone acetate)
- Topical retinoids (tretinoin, adapalene, tazarotene)
- Isotretinoin (an oral retinoid medication)
- Blue light phototherapy (Levulan-Blu-U (Photodynamic Therapy)) with or without aminolevulinic acid (Levulan)
- Laser therapy
Types of Acne Scars
- Hypertrophic scars: raised, firm thickenings of skin, sometimes red, most commonly occur on back and shoulders.
- Atrophic scars: depressed skin (lower than surrounding skin).
- Pitted scars: deep, narrow scars that are nicknamed “ice pick scars” due to their appearance.
- Acne scars are not the purple, brown or red discolorations that are noticed on the skin immediately after a pimple heals. These marks are called post-inflammatory hyperpigmentation (PIH). PIH resolves gradually over months, and it does not leave scars in most cases.
Tools Used to Improve or Clear Acne Scars
- Subscission - a needle is used to break underlying scar adhesions.
- Chemical peels can smooth textural abnormalities if they are mild.
- CROSS technique (Chemical Reconstruction Of Skin Scars) with tricarboxylic acid (TCA) is a local (applied only to the scar) treatment that is useful for pitted scars.
- ThermaScan laser (1319nm) helps to reorganize and regenerate collagen and other connective tissue in the dermis in a nonablative (no wound) fashion.
- Resurfacing lasers (Erbium, CO2, Fraxel) also smooth the skin surface. They are ablative and semi-ablative lasers that do create a skin wound. The depth of wound and healing time depend on the device that is used.