Acne can be mild, moderate or severe but no matter what type it is it can have a huge impact on self esteem. Acne can in some cases lead to lifelong scarring. Early intervention for acne is essential to help prevent permanent scarring. Dermatologists are experts in the management of acne and will tailor your treatment to your individual needs. Acne is a complex disease and treatments that offer long term cure are better than some techniques that improve your acne for a short period only.
The residual effects of acne can leave a variety of different types of scars. Up to 40% of acne suffers with moderate to severe acne will have some form of scarring.
Skin Colour Changes
Skin colour changes are extremely common. In patients with white skin this is usually characterized by flat pink/ red areas that are left behind once the “bumpiness” has resolved. This is called post-inflammatory erythema. People with darker skin often get darker brown marks once the acne has resolved, this is commonly known as post-inflammatory hyperpigmentation. White marks can also occur once acne has resolved. Unfortunately, these post-inflammatory changes do not improve with oral antibiotics or topical anti-acne therapy.
Our dermatologists have many years experience in treating acne. To reduce spots and minimise the chances of scarring, options include:
- Non-prescription creams and lotions: these can help milder cases of acne, but can make the skin dry if used too often.
- Prescription creams prescribed by your dermatologist: these can help to unblock the pores and reduce the bacteria on the skin.
- Oral antibiotics: taken by mouth for several months, antibiotics may reduce the growth of bacteria on the skin.
- Hormonal medications: the contraceptive pill and other hormone treatments may be used to treat acne in some women.
- Oral retinoids/vitamin A: these medications are very effective for the treatment of acne. They reduce the blockage of pores on the skin, making it more difficult for spots and infections to occur. They can only be prescribed by dermatologists.
There are a wide variety of scar types that can develop following acne. The type of scar influences the way it is treated and often multiple treatment modalities are required. For example, deep pitted scars also called ice-pick scars will require more treatment sessions and stronger lasers than flat, thin scars. Some scars can be raised, also known as keloid scars, and they will often require injections of an anti-inflammatory to flatten them down. Most people with acne scars have a combination of different scar types and hence a range of approaches is required which your dermatologist will discuss with you.
Treatment options for acne scarring include non-ablative fractionated laser therapy along with topical retinoids and chemical peels. Surgical options are also available and these include excision and also subscision, a procedure where the skin holding the scar down is released. These options are all designed to improve the appearance of scarring.
Skin Colour Changes
Most of the colour changes will improve naturally over time (6-18 months). Sun protection is important and some topical bleaching creams (eg Kojic and azelaic acid) can help with dark spots. Red spots may respond to laser (vascular laser). Scars develop over time and there is some evidence that early treatment of the post-inflammatory redness may reduce the development of scarring in the future.
Techniques used to manage scars need to be individualised. These techniques include punch grafting, filler injection for acne scars, subcision, photodynamic therapy or injection of corticosteroids.
- Punch grafting: involves removing the scar with a special instrument and then replacing it with normal skin. This procedure is then followed up with laser to smooth the appearance at the edges.
- Subcision: involves dividing the scar tissue beneath the scar and thus allowing the skin back to its original position.
- Thick keloid-like scars: Keloid or hypertrophic scars require the injection of corticosteroid into them. Multiple injections separated by 4 to 6 weeks may be required.
- Soft tissue filler injections: This procedure can be used for a range of scars but this is best suited to deeper ice pick scars to “lift” them up. As scars age they can sag slightly too so replacing lost facial volume in general can also help with the overall appearance of scars. Retreatment is usually required every 1-2 years depending on the soft tissue filler used.
|Mild Acne||Moderate to severe acne||Severe Acne resulting in Scar formation|