First acne now scarring, what can I do?

Life can seem terribly unkind when after years of struggling with acne, you are left with scarring – a constant reminder of what was once there. Acne scarring can develop in a number of ways for different skin types and different acne types.

Acne is caused by genetic and hormonal factors and has nothing to do with poor hygiene. It is common in teenagers but can continue into adulthood. Most people with acne tend to grow out of it. Acne is caused by pores on the skin becoming blocked with sebum (natural oil) and dead skin cells. Once this happens bacteria gets trapped and starts multiplying, causing comedones pustules papules and cysts.

Acne Scarring

It helps to understand the type of acne you had/ have so you can determine the type of scarring that’s been left behind. Problematic scarring tends to be caused by the more severe forms of acne, with nodules more likely to leave permanent scars than other types of acne. To achieve the best results it is advisable to start treatment for acne soon after it appears to prevent further severe acne and more scarring. If you have nodules, see your GP or dermatologist for treatment. Also before any treatment for scarring can be considered the acne does need to be under control first.

There are different types of scarring. Depressed scarring may develop after inflammatory acne. Ice pick scars are one of the hardest scars to treat as they are narrow deep scars. Boxcar scars can be treated with CO2 lasers, fraxel and chemical peels. They are generally depressed scars larger than ice pick scars but with defined edges. Lastly there are rolling scars, whereby the scar tissue is depressed and thinner but the edges are smooth and rounded.

A more uncommon type of acne scarring is when the skin becomes thicker, known as hypertrophic scarring or keloid scarring.

Pigment changes are also a risk for anyone who has had acne, or any other type of inflammatory condition. Hyperpigmentation, hypopigmentation and erythema are all pigment changes which can occur as a consequence of acne. The red or brown marks which are left after a spot has healed do tend to fade in time but to avoid them becoming more permanent it is also important to wear a sun block when you are outside. Try to avoid picking or squeezing spots too as this will also lead to further tissue damage and scarring.

There are many treatments available which will help to improve the appearance of post acne scarring. Microdermabrasion is good for removing dead skin cells and unblocking and refining pores. It has more of a rejuvenating effect and is suited to skin types where the scarring is minimal or there is no scarring at all. Chemical peels are another option where the top layers of skin are removed using a chemical such as an alpha or beta hydroxy acid. This encourages the skin to regenerate, however the depth the peel penetrates is not as tightly controlled as some other laser treatments. This method is quite effective for pigmented scarring; however it is not always advisable for darker skin tones. It is best to have a full consultation if you are interested in chemical peels to see what chemical is best suited to you. Fraxel laser is highly effective at treating deep and superficial scars. It does not remove any skin layers so the down time is much shorter. Most people just look a little swollen and sun burnt afterwards. It works by firing tiny holes into a set fraction of the skin which causes an increase in collagen and elastin. It is capable of improving icepick, boxcar and rolling scars. Fewer treatments are also needed with Fraxel laser treatment compared to other treatments. Laser resurfacing may be suitable for hypertrophic scars, where the scar has become very thick. This type of laser burns off the excess layers so that the scar is smoother and less noticeable.

Most laser treatments do include a local anaesthetic cream to be applied to the area before they treat you. This makes laser much more comfortable for you. A dermatologist would be a recommended professional to help you choose the most appropriate treatment plan.

A dermatologist may also prescribe special creams to boost the regenerating effects within your skin, thus improving results even further. They may even suggest using a product only homecare regime first, designed to improve scarring and review the results a few months later. Clinic treatment is not always required, so it is definitely worth seeking advice from an expert first.

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