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Acne scars and treatments

Severe acne often leaves nasty scars where the skin gets a "volcanic" shape. A scar results from the biologic process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g. after accident, disease, or surgery) results in some degree of scarring. Scar tissue is not identical to the tissue which it replaces and is usually of inferior functional quality. For example, scars in

the skin are less resistant to ultraviolet radiation, and sweat glands and hair follicles do not grow back within scar tissue, myocardial infarction causes scar formation in the heart muscle which leads to loss of muscular power and possibly heart failure. However, there are some tissues (e.g. bone) which can heal without any structural or functional deterioration.

In the simplest terms, scars form at the site of an injury to tissue. They are the visible reminders of injury and tissue repair. In the case of acne scars, the injury is caused by the body’s inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle. Two types of true acne scars exist, depressed areas such as ice-pick scars, and raised thickened tissue such as keloids.

Acne scars occur when spots become inflamed or don't heal properly. While some women are more prone to scarring because of hereditary factors or skin colour, there are precautions they can take to prevent scars and treatments available to significantly reduce their appearance.

There are two general types of acne scars, defined by tissue response to inflammation: (1) scars caused by increased tissue formation, and (2) scars caused by loss of tissue.

The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar. The typical keloid or hypertrophic scar is 1 to 2 millimeters in diameter, but some may be 1 centimeter or larger. Keloid scars tend to "run in families"—that is, abnormal growth of scar tissue is more likely to occur in susceptible people, who often are people with relatives who have similar types of scars. Hypertrophic and keloid scars persist for years, but may diminish in size over time.

Acne scars associated with loss of tissue—similar to scars that result from chicken pox—are more common than keloids and hypertrophic scars. Scars associated with loss of tissue are ice-pick scars, depressed fibrotic scars, soft scars, atrophic macules, and follicular macular atrophy. Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out. Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time. Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape. Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious. Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn’t fully develop. This condition is sometimes also called "perifollicular elastolysis." The lesions may persist for months to years.

Acne scars are very hard (and expensive) to treat and it is unusual for the scars to be successfully removed completely. In those cases, scar treatment may be appropriate. The most commonly used forms of scar treatments are:
Dermabrasion - The top layer of the skin is removed to make the scar look less pitted. It makes the scar less visible but does not remove it completely. Multiple treatments may be necessary to get the desired results.
Laser resurfacing - A laser is used to burn off the top layer of the skin.
Punch excision - The scar is excised with a punch tool and the edges are sutured together.
Chemical peels - Different types of acid are applied to the skin so that a smoother layer can surface.
Subcision - The scar is detached from deeper tissue, allowing a pool of blood to form under the scar which helps form a connective tissue under the scar, levelling it with the surface.

More information on acne

What is acne? - Acne is an inflammatory skin disease which affects the tiny pores which cover the face, arms, back and chest and the oil glands attached to them.
What causes acne? - One important factor does seem to be rising levels of the hormones called androgens (male sex hormones) that are found in both boys and girls at the time of puberty. Another factor is heredity or genetics.
What's the treatment for acne? - Acne treatments include killing the bacteria that are caused by the blocked follicles, reducing the secretion of oils from the glands, normalizing the follicle cell lifecycle, and exfoliating the skin.
Acne medicine and medications - Topical acne medications may contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or tretinoin, or retinoic acid. There are numerous non-prescription acne cleansers, astringents, moisturizers and pimple creams available.
Acne scars and treatments - Acne scars occur when spots become inflamed or don't heal properly. Acne scars are very hard to treat and it is unusual for the scars to be successfully removed completely.
What is acne rosacea (adult acne)? - Acne rosacea is a chronic skin condition of the forehead, cheeks, nose, and chin. Rhinophyma may also develop in association with inflammatory rosacea.
What causes acne rosacea? - Flare-ups of rosacea are caused by triggers that stimulate the blood vessels in the face to dilate, which causes facial flushing. There may be some relationship between rosacea and Helicobacter pylori bacteria.
What are the symptoms of acne rosacea? - Symptoms of acne rosacea include frequent flushing, vascular rosacea, inflammatory rosacea, and several other conditions involving the skin, eyes, and nose.
What're the treatments for acne rosacea? - The goal of treatment for rosacea is to reduce or eliminate symptoms and stop the condition from getting worse. Presently, there is no cure for rosacea. 
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All information is intended for reference only. Please consult your physician for accurate medical advices and treatment. Copyright 2005, health-cares.net, all rights reserved. Last update: July 18, 2005