A Brief Overview on Acne
Acne is a chronic and chronic issue that effects an estimated 85% of adolescents and often continues into adulthood. It is caused by a combination of several factors:
- Hair follicles become blocked with an overabundance of normal skin cells, mixing with sebum (oil-like substance), that create a plugged follicle/pore.
- Hormones can increase sebum production and during adolescence sebum producing oil glands enlarge.
- Bacteria can feed off of this increased sebum production and the increased production will lead to an overgrowth of this bacteria.
- Bacterial overgrowth can cause inflammation. Inflammation can lead to the hair follicle to rupture and the formation of a red or tender pimple.
Acne can often resulting in scarring secondary to the trauma the skin undergoes. Early and effective treatment of acne is the best means to minimize and prevent acne scarring.
Acne scarring is thought to be a direct result of your skin’s response to inflammation. Not everyone will experience acne scarring and those who do may not experience the same type of scarring.
Acne scarring is broken down into the following classifications:
- Atrophic Scars: The most common type of acne scarring, these scars are known for their formation from the destruction and loss of collagen in the skin. These form as indentations in the skin. They are further classified as “ice pick”, “rolling” and “boxcar scars”.
- Hypertrophic Scars and Keloids: Less common than atrophic scars, this type of scarring results in a firm, raised bump.
Often these types of scars will have associated erythema (or redness).
You may hear your provider refer to this as post-inflammatory erythema (PIE) or post-inflammatory hyperpigmentation (PIH). Though just as frustrating, PIE and PIH are not true forms of acne scarring. PIE and PIH can be thought of more as a “foot print” of acne or other sources of inflammation in the skin (eczema, fungal rashes, etc). When acne is well-controlled and inflammation is no longer persistently causing injury to the skin, this foot print will fade over time. However, this process can take months to even over a year.
Your provider can discuss the best option for addressing your PIE or PIH with you, but the foundation of treating PIE and PIH is time and sunscreen (SPF 30 or higher). The sun will darken these marks and elongated the amount of time required for them to fade.
Treatments for Acne Scarring
Treatments do exist for true acne scarring, but there is no treatment that will completely resolve a textured acne scar. Scars are considered permanent. It is also important that your active acne is well-controlled prior to attempting to treat your scars.
There is no one treatment that is effective for all scarring. Your provider can discuss the best options for you. Some options include:
- For Atrophic Scars: the basis of the more common treatments is collagen stimulation. This is when we traumatize the skin in a safe and controlled manner to help stimulate collagen production. This process can be slow and collagen production and remodeling can continue for up to 6 months after treatment. Often several treatments are required and your provider will take photos to attempt to monitor your progress. Some ways to stimulate collagen include:
- Chemical Peels
- More superficial chemical peels (like Skinceuticals Vitalize Peel) can help with minor texture scarring and can help with PIE/PIH.
- Collagen P.I.N. is a pen-like device with 12-36 tiny needles that deliver this controlled trauma to the skin. Your skin is numbed prior to the procedure with topical anesthetic and your provider will review post-care instructions and limitations with you.
- Fractora is another microneedling device but differs from Collagen P.I.N. in that it combines microneedling with radiofrequency. The radiofrequency delivers heat deeper into the skin to help with collagen neogenesis (new formation), while the tiny needles stimulate collagen production in the top layer of the skin. This device also greatly improves active acne.
- Chemical Peels
- Non-Fractionated/Non-Ablative Laser
- This type of laser will create small channels into the skin to heat under the skin, stimulating collagen neogenesis. Though more treatments may be needed in comparison to Ablative Resurfacing, there is less associated downtime and can be safer for darker skin.
- The most common treatment for these raised, firm (sometimes painful) scars is steroid injections into the scars. It can help reduce redness and flatten these scars.
- Silicone: Silicone has been shown to mildly improve the overall appearance of scars over time.
If you are suffering with active acne or are left with acne scars, the general dermatology providers at Braun Dermatology and Skin Cancer Center would love the opportunity to meet with you, review your concerns and create a treatment plan that works for you and your lifestyle. Call 571-302-5377 to schedule in Kingstowne, VA or 202-293-7618 to be seen in our Washington, DC location!
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