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Effective Treatments of Atrophic Acne Scars
Atrophic scarring is often an unfortunate and permanent complication of acne vulgaris. The treatment of atrophic acne scars varies depending on the types of acne scars and the limitations of the treatment modalities in their ability to improve scars.
Acne is a common condition that affects up to 80 percent of the adolescent population to some degree or another. It is caused and characterized by multiple factors including Propionibacterium acnes activity, increased sebum production, androgenic stimulation, follicular hypercornification, lymphocyte, macrophage and neutrophil inflammatory response, and cytokine activation.
How does Acne Scars form?
Inflammatory acne lesions can result in permanent scars. Scarring occurs early in acne and may affect some 95 percent of patients with this disease, relating to both its severity and delay before treatment.
The pathogenesis of atrophic acne scarring is most likely related to inflammatory mediators and enzymatic degradation of collagen fibers and subcutaneous fat.
Types of Acne Scars
Acne scars can be classified into three different types :
Atrophic
ice pick
rolling
boxcar
Hypertrophic
Keloidal
Treatment of Acne Scar
1. Chemical Peel
Chemical peeling is the process of applying chemicals to the skin to destroy the outer damaged layers, thus accelerating the normal process of exfoliation.
Different agents have different depths of penetration, and therefore, chemical peels can be divided into four different groups based on the histologic level of necrosis that they cause.
2. Laser Treatment
1. Ablative Erbium: yttrium-aluminum-garnet (Er:YAG) Laser
Er:YAG emits a wavelength of 2940nm, is 10 times more selective for water than CO2 laser due to its shorter wavelength, and reduces residual thermal damage. Er:YAG at 5J/cm vaporizes tissue at a depth of 20 to 25um with an additional 5 to l0μm zone of thermal necrosis. Thus, Er:YAG has more superficial ablation profile and a smaller zone of thermal damage beneath the ablated layer leading to shorter healing times and a lower rate of side effects. Re-epithelialization takes 4 to 7 days with En:YAG.
2. Ablative lasers Carbon dioxide (CO2) laser.
CO2 laser resurfacing vaporizes tissue at a depth of 20 to 60um and zones of thermal necrosis ranging another 20 to 50um. Energy at 10.600nm wavelength is absorbed by both intracellular and extracellular water, causing rapid heating and vaporization of tissue. Dermal heating below the zone of ablation induces a wound-healing response, which causes collagen remodeling and heat-mediated tissue contraction. Re-epithelialization generally takes 5 to 10 days, and erythema may persist for months. Side effects may include dyschromia (hyper- or hypopigmentation), infection, lines of demarcation between treated and untreated areas, and scarring.
3. Subcision (Subcutaneous Incisionless Surgery)
Subcision is a procedure in which a needle is inserted under the skin and passed in multiple directions. The mechanisms of scar improvement are releasing fibrotic strands underlying scars, organization of blood in the induced dermal pocket, and connective tissue formation in the area.
The advantages of this innovative method include the following: easy to apply, inexpensive, short down-time, applicable for various skin types (I–IV), no significant complications, and remarkable and persistent improvement in short time without injury to the skin surface. The disadvantages include pain at the time of subcision in some cases, bruising, transient discoloration, hemorrhagic papule and pustule, hypertrophic scar, necessity of frequent suctioning sessions, and recurrence.
4. Platelet Rich Plasma (PRP)
PRP injection is designed to promote healing when injected into the body. Typically, PRP therapy is used at a site where an injury occurred, but it also has anti-aging properties that can elevate the overall look of your skin. PRP therapy is a treatment process that involves combining your own plasma and platelets and reinjecting these combined substances into trouble areas in your skin, muscles, or joints to promote healing. This platelet-rich plasma is effective because it contains hundreds of proteins and nutrients that will heal your body naturally from the inside out
By injecting platelet-rich plasma into your face, you can promote cell growth and healing. This healing process allows the skin on your face to feel my hydrated, plumper and younger. Plasma and platelets can be seen as the foundation of great skin.
By increasing the number of platelets in the areas of your face that have been damaged by the sun, scarred by acne, or losing elasticity, you can add a boost to your skin cells so these areas will naturally heal on their own.
5. Skin Booster (Rejuran S)
Rejuran S is a more concentrated version of Rejuran Healer that was specially developed to treat acne scars. It contains Polynucleotides (PN) which are DNA fragments that help repair damaged cells and stimulate collagen. It's ability to boost skin healing and remodel collagen makes it ideal for treating acne scars.
Rejuran S is more concentrated and more viscous (thicker) in texture than Rejuran Healer, allowing Rejuran S be specially suited for acne scar treatments. Being more viscous, Rejuran S "fills" up acne scars to give immediate improvement in appearance. However, this effect is temporary and is not the main purpose of Rejuran S.
Instead, by "filling" and "propping up" acne scars, it creates a scaffold that allows more fibroblasts to stimulate production of collagen for acne scar improvement.
Usually Skin Booster can be a combination treatment with Subcision or fractional ablative laser to have a optimum effect of treatment.
6. Microneedling
Microneedling is the technique of rolling a device comprising a barrel studded with hundreds of needles, which create thousands of micro-punctures in the skin to the level of the papillary to mid-dermis. With this technique, the rolling is usually continued until bruising occurs, which initiates the complex cascade of growth factors that finally results in collagen production. Improvement start to be seen after 6 weeks, full effects take at least 3 months as the new collagen deposition take place slowly. The skin texture will continue to improve over 1 year period. Rolling acne scars and superficial boxcar scars can be treated with Microneedling.
7. Microdermabrasion
First major advance treatment of acne scarring. It is a facial resurfacing techniques that mechanically ablate damaged skin in order to promote re-epithelialization. Microdermabrasion able to improve rolling scar, however Microdermabrasion does not improve ice pick or deep boxcar scars optimally.
