How to reduce face acne scars. Effective Strategies for Reducing Acne Scars: A Comprehensive Guide

19.07.202326.06.2023 by alexxlab

How do acne scars form. What are the most effective treatments for acne scars. Can natural remedies help reduce acne scarring. Which professional treatments yield the best results for acne scar reduction. How can you prevent acne scars from forming in the first place.

Содержание

Understanding Acne Scars: Types and Formation

Acne scars are a common concern for many individuals who have struggled with acne. These scars can persist long after the active breakouts have subsided, serving as a lasting reminder of past skin troubles. But what exactly are acne scars, and how do they form?

Acne scars develop as a result of inflamed blemishes caused by skin pores engorged with excess oil, dead skin cells, and bacteria. When the pore swells, it causes a break in the follicle wall. Minor breaks heal quickly, but deeper breaks in the follicle wall allow infected material to spread into the dermis, leading to deeper lesions.

Common Types of Acne Scars

Atrophic scars: These are flat, shallow depressions that heal below the top layer of skin. They include ice pick scars, boxcar scars, and rolling scars.
Hypertrophic scars: These are raised scars that occur when the body produces too much collagen as acne wounds heal.
Post-inflammatory hyperpigmentation: These are dark spots left behind after acne heals, which are especially common in people with darker skin tones.

Are all acne marks considered scars. No, not all acne marks are true scars. Some marks, especially those that are red or brown, may be post-inflammatory changes that can fade over time without treatment. True acne scars involve changes to the skin’s texture and require more intensive treatment.

Preventing Acne Scars: Proactive Measures

The best way to deal with acne scars is to prevent them from forming in the first place. Here are some proactive steps you can take to minimize the risk of scarring:

Treat acne promptly: Early intervention is key. The sooner you address active acne, the less likely you are to develop scars.
Avoid picking or popping pimples: This can introduce bacteria deeper into the skin and increase inflammation, leading to a higher risk of scarring.
Use gentle skincare: Harsh scrubs and excessive exfoliation can irritate the skin and worsen acne, potentially leading to more scarring.
Protect your skin from the sun: Sun exposure can darken acne scars and make them more noticeable. Always use a broad-spectrum sunscreen with at least SPF 30.
Stay hydrated and maintain a healthy diet: Proper hydration and nutrition support overall skin health and can aid in the healing process.

Is it possible to completely prevent acne scars. While it’s not always possible to prevent acne scars entirely, especially in cases of severe acne, these preventive measures can significantly reduce your risk and minimize the severity of any scars that do form.

Natural Remedies for Acne Scar Reduction

Many people turn to natural remedies in hopes of reducing the appearance of acne scars. While the scientific evidence for these treatments is often limited, some individuals report positive results. Here are some popular natural approaches:

Aloe vera: Known for its soothing and anti-inflammatory properties, aloe vera may help reduce redness and promote healing.
Honey: With its antibacterial properties, honey may help prevent infection and support wound healing.
Lemon juice: The citric acid in lemon juice is thought to have a lightening effect on hyperpigmentation, but it can also cause irritation and increase sun sensitivity.
Coconut oil: Its moisturizing properties may help improve skin texture, but it can be comedogenic for some people.
Rosehip seed oil: Rich in vitamin C and essential fatty acids, it may help improve skin elasticity and reduce discoloration.

Do natural remedies work for all types of acne scars. Natural remedies may have some benefits for superficial scarring and post-inflammatory hyperpigmentation. However, they are unlikely to significantly improve deep, textured scars. It’s important to use these remedies cautiously and discontinue use if you experience any irritation or adverse reactions.

Professional Treatments for Acne Scar Reduction

For more significant acne scarring, professional treatments often yield the best results. These treatments are typically performed by dermatologists or skincare professionals and can be tailored to your specific skin type and scar profile.

Chemical Peels

Chemical peels involve applying a solution to the skin that causes the top layer to peel off, revealing fresher, less damaged skin underneath. They can be particularly effective for treating superficial acne scars and improving overall skin texture.

Microneedling

This treatment involves using a device with tiny needles to create controlled micro-injuries in the skin. This stimulates collagen production and can help improve the appearance of atrophic acne scars.

Laser Therapy

Various types of laser treatments can target acne scars. Ablative lasers remove the top layer of skin, while non-ablative lasers stimulate collagen production without damaging the surface. Fractional laser treatments create tiny wounds in the skin to trigger healing.

Dermal Fillers

For depressed acne scars, dermal fillers can be injected to raise the depressed areas and create a smoother skin surface. While not permanent, this treatment can provide immediate improvement.

Subcision

This surgical procedure involves inserting a needle under the skin to break up fibrous bands that are pulling down the scar, allowing the skin to rise.

How do you choose the right professional treatment for acne scars. The best treatment depends on your skin type, the type of scars you have, and your individual healing capacity. A consultation with a dermatologist can help determine the most appropriate treatment plan for your specific case.

Topical Treatments for Acne Scar Reduction

In addition to professional treatments, various topical products can help improve the appearance of acne scars over time. These products typically contain active ingredients that promote skin cell turnover, stimulate collagen production, or reduce pigmentation.

Retinoids

Topical retinoids, such as tretinoin or adapalene, can help improve skin texture and reduce the appearance of acne scars by promoting cell turnover and collagen production.

Vitamin C

As a potent antioxidant, vitamin C can help brighten the skin and reduce hyperpigmentation associated with acne scars.

Alpha Hydroxy Acids (AHAs)

AHAs like glycolic acid and lactic acid exfoliate the skin, promoting cell turnover and helping to fade superficial acne marks.

Niacinamide

This form of vitamin B3 can help reduce inflammation, improve skin barrier function, and potentially fade hyperpigmentation.

Hydroquinone

Often considered the gold standard for treating hyperpigmentation, hydroquinone can be effective but should be used under medical supervision due to potential side effects.

How long does it take to see results from topical treatments. Results from topical treatments can take several weeks to months to become noticeable. Consistency is key, and it’s important to use these products as directed and be patient with the process.

Lifestyle Factors Affecting Acne Scar Healing

While treatments play a significant role in acne scar reduction, lifestyle factors can also impact the healing process and overall skin health. Consider the following aspects:

Diet

A balanced diet rich in vitamins and minerals can support skin health. Foods high in antioxidants, omega-3 fatty acids, and zinc may be particularly beneficial for skin healing and repair.

Hydration

Proper hydration is essential for overall skin health. Drinking adequate water helps maintain skin elasticity and supports the body’s natural healing processes.

Sleep

Quality sleep is crucial for skin regeneration. During sleep, the body produces growth hormones that aid in cell repair and renewal.

Stress Management

Chronic stress can impair skin healing and exacerbate inflammation. Practices like meditation, yoga, or regular exercise can help manage stress levels.

Smoking

Smoking can impair wound healing and collagen production. Quitting smoking can have significant benefits for overall skin health and acne scar healing.

Can lifestyle changes alone improve acne scars. While lifestyle factors play a supportive role in skin health and healing, they are unlikely to dramatically improve existing acne scars on their own. However, these changes can enhance the effectiveness of other treatments and contribute to overall skin health.

The Psychological Impact of Acne Scars

The effects of acne scars extend beyond physical appearance. Many individuals with acne scars experience psychological distress, including lowered self-esteem, social anxiety, and even depression. It’s important to address both the physical and emotional aspects of dealing with acne scars.

Coping Strategies

Seek support: Talking to friends, family, or a therapist can help you process your feelings about your skin.
Practice self-compassion: Remember that your worth is not determined by your appearance.
Focus on self-care: Engaging in activities that make you feel good can boost your overall well-being.
Consider professional help: If acne scars are significantly impacting your mental health, consider speaking with a mental health professional.

How can you build confidence while dealing with acne scars. Building confidence is a process that involves self-acceptance and focusing on your positive attributes. Remember that everyone has imperfections, and your acne scars do not define you. Engaging in activities you enjoy, setting and achieving personal goals, and surrounding yourself with supportive people can all contribute to improved self-confidence.

Acne scars can be a challenging issue to deal with, but there are numerous strategies and treatments available to help reduce their appearance. From preventive measures and natural remedies to professional treatments and lifestyle adjustments, a comprehensive approach can yield the best results. Remember that improvement takes time, and what works best can vary from person to person. Consulting with a dermatologist can help you develop a tailored treatment plan that addresses your specific concerns and skin type. With patience and persistence, many people find significant improvement in the appearance of their acne scars, leading to increased confidence and overall well-being.

3 Tips To Prevent And Reduce Acne Scars: Northstar Dermatology: Dermatology

Acne Scars Are Preventable

Read Time: 3 minutes

Acne is an adolescent rite of passage that can leave behind a memorable mark well after the pimples go away. Instead of accepting a fate full of acne scars, individuals can take proactive steps to not only prevent acne scars but also reduce the appearance and size of the marks.

1. Treat acne right away

Acne can worsen without the right medical treatment. Patients should manage the inflammatory and painful symptoms associated with an acne problem right away. Patients can schedule an appointment with a doctor if over-the-counter medications don’t work. Immediate topical treatment prevents acne from becoming larger and developing a permanent scar.

2. Reduce inflammation

Deep acne scars are usually caused by blemishes that are very inflamed and large. The inflammation can cause discoloration and scarring. To reduce the appearance of acne scars, patients can reduce the swelling by avoiding irritating the skin during showers or when applying skincare products. Patients can also use topical spot treatments specifically designed to reduce acne inflammation.

3. Don’t pick at acne

Patients with acne should avoid picking or popping acne, especially with dirty hands. Squeezing pimples can introduce bacteria deep into the dermis and worsen the swelling. When the blemish has popped and developed a scab, patients should also avoid picking the scab to let the wound heal properly.

Don’t forget the sunscreen

Discoloration in acne scars is typically caused by excess melanocytes that can darken the skin. Patients should remember to use a safe and effective sunscreen solution every day to prevent the cells in acne from developing more melanocytes.

When to seek professional help

A simple visit to the dermatologist can help prevent and reduce acne scars. Some types of acne can benefit from a cortisone shot to reduce the pimple and minimize the risk of acne scarring. When scars do appear, doctors can use laser technology to remove the scars. Lasers aim to rebuild new, normal-looking collagen by damaging the scarred spot.

Acne scar reduction is the answer

Unfortunately, most acne scars will be permanent, but a variety of medical procedures can reduce the visibility of the scar color and size. Acne scar prevention is crucial, but not always attainable despite a patient’s best effort. Dermatologists can offer safe and effective treatment when acne scars appear.

Get Fuller Lips with Juvederm®

If you long for fuller lips and wish to avoid surgery, Juvéderm® has a lot to offer. Learn what to expect from this popular treatment.

Encouraging Facts About Psoriasis

Not all news about psoriasis is bad. Consider these encouraging facts about the chronic condition, as well as ways we can help.

4 Ways UV Rays Affect Your Skin

Ultraviolet rays are far from sunshine and roses, from a skin standpoint. Learn how the sun and tanning beds affect your skin and how to prevent or avoid the consequences.

Psoriasis vs. Eczema: Key Similarities and Differences

Both psoriasis and eczema can cause uncomfortable skin symptoms, but they share differences as well. Learn how to differentiate between these conditions, from symptoms to treatments.

Natural acne scar treatment: Can I get rid of acne scars naturally?

NATURAL ACNE SCAR TREATMENT: CAN I GET RID OF ACNE SCARS NATURALLY?

Acne scars can be a major irritation to those who suffer from them, for several reasons. They are a painful reminder of an annoying condition. Many people prefer to use natural remedies to help clear up the appearance of acne scars. However, the science behind these remedies is unclear. Some of these natural treatments may cause further irritation or additional problems, so it is advised to use them with caution.

It’s worth keeping in mind that “natural” doesn’t always mean better for your skin. These methods aren’t proven nor have they been approved by skincare scientists so be aware of things like irritation or soreness, and stop using them if you experience any of these symptoms.

IS NATURAL ACNE SCAR REMOVAL POSSIBLE?

Scars may naturally fade slightly over time, but they will likely not disappear completely without treatment. Natural treatments may have some benefits for superficial and minor scarring, however, for deep skin lesions and scarring, they may cause more harm than good.

WHAT ARE THE TYPES OF ACNE SCARS?

It is best to be aware of the type of scarring that you’re trying to remove. Treatment options that are suitable for addressing the issue may vary depending on the type of acne scarring you have. There are three main types of acne scars:

Hypertrophic scars

These scars occur when the skin has produced too much collagen to heal acne wounds and causes a mass of raised tissue on the skin. It can be itchy and tender.

Atrophic scars

These scars appear as small indentations and develop when there’s a loss of skin tissue.

Icepick scars are usually small noticeable scars that look like pinpricks.
Boxcar scars are larger indentations with clear edges.
Rolling scars have unclear edges and give the skin a rolling or uneven wavy appearance.

Keloid scars

These scars are similar to hypertrophic scars but they tend to be thicker than the original acne spot. These often cause the affected scarred area of skin to darken which increases their appearance in relation to the surrounding skin. They may be red or brown and also may be itchy or painful.

Are there any natural acne scar removal remedies to try at home?

Apple Cider Vinegar

Diluted apple cider vinegar may help reduce the appearance of acne scars. However, make sure the solution is diluted well. Concentrated apple cider vinegar can cause severe burns and further harm the face.

Turmeric Powder

Turmeric Powder has anti-inflammatory properties and can be great for reducing bacterial growth. It also helps skin regeneration and reduces scarring.

Coconut oil

Studies have reported that coconut oil moisturises your skin and prevents acne scars. Keep in mind that if you have extremely oily skin, you should avoid this option as it may worsen the situation. Use cold-pressed coconut oil for this condition.

Tea tree oil

This is a product derived from a tree in Australia that possesses antimicrobial and anti-inflammatory properties. Spot application of oil on the face may help clear bumps and even reduce scarring.

Lemon Juice

Lemon contains natural exfoliating acids that can stimulate cell renewal. While we do not recommend applying raw lemon juice directly onto your skin, you could consider adding it to a homemade face mask. Lemon Juice is rich in sugars, vitamin C and citric acid, although there is a high likelihood it will irritate the skin if you have particularly sensitive skin.

Manuka Honey

Applying Manuka honey is a good option, as it has great anti-inflammatory and antibacterial properties. For dark marks and pigmented skin, apply apple cider vinegar with a cotton bud to the scar, and apply the honey straight afterwards to help soothe the area.

Acupuncture

Acupuncture can be a very effective treatment for scarring as it increases circulation to the area, helping to reduce inflammation as well as stimulating collagen production. This encourages better tissue regeneration, helping to diminish the appearance of acne scarring. It is advised to consult a dermatologist or health care professional first before using this treatment.

What is the best natural acne scar treatment from dermatologists?

When it comes to natural treatments, consulting a professional skin care expert is highly suggested to avoid potentially further aggravating the skin. There isn’t a natural treatment that is proven to be the best, as different treatments work better for some people than for others.

CONSULT A DERMATOLOGIST ABOUT YOUR CASE OF ACNE SCARRING

While some people may have success by using one or more of these natural treatments, they will likely not be effective in cases of stubborn or severe scarring. For these situations, consulting a dermatologist about professional medical treatments will ensure you avoid any adverse side effects of home remedies and give you the best chance of achieving the acne-free skin that you desire.

Visit our page dedicated to acne scar treatments for more information, or contact us here to speak to one of our experts.

Remove acne marks on the face / Laser Doctor Moscow

All promotions

Many people know firsthand that it is not enough just to get rid of acne on the face – they can leave traces and scars after them. However, their removal is often a more complicated process than the treatment of acne. In our new article, we will tell you how to remove acne marks on the face: what procedures are carried out for this, which of them is currently considered one of the most effective.

Pimple marks

Pimples (blackheads) are small formations on the skin that are formed due to the fact that dead skin particles and sebum clog the ducts of the sebaceous glands. There are many ways to treat acne. Sometimes you can get rid of acne without a trace. But in some cases, traces remain after them, which are also a cosmetic defect.

What acne marks are formed on the face:

Pigmentation red or bluish. It is formed due to the deep penetration of the inflammatory process into the skin. This leads to vascular changes in the skin. In addition, red pigmentation often appears due to self-extrusion of papules.
Dark pigmentation. It is formed due to the accumulation of melanin in the affected area. The increased pigment content is due to a protective reaction from ultraviolet rays.
Scars and scars. Formed with an inflammatory lesion of the upper layer of the skin. Quite deep atrophic scars usually appear (located below the level of healthy skin).
Pore expansion. Due to the active production of the secretion of the sebaceous gland, it begins to be deposited in the pores, after which it is mixed with dead skin particles, various impurities, and the remains of cosmetics. As a result, the pores expand and their walls become denser.

At the same time, all traces of acne do not pose a danger to human health, but can seriously affect his appearance. Especially when placed on the face.

Causes of acne marks

Before removing acne marks on the face, you should figure out why they form at all. Currently, the following main reasons for their appearance are distinguished:

Long-term acne treatment or lack of it. Also, the reason may be a late start of treatment.
Self extrusion. The risk is higher with damage to the acne membranes and skin.
Severe inflammatory skin lesions with the penetration of inflammation into the deeper layers.

How to remove acne marks on the face

To remove acne marks on the face, you can sign up for one of the following procedures:

Acid peel. The peeling procedure will help not only even out the skin relief, but also exfoliate the upper stratum corneum. According to the depth and intensity of exposure, chemical peeling can be superficial, superficial-median and median. Superficial is one of the “softest”, and therefore it will not help to eliminate acne marks. For this, a superficial median or median is used. The intensity of exposure depends on the concentration of the active substance. The commonly used TCA is trichloroacetic acid. The concentration of the active substance is determined by the doctor, based on the condition of the patient’s skin and the desired result. After applying the composition, it is left for a certain time. Usually takes just five minutes. After that, the peeling is neutralized with another composition, and the residues are washed off. A full course of superficial-medial peeling can consist of 3-4 sessions. The median one is carried out by a one-time procedure. Since it has the deepest effect, the procedure is carried out in the season with the least solar activity – autumn or winter.
Microdermabrasion. This is a hardware procedure for mechanical resurfacing of the upper layer of the skin. Also allows you to remove acne marks on the face or on the body. It is carried out using a special apparatus that delivers a stream of corundum microcrystals to the surface of the skin. They polish the top layer of the skin, removing acne marks. In addition, after the procedure, recovery processes and the production of new collagen and elastin are activated, as a result of which the skin is smoothed. The manipula of the device is designed in such a way that it delivers microcrystals at an angle of 45 degrees. This is necessary for effective grinding and to prevent clogging of pores by the crystals themselves. The duration of one procedure can be more than an hour. After the end of the session, the specialist applies a nourishing and moisturizing mask to the treated area. The course includes 5-10 sessions.
Injectable cosmetic procedures. They are carried out to activate the processes of recovery and neocollagenesis. In addition, they saturate the tissues with useful substances. To combat acne marks, mesotherapy and plasmolifting are carried out.
During mesotherapy, a specialist injects so-called “meso-cocktails” into the skin with many injections – preparations that may include substances useful for tissues: vitamins, growth factors, collagen, hyaluronic acid, etc. The composition is individually selected taking into account the condition of the skin, the severity of acne marks. Often, the “mesococktail” is collected for each patient individually immediately before administration. The duration of one session is 30-40 minutes, the course can be from four to ten sessions.
Plasmolifting. The procedure for administering injections of the patient’s own plasma – autoplasma. To do this, at the very beginning of the procedure, blood is taken, after which the test tube is sent to a special centrifuge, which separates the blood into plasma and blood cells. After that, platelet-rich autoplasma is injected into the patient’s skin by several injections. To obtain a pronounced result, it will be necessary to conduct 3-4 sessions lasting 30-45 minutes. Before removing acne marks on the face with the help of plasmolifting, it should be remembered that several references will need to be prepared for the session. In more detail about the preparation for plasmolifting, you can talk with a dermatocosmetologist at the initial appointment.
Phototreatment Quantum. For treatment, a special apparatus is used that generates flashes of light of a wide spectrum. Light pulses are absorbed by melanin and hemoglobin. As a result, melanin is destroyed, and the affected vessels are sealed, which leads to an even skin tone. Therefore, the procedure has a complex effect. The duration of one procedure is 15-60 minutes, the course consists of 3-5 sessions.
Laser removal of acne marks on the face. Currently considered one of the most effective procedures. To eliminate traces of acne, a fractional laser is used, that is, a device in which the laser beam is divided into tens and hundreds of smaller beams. The lens arranges the rays in the form of a grid. During laser treatment, microthermal healing zones are formed on the skin, around which the production of new collagen and tissue repair processes are activated. As a result, acne scars are practically erased by laser, after which they are replaced by new healthy tissues. The duration of the procedure is from 20 to 80 minutes, the course consists of three sessions.
The procedure is carried out with ablative (DOT) and non-ablative (Fraxel) lasers. The difference between the devices lies in the effect: the ablative laser creates microthermal treatment zones in the upper and middle layers of the skin, while the non-ablative laser creates only in the middle. Therefore, visible results after DOT will begin to appear within a few days after the session. But the duration of the recovery period can be more than 15 days. After Fraxel, the result will be visible in two weeks, but the recovery period may not exceed 3-5 days.

You can choose the procedure you like to get rid of traces. But it is best to entrust the choice to a specialist during the consultation.

How to quickly remove acne marks on the face with a laser

Before removing acne marks on the face with a laser, you must first consult with your doctor. At the same time, the specialist will take an anamnesis and check you for contraindications to the session. Anamnesis is necessary to select the optimal laser for you, to adjust the intensity. It will also help evaluate the effectiveness of the laser procedure for removing acne marks in your particular case. In addition, at the consultation you will learn how to remove acne and traces of them with a quick and safe laser procedure.

Contraindications:

Viral and oncological diseases.
Acute phase of skin diseases.
Pregnancy and lactation.

If you do not have any contraindications, then laser removal of acne marks can be started immediately after the end of the test.

Laser acne treatment

Before the procedure, the doctor will prepare the skin: it will need to be cleaned, make-up removed, treated with an antiseptic. After that, an application anesthetic is applied to the treated area – an anesthetic in the form of a gel or cream. If the patient has a low pain threshold, then injection anesthesia can also be used. When the painkiller works, the doctor will proceed to the direct treatment of the skin with a laser. The duration of the session will depend on the area being treated. When the procedure is over, the doctor will inform the date of the next session, as well as give prescriptions for the time of the post-procedural period.

Recovery after laser removal of acne scars on the face

After the session, the skin, as a rule, slightly swells. Perhaps redness. Full recovery will depend on the selected laser and its settings. In the early days, it is not recommended to wash your face with running water, use cosmetics. Panthenol-based formulations can be used to speed up the healing process. Also, to accelerate healing, injection procedures can be performed: mesotherapy, plasmolifting, biorevitalization.

During the first four weeks after the procedure, sunbathing is not recommended, and sunscreen with a high SPF level should be used before leaving the room. In addition, within two weeks, trips to the sauna or bath should be excluded. Also, the doctor may give additional prescriptions for the duration of the recovery period.

Procedure in the clinic “Laser Doctor”

Book online
Request a call

SUBSCRIBE TO THE NEWSLETTER

Stay up to date with all the promotions, get exclusive offers every month and an additional discount on your birthday!

By clicking on the button, you consent to the processing of personal data and agree to
privacy policy

Modern methods of correction of post-acne scars

The duration of resolution of inflammatory elements in acne correlates with the risk of scarring. What methods of aesthetic medicine will help to avoid their formation, and which ones will reduce the traces of post-acne?

One study found that 95% of patients had some degree of scarring. According to other sources, the resolution of acne elements with scar formation is 3.4-6.8 times more common in severe forms of the disease than in patients with milder forms of acne. In addition, it was found that in patients who did not receive adequate therapy in the first 3 years from the onset of the disease, cicatricial deformities are formed 1.6–2.8 times more often.

The Global Acne Treatment Alliance proposed to combine the following phenomena under the term “post-acne”:

– cicatricial deformities formed during the resolution of acne rash elements;
– post-inflammatory hyper- and depigmentation;
– congestive erythema.

But if erythema and pigmentation disorders are temporary, then cicatricial deformities remain forever.

There is still no unequivocal answer to the question of what a scar is: a variant of the norm or pathology. According to the classification proposed by A. E. Reznikova (1999), all types of cicatricial deformities can be divided into two groups: normal (normotrophic and atrophic) and pathological (hypertrophic and keloid). This classification is based on the fact that the formation of normal scars occurs as a result of normal physiological protective reactions of the body in response to skin damage, while pathological scars are formed when these processes are disturbed.

Atrophic acne scars

Atrophic scars are the most common, but hypertrophic and keloid scars are also found. At the same time, the severity of scars does not correlate with the severity of the disease. The development of hypertrophic and keloid scars is noted in 10-20% of cases. Their formation is associated with insufficient activity of MMPs. They are localized mainly on the skin of the back and chest, rarely on the face. Keloid scars can develop spontaneously or long after the injury.

Atrophic scars occur in 80-90% of cases and are formed more often on the face, less often on the body. According to modern ideas about the pathogenesis of the scar, the evolution of inflammatory elements of acne with an outcome in an atrophic or hypertrophic scar is associated with an imbalance of MMPs metalloproteinases (MMP-1, MMP-2, MMP-9, MMP-13, proMMP-1, proMMP-9), responsible for the architecture of the extracellular matrix and their tissue inhibitors TIMPs.

Post-acne scars are formed with the participation of P.acnes cell wall peptidoglycan, which, through gene expression of proMMP-2 synthesis, enhances the degradation of the extracellular matrix.

Atrophic acne scars.

M-shaped (Rolling) scars, 4-6 mm
Stretched, receding scars with sloping edges, giving the skin a wavy appearance.

V-shaped (Ice pick) scars, < 2 mm
Acute, deep, receding scars, wide at the surface and tapering towards the base.

U-shaped (Boxcar) scars, 0.1-4 mm
Superficial or deep, wide both at the surface and at the base, round or oval in shape with clear edges.

Forms of atrophic post-acne scars

There are various forms of atrophic post-acne scars: V-shaped (Icepick), M-shaped (Rolling), U-shaped (Boxcar). But since in clinical practice, as a rule, there is a combination of the listed types of scars, differential diagnosis between them becomes very difficult. In this regard, in 2006 D. Goodman et al. The Global Qualitative Classification of Acne Scars was presented (Table 1). This scale is quite simple and convenient for use in clinical practice, which allows you to more accurately determine the tactics of treatment and evaluate the results.

Despite the high risk of developing acne scars, at the moment, the current standards of acne therapy do not indicate the implementation of measures to prevent the development of post-acne scars. Although the need for preventive treatment simultaneously with the main one or as soon as possible after its completion is beyond doubt. To determine the tactics of preventive measures for the development of cicatricial deformities, it is necessary to take into account the predictors of their development.

In this connection, the early start of acne therapy, adequate to the severity of the disease, an integrated approach to solving problems, the joint work of related specialists, the correct attitude of the patient, a sufficient degree of compliance in most cases are the key to a positive result of treatment and prevention of the evolution of acne elements. outcome in the scar.

Treatment of scars must be carried out using a properly selected method, for the choice of which an accurate differential diagnosis of the scar is important. And if it is usually not difficult to distinguish a normotrophic scar from a hypertrophic one, then the differences between a hypertrophic and a keloid scar are far from always obvious.

Table 1. Global qualitative classification of acne scars proposed by D. Goodman and Baron (2006)

severity
lesion level
clinical manifestations
points
1
macular
Erythematous, hyper- or hypopigmented flat scars that do not change the skin relief, but affect its color.
1
2
Weak
Slightly pronounced atrophic or hypertrophic scars, not visible at a distance of 50 cm or more, easily masked by cosmetics, on the chin in men – with a shadow of hair growing after shaving, with extrafacial localization – naturally growing hair.
2
3
Medium
Moderate atrophic or hypertrophic scars, well visible at a distance of 50 cm or more, poorly masked by cosmetics, the shadow of hair growing after shaving or naturally growing hair in extrafacial localization; when the skin is stretched, atrophic scars on the face are smoothed out.
3
4
Pronounced
Pronounced atrophic or hypertrophic scars, clearly visible at a distance of more than 50 cm, poorly masked by cosmetics, the shadow of hair growing after shaving or naturally growing hair in extrafacial localization; when the skin is stretched, atrophic scars are not smoothed out.
4
For the differential diagnosis of hypertrophic and keloid scars, anamnestic data are of the greatest importance. The development of a hypertrophic scar occurs within 6–10 months after injury, while keloid scars can occur spontaneously or several years after injury (Table 2). In patients with keloid scars, there is an increase in deep skin sensitivity; subjectively, itching in the area of the lesion may disturb. Subjective sensations of patients with hypertrophic scars, as a rule, are absent.

Of the additional methods of scar prevention, the use of methods aimed at improving tissue trophism is justified, these include cryomassage, vacuum massage, electrophoresis, phonophoresis, microcurrent therapy, magnetic thermal therapy.

Table 2. Differential diagnosis of normal and pathological cicatricial deformities

normotrophic scars

hypertrophic scars

keloid scars

9000 9 Formation 7–10 days after injury

Formation within 6–10 months after injury

Formation several months, years after injury or spontaneously

No family predisposition

Without subjective sensations

Increased deep skin sensitivity , itching

Scar localization corresponds to the area of injury

Scar extends beyond the injury
At the same level with the surrounding skin or retracted
Elevated above the level of the skin

Flatten spontaneously

May flatten over time
Do not flatten with age
Never ulcerate
May ulcerate 90 003

Very rarely ulcerate

Normal color skin or hypopigmented
Predominantly red, hypo- or hyperpigmented

How to get rid of atrophic scars? In choosing one or another method of correction of an already formed post-acne scar, the presence of inflammatory elements simultaneously with post-acne elements is of great importance, which significantly reduces the range of possible treatment methods. The main treatment of such patients should be supplemented by the use of laser techniques that are also effective against the inflammatory elements of acne (PDL, Nd:YAG laser, diode laser with a wavelength of 1320 nm).

In the absence of inflammatory elements, some types of skin resurfacing, surgical excision of an atrophic scar, the use of dermal fillers and deep peels are approved by the World Acne Treatment Alliance for the correction of post-acne scars.

Methods for correcting post-acne scars

Chemical peels
For the correction of more superficial scars and dyschromia, it is recommended to use mid-surface and medial peels with 70% glycolic acid, 30% salicylic acid, 20–35 TCA or 40–70% pyrolysis inogradic acid [ 3]. Due to its high efficiency, the technique of spot application of deep TCA peeling (CROSS-technique) has become very popular, especially in the correction of V- and U-shaped scars. In a study by N. Khunger et al., there was an improvement of more than 50% in 93. 3% of patients after 4 peels at 2-week intervals.

Surgical method
A universal method for the correction of deep atrophic scars are surgical techniques that are recommended to be combined with one of the skin resurfacing techniques. Thus, in one of the studies on the effectiveness of the method of correction of M-shaped post-acne scars using surgical subcision and 100% TCA peeling in patients with III and IV phototypes (Fitzpatrick), it was found that the subcision method is more effective, causing fewer side effects. However, a further reduction in the depth of the scar defect is more pronounced with subsequent use of TCA.

A method for correcting M-shaped post-acne scars using surgical subcision.

Mechanical skin resurfacing
The use of mechanical dermabrasion (resurfacing of atrophic scars) is justified in the presence of a large number of post-acne scars located close to each other. However, due to the fact that this method is very traumatic, painful for the patient, requiring long-term rehabilitation, with a high risk of side effects in the form of pathological scars and dyschromia, its use is very limited. Microdermabrasion is a more gentle method, but its effectiveness in relation to the correction of deep scars is less pronounced.

Similar to microdermabrasion is the needling method using mesoscooters. According to some reports, this method, stimulating the synthesis of type I collagen, is more effective than IPL systems.

Intradermal stimulation of scar tissue (Skinbiogeting)
This method is used exclusively for atrophic scars and consists in separating the bottom of the scar from the underlying tissues. Technically, this technique is carried out with a simple needle with an injection of novocaine under the scar or a special thread.

Mechanical separation of the scar from the underlying tissues causes aseptic inflammation due to trauma, followed by activation of fibroblasts. The resulting defect is filled with connective tissue, as a result of which the bottom of the scar thickens and, as a result, the depth of the defect decreases.

Dermal fillers
Correction of cicatricial deformities with dermal fillers (filling atrophic scars) has a large number of limitations: it can only be used on atrophic U-shaped scars with low scar tissue density. In addition, depending on the material chosen, it has a short duration of effect – 3-12 months. The advantages of the technique are good patient tolerance and low risk of complications. Stabilized hyaluronic acid, collagen (animal or synthetic origin), adipose tissue are used as fillers.

Mesotherapy
Mesotherapy is used for all types of post-acne scars. Vitamin, biologically active preparations that improve tissue microcirculation are used.

The use of this method is justified in combination with various types of resurfacing (peeling, dermabrasion, laser resurfacing) and in the early stages of scar formation.

Electrophoresis
Electrophoresis with lidase is used only for hypertrophic and keloid post-acne scars in the early stages of their formation. 2 courses of 10 procedures are carried out daily or every other day. The break between courses is 1-2 weeks. The use of lidase is aimed at destroying the extracellular matrix, more precisely its polysaccharide component. Having a “loosening” effect, it promotes the penetration of other medicinal substances. Since collagen is another important component of the extracellular matrix, the use of collagenase, especially at later stages of scar formation, is also pathogenetically justified. Electrophoresis with collagenase is carried out according to a similar scheme. It is possible to combine this method with electrophoresis of prednisolone or dexamethasone, since corticosteroids reduce the activity of fibroblasts, block enzymes involved in collagen synthesis, and also reduce the permeability of the vascular wall, which leads to inhibition of scar tissue growth.

Ultrasonic therapy
This method is based on the use of ultrasonic vibrations with a frequency above 16 kHz. Ultrasound has a defibrosing, anti-inflammatory effect on biological tissue, and leads to an acceleration of local blood circulation. It has been proven that new collagen and elastin fibers formed under the action of ultrasound have greater elasticity.

When using low power – from 0.4 to 0.8 W – ultrasound has a stimulating effect on trophic processes in tissues. Such stimulation is indicated in the treatment of fresh scars. The course is 14-20 procedures with an interval of 2-3 weeks.

As the power increases, the release of heat increases, the defibrosing effect of ultrasound increases, which is necessary for the correction of old scars. The defibrosing, softening effect of scars is achieved in the range of 0.8–2 W/cm2. A mode of constant generation of an ultrasonic wave per zone is recommended for 3-5 minutes with a course of 10-15 procedures every other day.

Laser therapy
Atrophic acne scars are also removed with laser therapy. Still the gold standard in the correction of post-acne scars from laser techniques is the ablative method of CO2 laser correction. As observations show, this technique allows achieving clinically significant results (by 50-81%) after the first procedure. However, due to the fact that the CO2 laser generates high-density energy, has low selectivity to water, and forms additional zones of thermal tissue damage, the risk of side effects is quite high. Erbium laser resurfacing is a less traumatic ablative method due to its high affinity for water molecules. However, to achieve an effect comparable to CO2 laser, several procedures are required.

The emergence of a new method of influencing the skin with a laser beam of fractional photothermolysis made it possible to reduce the trauma of ablative techniques, in addition, it became possible to increase the depth of penetration of the laser beam with minimal trauma to the epidermis.

A feature of fractional lasers is that the radiation used, when exposed to biological tissue, does not come in a continuous stream (as, for example, with broadband lasers), but pointwise, forming scattered multiple microthermal treatment zones 70–150 microns in diameter and 380–1600 microns in diameter. depth around which intact tissue is preserved. This effect is due to a microlens array installed at the output of the light beam, while a high radiation density is provided in the focal spots (about 200 J/cm2).