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ACNE SCARS

Cicatricial acne (scars caused by acne) is a common inflammatory pathology in young people, which affects the pilosebaceous follicles. They initially manifest with blackheads (comedones: obstruction of the exit of the follicle), pustules and cysts that some evolve into scars.

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    Scarring acne

    In general, juvenile acne leaves no trace after a few months of its own evolution, although recalcitrant or severe forms have an emotional impact, with loss of self-esteem, anxiety and depression.

    The most frequent location is the face, being the back and presternal area, locations of different evolution, due to the own cutaneous tightness of the area, bulky scars are formed that do not self-involute, unlike the other scars. Any acne can leave scars. When faced with acne, we must know if there is a history of abnormal scarring. Acne can last for years and should be treated according to the type of acne.

    Causes of acne scars (acne cicatricialis)?

    Often, the causes of acne scars are due to untreated or ineffective treatments. Frequently, some scars are secondary to self-manipulation, improper skin cleansing and sometimes 21% are due to a genetic factor.

    The hyperproduction of sebum, the plugging of follicles and the presence of bacteria interact in its pathogenesis.

    The excess of androgens in recalcitrant cases, in polycystic ovary syndrome or by hormonal drugs such as progesterone or corticosteroids.

    There are drugs involved such as phenytoin, antidepressants, lithium and biological treatments.

    Types of acne scars

    • Atrophic
    • Hyperpigmented
    • Hypopigmented
    • Hypotrophic, keloid
    • Ice beak
    • Square (box scar)
    • Wavy

    Treatments for each type of scar

    Atrophic scars

    Due to the elimination of collagen fibers upper dermis

    • Peelings were once widely used. Lasers: non-ablative pulsed, are comfortable and allow a return to work within 24 hours.
    • Dermoroller: excellent, requires several sessions and can be incorporated within a few hours. They are effective in creating a new skin in the marks of a few microns in the form of stippling, respecting the surrounding perifollicula that allow to regenerate the micro wound quickly, we can modulate the depth and energy without damaging the surrounding anatomical structures.

    Hyperpigmented - Hypopigmented Scars

    Due to the elimination of collagen fibers upper dermis

    • Pulsed dye laser. Recommended for erythematous (reddened and inflamed) and sensitive scars.
    • Pretreatment with depigmenting formulations + depigmenting laser. Recommended for pigmented acne scars.
    • In the hypopigmented ones, it is ideal to incorporate to the physical treatments to the topical treatments especially tacrolimus in the individualized master formulation, regulated through the melanocytes surrounding the atrophy.

    Hypotrophic scars - Wavy. (In sea waves)

    Estas cicatrices son las más difíciles de tratar: Tenemos procedimientos de aplanamiento por técnicas ablativas o segando la base o raíces de la cicatriz con agujas especiales y rellenos focales de ácido hialurónico

    Ice pick scars

    These acne scars are not very visible if they are few in number and require stretching the skin to better visualize them. They are the infundibulae (hair outgrowth). They are deep. To remove them we have several options such as minimal injection of trichloroacetic acid inside the pore, the dermaroller or pulsed laser that control their emission of light and heat selectively affect the perifollicular walls.

    Squares in box scar

    The combination of several treatments. Release the roots of the scar with the subcutaneous needle procedure followed by several sessions of ablative laser resurfacing.
    Hyaluronic acid fillers

    Hypertrophic vs. keloid scars

    Hypertrophic scars are reversible with time (about one year approximately) and respond well to corticosteroid infiltrations, pressure, silicone application and pulsed dye laser. Its control and treatment is decisive to avoid keloid evolution.

    Keloid very frequent in areas where there is skin tightness: lower third of the face, nape of the neck, trunk and extremities. They are pruritic due to their growth activity.

    Si son queloide de menos de un año, tenemos buenos resultados con infiltraciones de corticoides, bleomicina, 5 fluoracilo y asociado a láser colorante.

    En queloides recalcitrantes, la exéresis con láser CO2 e inmediatamente radioterapia localizada, exenta de riesgos con las tecnologías actuales. Controles post tratamiento y aplicación de siliconas.

    Protocol

    Pablo Umbert Institute Corachán Clinic (CC)
    Beauty Derm Service (Annex CC): laser, surgical and dermoaesthetic technologies

    INTRODUCTION

    Dr. Pablo Umbert and collaborators perform a prior examination, age, location, degree of pigmentation, age of the scar or scars and their etiology.
    Observe other body scars
    The emotional and psychological state is important
    We evaluate the different options, specifying the different techniques.

    • Months of little sunshine.
    • Explanation of the procedure to be carried out with images of similar cases.
    • Number of sessions.
    • Time required for post-treatment (“Day time”).
    • Possibility of mixed treatments.
    • Different technologies, which we adapt to each patient.
    • Costs.

    PROTOCOL DESCRIPTION

    • General clinic visit, assess mentioned parameters.
    • What medications do you take.
    • Seasonality.
    • Dermatological assessment: pigmentation, skin aging, previous treatments.
    • Pretreatment preparation.
    • Preventive antiherpetic treatment.
    • Informed consent.

    TYPE OF SCAR

    Individualized treatments depending on: Shapes: point or peak, valley, square, triangular, linear.
    Depth; papillary, medium, deep dermis.
    Hypertrophic, hard or keloids: LASER COLORING is the star associated with infiltrations, topical application of silicones and compression methods.

    PROCEDURES

    Day Time Duration Anesthesia No. Sessions Cost
    Peelings +- 2 – 4 days 30 min +- topical 1 +
    Dermoroller 1 day 30 min +- topical +- 3 ++
    Laser Resurf. non-ablative +- 1 day 20 – 30 min +- topical 2-3 +++
    Laser Resurf. ablative 4- 6 days 40 min topical +- 2 ++++
    Plastic surgery 1 day +- 45 min Local 1 Variable
    Refill +-2 days 10 min No +- 1-2 Material and quantity
    Dye Laser; hypertrophic scars No 5 min No +- 2-3 +++

    CONCLUSION

    Dermatologists are experts in the biology of the skin, the anatomical structures, such as the reactivity of the skin in scar formation. Each scar must be assessed individually. In most cases we use mixed techniques.
    Doctor Pablo Umbert