ACNE SCARS
Scarring acne
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)?
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
- 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
- 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)
Ice pick scars
Squares in box scar
Hyaluronic acid fillers
Hypertrophic vs. keloid scars
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
Beauty Derm Service (Annex CC): laser, surgical and dermoaesthetic technologies
INTRODUCTION
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
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 | +++ |