Acne and You

Acne scars can be more distressful than the pimples and cysts that cause them. Before answering the question posed, it's necessary to discuss the different types of scars.

Most acne scars are not true scars and aren't permanent. Post-pimple marks are pink, red or brown spots that will fade with time and can be covered by makeup. Pink or red marks should fade in 3 to 4 months.

Dark brown marks can last 6 months to a year or longer. These are caused by the melanin pigment in the dermis found in cells called melanophages. These scavenger-like cells remain behind to clean up the pus and mess caused by papules and pustules. The challenge in treating these medically is penetration to the depth of the upper dermis, where melanophages reside. The darker your skin, the darker the spots will be. They can be treated painlessly with skin lighteners containing hydroquinone, which does not affect the normal skin color.

Superficial scarring, such as small, shallow depressions, can be improved with topical retinoids, available over-the-counter and in prescription medications. If caught early, these depressed, shallow scars may respond to microdermabrasion, which helps stimulate collagen production. There are over-the-counter microdermabrasion products, or you can have it done professionally. At minimum, 6 to 8 treatments performed on a weekly basis is necessary to see any results.

Treatment of more serious acne scars

Shallow, sunken depressions in the skin with fairly smooth edges, and sunken depressions with ragged, uneven edges are known as Dell scars. Several treatments with microdermabrasion can soften the ragged-edge scars a bit. Laser resurfacing with a CO2 laser or radiofrequency treatments have shown promising results for long-term improvement of these scars. Areas of sunken depression may be filled with materials such as bovine (cow) or human collagen. For deep depressions, there are permanent fillers which serve as something like Bondo does on dents in a car. If you decide on this option, discuss it with the doctor and make sure you understand the pros and cons - if the filler fails, it can leave an even bigger depression and larger scar than you had originally.

The scars usually found on the cheeks are called ice-pick scars, because of their appearance - they look like someone has taken an ice pick to the skin. They're small, deep holes with jagged edges and steep sides. These can evolve over time into depressed fibrotic scars, which also have sharp edges and steep sides, but are larger and firmer at their base than ice-pick scars. These scars are difficult to treat, unfortunately. They require surgery, either cutting out the hole and sewing the sides together, or transplanting skin from behind the ear to fill in the hole, then lasering the entire area so it blends in with the surrounding skin.

Severe cystic acne scarring can result in sinus tracts, leaving spaghetti-like tunnels under the skin that connect one sebaceous gland to another. These pull down and tether the skin. Extensive surgery to remove these tracts may lead to further scarring and increase the likelihood that new cysts will form in these damaged areas. If you have this type of scarring, seek out an accomplished specialist with references for performing surgery on these types of scars.

You can see from the above that scarring can be difficult to remove, which is why the primary goal of most dermatologists is to prevent scarring. If your acne is progressing to the severe stage and home remedies and over-the-counter treatments aren't working for you, see a dermatologist immediately.

There are some people who have acne scarring on their faces that is embarrassing to them and they want to get rid of it.  However, many of the methods that are available nowadays are very painful and entail down time from work, which is not an alternative for many people.  The therapy is also not often covered by the insurance that the person might have, so in addition to losing work time, the entire cost of the procedure must be covered out of pocket.  Although there are often payment methods that people can use to cover the expense, this is still a big decision and commitment to smooth out the skin of the face.  For those with mild scarring, there are a few methods that may work to resolve their problem.  One of these is called the acne scar laser treatment.  For those who have deeper, pitted scarring, there are other methods, such as the acne scar removal treatment.

How Laser Treatment Works

Ablative laser acne scar laser treatments use lasers that remove the top layers of the skin. At the same time, it heats the underlying skin (the dermis) and stimulates the growth of new collagen fibers.  The skin that forms as the wound heals is smoother and tighter.  In this way, the scars are removed with the top layers of skin and the collagen stimulation helps with the healing process and to make the skin fuller and healthier looking once the healing has occurred.  The recovery with ablative laser therapy is painful, since the top layers have been taken off of the skin, and require the patient to recover at home rather than being able to go about day-to-day activities.

Laser resurfacing is a popular option. It removes damaged skin and allows younger-looking skin to take its place. It is effective for minor facial flaws. It has the drawback that the effects aren't permanent and have to be repeated. Nonablative lasers avoid injury to the surface skin and treat the underlying layer, This stimulates the production of collagen but requires less recovery time because the upper layer of skin isn't damaged by the treatment. They are less powerful, however, and usually require multiple sessions.

What to Expect from Laser Acne Scar Treatment

The procedure is performed in an outpatient surgery center or in a surgical suite in the doctor's office. No overnight hospital stay is required. Because the procedure can be painful, the skin is usually numbed with a topical anesthetic and you may be provided with a sedative to help you relax. You may be given general anesthesia if the planned laser treatment is extensive.

Ablative laser resurfacing procedures take anywhere from 30 minutes to 2 hours, depending on the technique used and the size of the area being treated. After the procedure, you'll look kind of like a boiled lobster! You'll feel like you have a severe sunburn, your skin may be raw, oozing and have blisters. You may have pain. The surgeon or the surgery center staff will advise you on postoperative care and followup.

Nonablative procedures are known as "lunch time" procedures because they don't damage the epidermis (the upper layer of skin) and patients don't have the boiled lobster look.

You may notice an immediate difference in skin quality and will likely continue to see improvement over the 6 to 12 months following your procedure. Although the effects of laser resurfacing can last for years, repeat procedures may be necessary.

Which laser acne removal is best for you?

This is something you'll need to discuss with your dermatologist and/or the surgeon you are consulting with about the procedure. Each has it's pros and cons and it really depends on how severe your acne scars are, what procedure will be most effective, and what you can tolerate in terms of recovery.

When I was a teenager and well into my young adult years, I suffered from horrible acne. I spent a lot of time (and money) at the dermatologist's office, undergoing a variety of treatments, and he used to joke with me that it was taking longer for me to grow out of acne than most of his patients. No matter what I did, the treatment would only alleviate the acne somewhat, or for a short time, then it would be back with a vengeance.

Now, there are many more effective treatment options available. Understanding acne and how it can be treated is the first step in having the kind of skin you want - free of blemish.

What is acne?

Acne is a common skin disease that results when pores get blocked and bacteria form inside them. It comes in a variety of familiar forms and affects nearly everyone at some stage, particularly in their teen years. The inflamed, red bumps that sometimes form can be painful, and even painless white pimples are unsightly.

In the surface of the skin are pores, tiny openings called a hair follicle. Deeper inside the pore, near the base of the follicle, there are sebaceous glands that produce sebum, a natural type of oil. That oil helps keep the skin flexible and protected.

Hair continues to grow through the surface, while oil or sebum oozes out the side and is spread around the area. Skin cells grow and die and are sloughed off through washing, rubbing or spontaneously. But that process can be interrupted when the pores close and when bacteria form inside them. The result is acne.

The white pimples that sometimes form are usually a combination of dead skin cells, white blood cells and bacteria. The trapped pus often creates an inflamed, red area around it. The term 'pus' is an adaptation of 'pustule', a type of acne that results when the follicle wall bursts and the white blood cells rush into the area as part of a healing process.

When the tiny bumps or spots appear black they're called blackheads, naturally enough. They're a non-inflamed form of acne that come from the material having poked through the surface. Their dark color isn't the result of contact with dirt on the skin. It's a combination of dead skin cells and sebum that have oxidized. Oxygen in the air causes a chemical reaction that turns them black.

Often, however, the material doesn't break the skin, but simply pushes it up, forming a small, white bump called whiteheads. One form are known as 'milia'. Normally dead skin cells will get washed off or simply fall off the surface. But they can get trapped underneath the surface. This type of acne is common among infants, but can affect people at any age.

All these variations go by a general medical term called 'comedones', and whether that formation is open or closed is part of the clinical difference between them.

As the acne develops it can variously form what are called papules, nodules or cysts. A papule forms when the walls holding the hair follicle burst near the surface. They're small and don't contain pus. A nodule is a hardened lump under the skin, resulting from a break at the base of the follicle. A cyst is a larger, reddened bump. They're soft, but can be very painful.

Naturally, while it's helpful to know what acne is, the most important thing is to be able to treat it. In order to do that, it's necessary to know what type we have. We hope you find the information you need here to help you determine the type of acne you have and the best treatment options.