One of the vastly seen skin disease in adolescents is acne. It affects about 80-90% adolescents attaining pubertal age. Some of this acne also continues into adulthood leaving some kind of psychological and social impact. Acne, also called as acne vulgaris is a chronic skin condition that results from dead skin cells and sebum from the sebaceous glands.
Overview
Acne presents itself in the form of pimples, blackheads, whiteheads, and scarring. Acne are common in body parts which consists of higher density of sebaceous glands – especially on the face, back and chest. Some of these inflammatory acne lesions can cause permanent scarring.
Causes
The causes of acne are many. Genetic make-up of a person is one of the factors that determines the susceptibility to developing acne. Other factors include :
- Acne are commonly seen in adolescents as sebum production from the sebaceous gland is at its peak during puberty due to a drastic shift in hormone levels and metabolism. During puberty, there is a surge in some hormone levels like androgen, which causes the sebaceous gland to enlarge and produce more sebum
- Acne are also usually seen is women attaining menses and women with hormonal imbalances like polycystic ovarian syndrome (PCOS); increased levels of male sex hormone – androgen
- Bacterial infections like Cutibacterium acnes can cause development of acne. Increased growth of this organism on the skin can cause acne and acne scarring
- Increased humidity and polluted air can cause acnes
- Diet also influences the occurrence of these acnes. Consumption of large amounts of dairy products like milk, cheese, butter, cottage cheese can lead to development of acne as these products increase mucous production in the body which acts as a trigger for clogging the pores. Also, a diet that is high in fat and refined sugars is a cause for acnes. Research has shown that diet containing milk and milk products stimulate the release of insulin and insulin like growth factor -1 (IGF-1), which further increase the production of androgen hormones, sebum and thereby, acne.
- Cosmetic products like a greasy moisturizer, other make-up and skin care products can cause the pores to clog and increase the occurrence of acnes
- Stress can also trigger acne breakouts. This could be due to increase in the levels of hormones which lead to excess sebum production and thus, acne
Acne scars occur due to inflammation inside the dermis layer of the skin and are known to affect almost all people with acne vulgaris. Atypical repair and skin inflammation lead to scar formation. Scarring is more common with severe forms of acne but it is not uncommon with other milder forms of acne as well. Scars occur when the acne breakout infiltrate the skin deeply and damage the underlying skin tissue. Acne scars are treatable but the treatment is long term. To get rid of acne scars, it is important to clear all the acne as newer breakouts can cause newer acne scars. Since the face is constantly being exposed to the environmental pollutants, scars on the face are most stubborn to treatment.
Types of Acne Scars
It is essential to know the type of the scar before starting to treat them as each type of acne scar behave differently to different treatments, and some treatments are known to work better than others for those particular type of acne scars.
- Atrophic or indented scars : They are frequently seen on the face. They develop because the collagen that is required for wound healing and repairing is inadequate
- Hypertrophic or raised scars : They appear on the surface adjacent the skin, caused by excess collagen production for repair. Hypertrophic scars are more commonly seen with chest and back acne
Treatment for acne scarring
Different acne scars need to be treated differently. For treating acne scars, it is best to visit a board certified dermatologist. Some of the options of treatment for acne scars are :
- Alpha Hydroxy Acids (AHAs) : AHAs are component found in products that are used to treat acne. AHAs help in removing the skin debris and prevent formation of blocked pores. AHAs can also help in fading the acne scars. They do so by exfoliating the outermost layer of the skin. This treats the discolouration and irregular appearance that is caused by scarring
- Salicylic acid : Salicylic acid is the most common chemical component seen in majority of acne treatment products. It is an excellent cleanser and exfoliater, helps in unclogging pores and decreases inflammation. It is one of the best known treatments for all types of acne scarring
- Azelaic acid : This acid has anti-inflammatory and anti-bacterial properties that are effective in treating acne and acne scars. Azelaic acid decreases the acne causing bacteria and unclogs the pores.
- Lactic Acid : Some studies have shown that peels containing lactic acid that are done once in two weeks over two to three months help in revamping the texture, appearance and discolouration on the skin along with diminishing acne scars
- Retinoids : Topical application of retinoids are common in the treatment of acne and have scar-smoothing properties. There is evidence to suggest that retinoids act by increasing the cell turnover and repair, enhance skin texture and also reduce the pigmentation on the skin, thereby reducing the appearance of scars. They work best on depressed or indented scars
- Other intervention options include : Dermabrasion, synthetic peels and laser resurfacing
- Dermabrasion : This is a type of a cosmetic procedure which is known to be most effective and widely used methods for treating acne scars. This requires a dermatologist to carry out the procedure. It is basically an exfoliating method which uses a rotating instrument to removes the outer layers of the skin and exposes the inner layers of the skin that are smoother. Although it gives good results, it has some downsides and may not be suitable for many people
- Synthetic peels : These include some mild acids that are topically applied on the skin which causes the epidermal layer of the skin to exfoliate and therefore bringing up the new layer of the skin. Though these chemical peels are popular and result in smoother and younger skin, they have to be used with caution with appropriate expertise
- Fillers : Some dermatologists may use something called as fillers in the treatment of acne scars. They even out the skin texture as they are made with collagen. These fillers are injected below the surface of the skin to ease out the scars, especially indented or depressed scars
- Micro-needling : This is the latest treatment option in acne scaring, which makes use of tiny handheld, needled roller, like a pen on the surface of the scars. The needles perforate and puncture the skin, which produces collagen for healing, enhancing the appearance of skin
- Laser treatment : This works on the similar principle as that of peels and dermabrasion, that is to shed off the topmost layer of the skin. It uses high intensity laser beams for skin removal, unlike using acids and any kind of tools. This also requires intervention by certified dermatologist
- Sunscreen : Sunscreens with a good SPF protect the skin from sun damage and environmental toxins, thus reducing the possibility of developing acne and acne scars
Another treatment option for acne scarring is plastic surgery, but this is an extremely invasive procedure in which the scarred tissue is surgically removed. This option depends upon the severity of acne scarring and requires to weigh the pros and cons before opting for it.
There are many home remedies available for treating acne scars which are safe to use and do not cause damage to the skin.
Acne Scars Photos
Conclusion
Acne scars can be annoying and make take a long time to heal. There are numerous treatment options available that can fade away the visibility of scars. The ideal way to treat an acne scar is to prevent its occurrence. The final choice for treating acne scars should depend upon the type and severity of the scars by an expert in the field. Although many treatments are available to treat the scars, some scars are permanent and may not be removed completely.
References
- https://www.hindawi.com/journals/drp/2010/893080/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445894/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4570086/
- https://journals.sagepub.com/doi/10.1177/2059513117695312
Sirisha B