Acne & Acne Scarring


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What is acne ?

  • It appears to be hereditary,  affecting 95-100% teenage boys, 83-85% teenage girls however,  acne lesions affect the adult female population predominately.
  • It typically begins during adolescence, when hormonal changes cause enlargement of sebaceous glands.  Acne may present as both open (whiteheads) and closed comedones (blackheads),  inflammatory lesions such as red pimples, pus filled or cystic .  The condition often results in scarring and pigmented marks (post inflammatory hyperpigmentation).

 

  • It is a multifactorial disease

 

 

 

  • Acne occurs in skin that has densest population of sebaceous follicles: facial and upper body areas. In fact, the facial, neck and chest areas have approx. 900 sebaceous glands per cm2 as opposed to less than 100/cm2 over the rest of the body areas. The amount of sebum produced and acne grade are strongly related.

Classification

Grade I : comedones only (blackheads)
Grade II: comedones plus papules (blackheads and red pimples)
Grade III: comedones, papules plus pustules (blackheads, red pimples and infected pimples)

Grade IV: comedones, papules, pustules and cysts   (blackheads, red pimples, infected pimples and deep seated infection, often painful )
                                                             
Each category may be further divided into mild, moderate or severe cases.

(Therapeutic Guidelines: Dermatology 1999 Version 1,Therapeutic Guidelines Limited)

  • The over production of dead skin cells in the follicles causes obstruction.
  • A usually friendly skin bacteria called Propionibacterium acnes (P. acnes) is involved in the pathogenesis of inflammatory acne converting non inflammatory acne to an inflammatory one. P. acnes bacteria incites the wall breach and is involved in the pro inflammatory cascade that follows.
  • Acne Inflammation: the process involves lymphocytes and neutrophils (white blood cells) affecting the wall of the closed comedone,  if breached the extrusion of irritants into the deeper skin (dermis) leads to a variety of lesions The inflammatory acne lesions often result in permanent scars
  • Acne is often painful, disfiguring and permanent scarring is common. (Farrar & Ingham, 2004) For this reason, its effects are not only physical but also social and psychological.  Acne negatively affects quality of life and increases the risk of anxiety and depression. (Yazici, et. al. 2004)


Acne Treatments

Traditional Medication

There are several drugs which are regularly prescribed for acne. These include anti-biotics, contraceptives, hormone therapies and isotretinoin (Ro-Accutane). There is a growing concern with the use of some of these therapies particularly due to potential problems and adverse side effects that they may cause. Anti-biotics are commonly prescribed. Unfortunately the use of anti-biotics can lead to the development of antibiotic resistance.  The incidence of bacterial resistance has increased dramatically over recent years and the necessary long-term use of these drugs is likely to contribute to the pool of resistant bacteria.

Teenagers are the main population who suffer from acne and thus may be adversely affected by hormone based drugs and isotretinoin due to their emotional volatility. In fact, acne by itself can be associated with depression, so the combined effect may be amplified due to teenage vulnerability and these drugs which may elicit strong emotions.  Despite their effectiveness, these drugs carry common side effects as well as risks of severe side effects including birth defects and depression.

  Today's treatments

In recent years, advancements in laser and light therapy and clinical treatments have given acne sufferers alternative treatment options. Concomitant use of light therapy or clinical treatments and topical use of vitamin A reduces the sebaceous secretion, inflammation and reduces post inflammatory hyper pigmentation associated with acne scarring.

Our clinicians at Melbourne Laser & Aesthetic Centre target acne and acne scarring using several modalities.  A multifactorial disease such as acne needs a multifaceted approach. Various methods are used to address inflammatory lesions, sterilize the skin, reduce the obstruction of the follicles, control sebum production and to encourage systemic balance through use of wholistic remedies. Specific combinations of vitamins and other oral supplementation are recommended to improve clearance of acne lesions and to improve skin healing. Our clinicians will develop a clinical treatment program to address your acne condition and any specific concerns you may have.  A homecare program will also be required to further enhance and maintain results. Various modalities may be included in such a program;

Indented scars will require scar revision with Fractionated Laser or Skin Needling once acne has resolved.

 

Frequently asked questions

Do I need a consultation?

A consultation is time spent speaking with you about your skin concerns.  It is an important time when we can assess the grade of acne, scarring, any medical history, offer advice and develop a program that suits your particular needs.

Will I need to change my skincare products?

Recent advancements in cosmetic science have resulted in more effective skincare. Cosmeceutical ingredients which have been scientifically verified are used in various strengths to treat skin efficiently. The skincare products used and recommended in our clinic are medical strength.  In order to obtain results quickly, it is advisable to use products recommended as they provide daily application of essential cosmeceuticals.  Our clinicians will develop a program of acne treatments and products which will suit your budget.

How long will it take to clear my acne?

A treatment program will address your type of acne condition. We aim primarily to clear acne lesions, reduce inflammation and enhance the healing process. This initial stage may take 4-6 weeks depending on type and frequency of treatments required. Homecare topical treatments, supplements and monthly maintenance treatments will continue to keep the skin clear.

 

Acne Scarring

 

Acne lesions often leave behind scarring.  Most commonly, acne scars are indented, raised and/or pigmented.  Acne scarring can be treated with a variety of non surgical modalities depending on the type of scar. There are various types of Acne scars; these include indented or atrophic scars : Ice pick, rolling and  boxcar as well as raised or thickened scars such as hypertrophic and keloid scars. Traumatic scars and Acne scar treatments may require using any one or a combination of modalities.

 

Other modalities are often incorporated depending on the individual condition: Cosmetic Dermaroller, Medical microdermabrasion, chemical peeling, Laser treatment, Alkaline scar remodelling and silicone gels for hypertrophic scars.  It is essential that our clinicians assess the type of scarring and plan a program that is individualised.

  

An appointment to assess the scar and to discuss treatment modalities available can be made online or by phoning the clinic on  (03) 8686 5786  Initial consultations $45.00, revisits no charge.