Acne is the most common skin disorder, affecting around 15% of the adult population and up to 80% of adolescents. Facial scarring because of acne occurs to some degree in most cases. The majority of acne scars are flat and depressed below the surrounding skin (atrophic), generally small and often round with an indented or inverted centre. To prevent acne scars, do not pop, squeeze, or pick at acne; do not pull scabs of acne; seek treatment early for acne that does not respond to OTC medications.

Types of Acne Scars:

–          red and/or hyperpigmented marks: a post-inflammatory change that usually disappears in 6-12 months

–          acne scars – icepick: depressed scars, deep, narrow and sharp; usually too deep for dermabrasion or laser skin resurfacing

–          acne scars – boxcar: depressed scars, round with sharp edges

–          rolling acne scars: depressed scars, wavy texture in the skin

–          keloids and hypertrophic scars are raised acne scars that may become larger and more noticeable, sometimes painful and itchy.  

Silicone gel like Strataderm is effective for treatment of acne scars and prevention of keloids and hypertrophic scars. Other effective treatments for depressed acne scars include laser skin resurfacing, dermabrasion, scar surgery (punch excision, punch elevation, punch graft, subcutaneous incision), fillers, chemical peel, microdermabrasion and similar procedures that you should discuss with your dermatologist. For raised acne scars, like keloid and hypertrophic scars, your doctor might consider options like intralesional injections, cryotherapy, surgery, laser and light therapy. Your dermatologist will be able to create a treatment plan based on the type of your acne acne scars, results you can expect, and your medical history.

Acne Scars:

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With every wound there are certain individual and environmental factors that influence abnormal scarring (e.g. keloid scars or hypertrophic scars) which make the choice of appropriate scar treatment and scar prevention essential.

Age and Hormonal Influence

Although keloid scars and hypertrophic scars can develop at any age, they tend to develop more readily during and after puberty. Menopause tends to prompt the regression of scarring and pregnancy tends to exacerbate it. Scars from thyroid surgery (thyroidectomy scars) can be problematic due to hormonal changes.

Genetic Factors and Previous History

Abnormal scarring is 15 times more likely to occur in darker-skinned individuals. Keloid scar formation occurs in areas of high melanocyte concentration and is rarely found on the eyelids, genitalia, soles and palms. Individuals with ginger hair and freckles are also at an increased risk of keloid scars. People with a previous personal history of keloid scarring are more likely to scar again in an abnormal fashion and those with a family history are also at an increased risk.

Scar location and surgery technique

Scars over or near muscles that are particularly active often spread or become more visible than the scars formed on less active areas. Skin and wound tension during wound repair is also a contributor to increased scarring.

Wound Infection

Wound infection increases the risk of abnormal scarring.

Type of Skin Injury

A variety of different types of skin injuries can lead to the development of keloid and hypertrophic scarring including surgery, burns and inflammatory skin processes such as acne, psoriasis and chicken pox.

Silicone based products, like Strataderm silicone gel, have been recommended by International clinical recommendations on scar management and have become the standard care for plastic surgeons when it comes to scar treatment and prevention of keloid and hypertrophic scars. Silicone is not only considered first line treatment for scars but it is also recommended for use in conjunction with other scar therapy options, such as corticosteroid injections and pressure garments.

Read more about how to avoid abnormal scars.

Scientists at Wake Forest Institute for Regenerative Medicine have developed a device based on an inkjet printer that prints skin cells on burns and other wounds.

The device contains a tank holding a mixture of harvested skin cells, stem cells and nutrients and a computerized nozzle which first sprays a layer of fibroblast skin cells and then a layer of protective keratinocyte cells.

In initial tests on wounded lab mice, burns treated with the cell printer healed in two weeks, compared with the usual five weeks skin grafts take to heal. Additionally, the mice with the printed-on skin showed less scarring and more hair regeneration, as the sprayed-on stem cells better incorporated themselves into all the various cell types of the burned flesh.

Successful mouse tests have driven the Wake Forest scientists onward to tests with pigs, whose skin more closely resembles that of humans. After the tests with pigs conclude, the doctors can finally move on to human trials, and eventual FDA approval. Additionally, the Wake Forest team is working with the U.S. Armed Forces Institute of Regenerative Medicine to utilize this technology on the battlefield.

Some key points by Dr. Adrian Richards about keloid and hypertrophic scars and about scar treatment options:

– Hypertrophic scarring occurs within the normal scar, is limited. Hypertrophic scars tend to get better with time.

– Keloid scars occur in people with darker complexion, and can be started by minor trauma, like piercing or ingrown hair. Keloids grow outside the area of the original scar.

Treatment options: massage; next stage: you can use silicone gels (like Strataderm, Dermatix) or silicone sheets (Cica Care); next stage: steroid injections. Keloid scars are more difficult to treat. Another option for keloids is radiotherapy.

Even though Jessica Alba apparently loves (her) stretch marks not every woman agrees with her. OK, we have to admit we don’t know a single woman who would agree with Jessica’s statement:

“Even though some might consider them a flaw, I’ve learned to love my stretch marks. Pregnancy was the most incredible experience I’ve ever had. So I’ll take the stretch marks.”

Stretch marks (or striae) are a form of scars caused by the pulling and stretching forces in the underlying layers of the skin (dermis). Most women (up to 90%) will develop stretch marks during pregnancy .

Various treatments are available for the purpose of improving the appearance of existing scars or stretch marks, including laser treatments, dermabrasion, prescription retinoids and silicone gels like Strataderm.

There are claims that cocoa butter is effective against stretch marks, however no research studies have shown its ability to either prevent stretch marks, or to reduce their appearance once a stretch mark has already formed. On the contrary –  the studies have clearly shown that the application of cocoa butter does not reduce the likelihood of developing stretch marks

The same applies for products like Bio-Oil® – the UK Advertising Standards Authority has gone as far as to prohibit claims that it helps scars or stretch marks because such claims could not be supported by clinical evidence.

Corticosteroid injections have been used for many years in the treatment of hypertrophic scars and keloids, alone or in combination with other modalities (e.g. silicone gel).

Steroid injections into the scar have been found to soften and flatten keloids but cannot narrow hypertrophic scars or eliminate keloids.

The side effects of this treatment option include pain (can be managed with local anasthetic), skin atrophy, hypopigmentation (loss of skin color) and telangiectasia. The procedure may be expensive, time consuming and there is a large risk of treatment failure. Extreme care should be taken injecting into dark pigmented skin as depigmentation can occur. The most commonly used steroid injection is Triamcinolone Acetonide which is recommended to be injected every 3 to 6 weeks. Dermatologists generally give a series of injections. Usually given every few weeks, the frequency will depend on the type of scar and many other considerations. Some patients receive an injection every 2 or 3 weeks. Others get an injection once every 3 to 6 weeks.

If you are planning to have breast augmentation surgery and are worried about scars, read this short article from Plastic Surgery Channel. Don’t forget to watch the video featuring Dr Kevin M. Keller (video includes graphic surgery footage). Dr Keller discusses the risk and benefits of different surgery techniques – making it clear why it is important to ask your plastic surgeon about the technicque he or she uses.

Inframammary incision leaves a scar that is only visible when you are lying down (inframammary scar).

Periareolar incision is made around the bottom half of the areola (periareolar scar).

Transaxillary incision leaves no scar on the breast itself but instead in the patient’s underarm (transaxillary scar).