Category Archives: Dermatology

How Common is Psoriasis?

Psoriasis  is one of the commonest skin diseases . It has the dubious distinction of having second place in prevalence  amongst all skin diseases, the first being acne vulgaris. Psoriasis is also one of the oldest skin diseases known to medical science.

Prevalence of Psoriasis

Global Prevalence of Psoriasis (Greb JE et al. Psoriasis. Nat.Rev.Dis.Primers doi:10.1038/nrdp.2016.82)

Genetic and environmental factors greatly influence the clinical development of psoriasis. This results in wide differences in the prevalence of this disease among different ethnic groups and in different parts of the world.

Patients with minimal clinical manifestations often do not  seek medical attention. In many third world countries, poverty, illiteracy, ignorance, and , in case of females, modesty may be preventing patients from approaching health care providers for diagnosis and management of the disease.Hence psoriasis may be much more prevalent than the studies indicate.

Most studies on prevalence are based on information from clinical examinations, interviews, census studies and mailed questionnaires.

Thus, estimates of the occurrence of psoriasis in different parts of the world vary from 0.1 to 3%.

Around 125 million people worldwide (up to 3% of the population) have psoriasis.

23% of people – that’s28 million – with psoriasis go on to develop psoriatic arthritis, a potentially debilitating type of joint disease, a complication of psoriasis.

Its prevalence in a hospital population was about 6% to 8.7% in two studies

In the United States, between 2 and 2.6% of the population is affected with psoriasis. That works around to approximately 7.5 million persons with psoriasis. Between 150,000 and 260,000 new cases of psoriasis are reported annually.

Four hundred people die annually from psoriasis-related causes in the US.

Approximately1.5 million people with psoriatic arthritis seek medical care each year in theUS.

Geographical & Racial Distribution

Psoriasis is more common in whites. The incidence of psoriasis is much lower in dark-skinned West Africans andAfrican-Americans than in light-skinned people of European ancestry. Incidence is also low in Japanese and Eskimos, and is extremely low to non-existent in Native Americans in both North and South America.

The prevalence of psoriasis in African Americans has been estimated at 0.7% based on 3860 consecutive patients seen in a private dermatology practice in Cleveland, Ohio. Gelfand et al(2005) confirmed these previous investigations that have suggested that psoriasis is less common in African Americans than in Caucasians. However, according to their  study, psoriasis was certainly not rare in African Americans as was previously thought of.  Their study showed the prevalence of psoriasis as 2.5% in Caucasian patients and  1.3% in African American patients.

In Africa, variations in the prevalence of psoriasis have been observed between West African countries such as Nigeria (0.8%) and East African countries such as Kenya (2.6%).

Age of Onset inPsoriasis

Psoriasis occurs in both children and adults and may appear at any age, although it is most commonly diagnosed between the ages of 12 and 35. A second peak appears between the ages of  60 to 69 years.

There have also been case reports of psoriasis appearing in infants within weeks of birth and in patients above the age of 70 years, but these are more of exceptions rather than the norm.

Approximately 10-15% of new cases begin in children younger than 10 years. Children tend to have more of the guttate variety of psoriasis than the plaque psoriasis compared to adults.The median age at onset is 28 years.

Females tend to develop psoriasis slightly earlier than males and those with a family history have an early age of onset.

Sex

Psoriasis occurs with almost equal frequency in males and females. Many studies have found higher prevalence among males while others vouch for a higher female prevalence. As the difference between the genders are not very prominent, we will settle for the equal frequency.

There may be another reason for the disparity in sex prevalence studies.

As females are more concerned about the condition of  skin and nails and are more aesthetically inclined than their counterparts, they must be approaching doctors more often with milder varieties of psoriasis.

Read more about Psoriasis

Psoriasis: A Brief History

Psoriasis is probably one of the longest known illnesses of humans and also one of the most misunderstood one. It was confused with leprosy till the 19th century.

The biblical term ‘lepra’ was actually applied to various cutaneous disorders including psoriasis, vitiligo, eczema, boils and alopecia areata. Some believe that  ‘tzaraat’ mentioned in the Bible represents psoriasis.

Hippocrates (460 – 377 BC) did describe a skin condition akin to psoriasis.

There are mentions in the literature about the term “psoriasis” as being  used by Aristophanes of Byzantium at the end of the third century B.C. But Aristophanes’ description  of the disease does not, however, correspond to our clinical picture of psoriasis.

Some historians, however, believe that  it was the Roman physician Galen who used the term “psoriasis vulgaris” for the first time, though not particularly for the exact entity .

The name psoriasis is derived from the Greek word psora which means to itch. In fact, before Hebra (see below) the term ‘psoriasis’ was used for many skin diseases where itching was a prominent feature.

In the first century, the Roman Sage Cornelius Celsus described a condition similar to psoriasis and classified it as the fourth variant of impetigo.

JosephJacob Plenck (Vienna, 1776) wrote of a condition similar to psoriasis as being amongst the group of desquamative (scaly or scale like) diseases. He did not dig deeper to differentiate it from other dermatological conditions.

Psoriasis was known as Willan’s lepra in the late 18th century after the English dermatologist, Robert Willan (1757 – 1812) recognised the disease as an independent entity. He identified two categories. Leprosa Graecorum was the term he used to describe the condition when the skin had scales. Psora Leprosa described the condition when it became eruptive.

Finally, it was in 1841 Ferdinand Hebra, a Viennese dermatologist improved on Willan’s notes and assigned the name  ‘Psoriasis’ to the disease for the first time in the long history of the disease.  It was Hebra who described the clinical picture of psoriasis as we recognise it today. The hereditary factor of psoriasis was already known by that time.

Psoriasis was further differentiated into specific types and effective remedies discovered during 20th Century.

Read more about Psoriasis

What is Psoriasis

Psoriasis is a non-contagious, genetic skin disease that results when faulty signals in the immune system prompt skin cells to regenerate too quickly, causing red, scaly lesions on the skin. It is now considered an autoimmune disease.

Scalp Psoriasis

Psoriasis is a lifelong disease like diabetes and hypertension. It typically causes dry, red, scaly lesions that can appear anywhere on the body, including the scalp, trunk, extremities and nails. Common areas involved are the extensor aspects like elbows, knees and the trunk.

Psoriasis is not contagious, that means you cannot catch it from someone else, nor can you give it to someone else, unless of course, they are your children.

Psoriasis Hands

The genetic origin means that if one of the parents has psoriasis, children stand a 10 to 25%chance of developing it. If both parents have it the odds for the children increase up to 50%.

The natural course of psoriasis is dotted with periods of waxing and waning. The lesions clear for sometime (called remissions), and, following some triggers, come back again. At times, when a treatment, like potent topical corticosteroids, is withdrawn suddenly, psoriasis may worsen or become generalised. This is known as are bound phenomenon and is something that has to be avoided at all costs.

Psoriasis has no complete cure, but with proper treatment and life style changes, psoriasis can be kept under optimum control and remission so as not to affect the quality of life of the patient.

The absence of a specific cure also means that psoriasis requires life long care and management.

Though there is no cure yet for the disease, recent introduction of new biological therapies has provided a fresh ray of hope for psoriatic patients for a better quality of life ahead. What is unique about biologic treatments is that they pinpoint certain immune responses that are involved in psoriasis, not the entire immune system, thereby creating fewer side effects for the patient and less damage to the immune system as a whole.

Read More about Psoriasis

Psoriasis 101

This is a short introduction to Psoriasis, the first of a series of educational articles on psoriasis by Dr Hanish Babu, MD, Dermatologist

Psoriasis plaques on hand
  1. Psoriasis is a chronic dry, scaly skin condition for which no cure has yet been found.
  2. Psoriasis is derived from the Greek word ‘psora’, which means itch.
  3. Psoriasis is not contagious.
  4. Psoriasis has a genetic basis, whereby in predisposed individuals certain triggering events or factors induce the body’s immune system to mistakenly speed up the growth cycle of skin cells.
  5. 125 million people worldwide (up to 3% of the population) have psoriasis. According to National Institute of Health, there are more than 7.5 million psoriasis patients in the United States.
  6. 10-30% of people with psoriasis may develop psoriatic arthritis with inflamed, stiff and painful joints.
  7. Studies have shown that people with psoriasis have almost the same reduction in quality of life as people with diseases such as cancer, diabetes or depression.
  8. Treatment for psoriasis is both topical and systemic and the choice and outcome of these treatments varies from individual to individual. Many patients suffer psoriasis in silence due to improper diagnosis and treatment.
  9. Most patients with psoriasis/psoriatic arthritis avoid social activities requiring body exposure due to embarrassment and fear of rejection.
  10. Recently, new biological therapies have been introduced giving new hope to people with psoriasis.

Read more about Psoriasis:

Topical Corticosteroids: Double Edged Swords!

Topical corticosteroids have revolutionised the treatment of inflammatory skin diseases, since they were introduced in 1952. They are very effective treatment options for many skin diseases and have revolutionised the management of eczema, allergies and other inflammatory skin diseases like psoriasis. Their effectiveness is prompt and most acute allergies can be cured within a few days. For chronic illnesses, like Atopic Eczema in children and psoriasis, they have to be used for a longer duration.

But, If not used with proper titre of dose and strength, they can cause damage to the skin, sometimes permanent. There are many unscientific formulations masquerading as anti-fungal creams and whitening or bleaching creams in the market, where one of the ingredient is potent or super potent steroid. Thus topical steroid creams are double edged swords, the use of which should be carefully titred according to their potency, stage of disease, age of the patient and site of application.

A knowledge of different classes of topical steroids according to their potency is important for everyone prescribing or using these effective and useful medications.

Classes of Steroids and Precautions
Classes of Steroids and Precautions

From the above it is clear that  topical corticosteroids  should be carefully chosen according to their potency, stage of disease, age of the patient and site of application. This is of paramount importance and all those who use these wonderful medications, including patients, pharmacists and doctors should be aware of their strengths and indications of use.

Topical corticosteroids come in several forms, including creams, lotions and ointments. Creams and solutions are a class below in potency than ointments. Ointments are greasy and preferred in chronic dermatitis and scaly diseases like psoriasis. Creams can be used in acute and subacute skin inflammation. Gels and lotions are preferred in hairy areas and scalp.

Side Effects of Topical Corticosteroids

Topical steroids have both topical (limited to skin) and systemic side effects.

Topical Side Effects of Topical Steroids Limited to Skin
  • Topical application of steroids causes thinning of the skin by causing atrophy of the skin layers.
  • Dilation of capillaries that are shown through the thinned skin, known as telengiectasia.
  • Stretching and splitting of the skin causing stretch marks or striae dystensiae.
  • Pimple like eruptions on the treated area, especially on the face, chest, back and limbs, called steroid acne.
  • The main problem with topical (and systemic steroids) is the rebound phenomenon or exacerbation of the lesions that occur if the steroids are suddenly stopped or withdrawn. A localized form of psoriasis can become generalized or a generalized form can get precipitated as pustular or erythrodermic forms when steroids are withdrawn.
  • Higher strength steroids should be avoided on the face, especially near eyes, on the body folds and near the genital organs. Steroids used near eyes for prolonged duration have been shown to cause cataract formation in the eyes and glaucoma.
  • Steroids are best avoided in the presence of infection as these can exacerbate infections.
  • Other topical side effects of topical steroids include easy bruising, purpura, skin ulceration, non healing of ulcers, exacerbation of infections, perioral dermatitis, rosacea, hypo pigmentation, hyper pigmentation, and excessive hair growth. Mistaken application of steroids on ring worms cause changes in morphology and spread of the fungal infection, known as tinea incognito.
Systemic Side Effects of Topical Steroids
  • Adrenal Suppression. Because of the absorption of potent steroids into the blood stream, the adrenal glands could become suppressed and their production of normal steroids will suffer as a result. This can have far reaching effects on the body. If prolonged, this can produce a cushingoid (moon like) face in patients and cause other systemic effects.
  • Tachyphylaxis.The body develops resistance to the topical application after some time.
How to Avoid Topical Steroid Side Effects
Unscientific Steroid Combinations
Unscientific Steroid Combinations are better avoided
  1. Topical Steroids are wonder drugs for many skin diseases like eczema and skin allergies but should be used only under supervision of a skin specialist or a modern medicine doctor who is trained to use it.
  2. Never buy steroid containing creams directly from pharmacy
  3. Avoid using fairness, whitening or bleaching creams from saloons, parlours and unlabelled sources. These may contain very strong steroids and cause serious damage to your skin.
  4. Avoid using so called anti-fungal creams containing steroids. When in doubt, consult a skin specialist before using such creams.
  5. Potent and super-potent steroid creams should only be used under the supervision of a skin specialist.
  6. Never use steroid containing creams in the presence of infection or if diagnosis is not sure.
  7. Use appropriate graded strength according to severity, age, site of involvement.
  8. Gradual withdrawal and replacement with safer creams should be resorted to.
  9. Superpotentà Potent à Moderate à Least Potent.  Shift down as the condition improves.
  10. Application free interval: 5-7 days after every two weeks of application helps avoid side effects.
  11. Never use higher strength topical steroids in infants and children.
  12. Avoid moderate to superpotent classes of topical steroids in sensitive areas like face and body folds.
  13. Once acute phase is under control, shift to steroid sparing calcineurin inhibitors like Tacrolimus, Pimecrolimus.
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 10 am – 2 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Acne Scars: FAQ

Frequently asked questions on Acne Scars will clarify your doubts on how to get rid of acne scars.

Acne Scars : FAQ
Acne Scars: Better Prevented!
1. Acne Scars FAQ: What is a Scar?  
  Scar is a collection of new connective tissue. In the skin scar implies damage to both epidermal and dermal layers. If there is more deposition of connective tissue (collagen), the scar is known as hypertrophic scar. These scars are initially red, raised, firm, and, at times, itchy and painful. If the skin heals with the least amount of collagen, this is known as atrophic scar. Atrophic scars are shiny and papery thin to the touch.  
     
2. Acne Scars FAQ: How is Acne Scars Formed?  
  Acne scars are caused by healing of inflamed acne lesions. Skin repairs itself after any injury, including inflammation, by generating new collagen underneath. This deposition of new connective tissue causes acne scar (see above). The main cause of acne scar is uncontrolled disease activity causing continuous inflammatory response within the dermis. The damaged skin repairs itself with scarring.
Learn how acne scars are formed.
 
     
3.   Acne Scars FAQ: I have a face full  of acne scars and dark spots. My friend also had acne, but now has a clear face! Why do some people get acne scars and others do not?  
  How and why some people get scar and others do not is not completely understood. The following may be the reasons: Some people may be more prone for acne scar than others They may be genetically predisposed to get scars: getting scars, not only the acne ones but the regular scars as well, runs in the family! People who have severe and very severe types of acne(the deep nodulo-cystic variety of acne), where the inflammation is not controlled properly and in time, can have deeper and pronounced acne scars. Picking at the acne lesions with nails or pins increase the chances of  scarring in acne.
Read more about acne scar causes.
 
     
4. Acne Scars FAQ: How to avoid getting acne scars?  
  The single most important way to avoid scarring is to effectively treat the acne before it worsens and causes severe inflammation. The more the inflammation, the deeper and larger will be the scar. So taking steps in generally limiting the inflammation at its early stage is very important to avoid getting acne scars. Also avoid irritating the acne lesions by constantly picking at the lesions.
Read more about Why Preventing Acne Scars is Better than Cure.
 
     
5. Acne Scars FAQ: What are the Types of Acne Scars?  
  There are many types of acne scars. The type, size and texture of scars differ according to the  following factors:
Type of skin: The oilier, more severe
Type of acne: The more inflamed, the deeper and firmer the scars Extend of acne: The deeper the lesions, the deeper the scar.
Type of treatment received: Systemic medication, if taken early in the disease state can Keloid ( a type of uncontrolled hypertrophic scar) tendency runs in families. Individuals with this tendency will have larger, thicker and raised scars. 
Read more on Types of acne scars.
 
     
6. Acne Scars FAQ: Can I start my acne scar treatment while I am on accutane treatment?  
  Harsh topical treatment and laser treatments should not be performed while on accutane. You should wait at least 6 months after accutane is stopped to treat your scar. Some studies have pointed out that actuate causes more scarring in some individuals. But these are not conclusive as accutane treatment is taken for severe and very severe types of inflamed and nodulocystic acne, which otherwise also heal with scarring, with or without scarring.
 
     
7.   Acne Scars FAQ: I used to have pimples earlier. Now i am 26 yrs and I have marks left over by them. How can I clear those marks.  
  Your question is not very clear. Do you have only marks (blemishes) or actual scars? The treatment differs for each, evidently. Please read more about acne blemish treatment and acne scar treatment.  
Acne Scar: Frequently Asked Questions: Related Articles
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Acne Scar Removal: Surgical and Cosmetic Treatment

The most effective treatment for acne scars is the surgical, cosmetic and laser treatments.

There are a number of surgical and cosmetic procedures for removal of acne scars.

There are many options for surgical and cosmetic removal of acne scars.
Acne Scars: Many options for Treatment.
Acne Scar Removal: Surgical and Cosmetological Treatments
  • Chemical peels
  • Dermabrasion
  • Exoderm Lift
  • Needle Subcision of Individual Acne Scars
  • Acne Scar Revision
  • Laser Resurfacing of Scars
  • Cryoslush
  • Soft-tissue augmentation
  • Intralesional steroid injection
  • Electrodesication
  • Excisional surgery in selected cases

These are some of the effective techniques used for acne scar removal. The choice of therapy depends upon the type of scar, depth of scar and the choice offered by your dermatologist.

Acne Scar Removal: Chemical Peels

If the scars are small or shallow, they may be treated with chemical peel (also known as chem-exfoliation or derma-peeling). Peeling is also effective in the treatment of stubborn comedones.

If the scarring is deep or extensive, the chemical peels may be repeated at regular intervals.

Certain chemical agents capable of peeling off the skin layers are applied in different strengths depending upon the depth of the lesions. Removal of superficial layers stimulate regeneration of new tissue underneath resulting in the formation of fresh, rejuvenated skin.

The main chemical used as peels are:

  • Trichlor Acetic Acid (TCA)
  • Glycolic acid
  • Phenol
  • Salicylic acid
  • Lactic acid
  • Tretinoin
  • Resorcinol

Most of these are available as OTC products. But it is advisable to have the peeling performed by your dermatologist as the strength and and depth of peeling has to be controlled to obtain optimum results.
Indications: Shallow, soft or superficial macular atrophic scars can be treated with chemical peels.
Caution: Ice pick scars and fibrotic or hypertrophic scars cannot be treated with chemical peels. If not done properly (i.e, using higher strenghths that cause actual burns!), the skin can get burnt and result in more pronounced scars than before. This is a risk that both the dermatologist and the patient has to be aware of.

Acne Scar Removal: Dermabrasion

Dermabrasion is a common treatment employed for most types of acne scars, mainly medium depth acne scars. Dermabrasion, as the name denotes, abrades the superficial layers of skin. This is done, with the help of a brush with a diamond tip or brush that rotates at high speed.
Dermabrasion helps in removing shallow scars and reduce the depth of deep scars.
Microdermabrasion is a process which peels of the superficial skin layers, but this is done with the help of aluminium oxide crystals passed through a vacuum.
Indications:Dermabrasion can reach deeper layers of skin than a chemical peel and hence can be used to treat both deeper and hypertrophic scars. Dermabrasion alone is not advisable for ice pick scars, as removal of superficial layers may result in opening up of the wider base of the scar and the scar may actually look larger than before! A technique whereby, dermabrasion is combined with punch excision of ice pick scar tissue has been found effective by some dermatosurgeons.
Caution: Dermabrasion also, if not done properly, can cause extensive scarring. Dermabrasion is contraindicated in keloidal acne scars, as any stimulation of the dermal layers can result in further keloid formation.

Acne Scar Removal: Exoderm Lift

Exoderm lift is the most extreme form of scar treatment that one can undergo. It is also one that have produced the most dramatic results: very good improvement in some and increased scarring in others!
The procedure is extremely strong and has to be carried out very cautiously. Exoderm Lift is composed of 12 components, including phenol, resorcin, citric acid and a variety of natural oils. The combined effect of these peeling agents has a liquifying effect on the skin, which is later followed by stimulation of new collagen and elastic fibers formation simulating an internal lift of the skin. The new lifted skin looks fresh and young.
Indications: Exoderm lift can be used to treat deep and hypertrophic acne scars.
Caution: Avoid in individuals with keloid tendency. Exoderm lift can produce the same effects as 2 degree or 3 degree burns and hence can cause potential worsening of the acne scars. Hence, it is advisable to test a small area first to asses the results and then go for the full treatment schedule if the results are satisfactory.

Acne Scar Removal: Needle Subcision or Undermining of Acne Scar

This is a technique through which a needle inserted from the side of the scar is swept to the sides to severe the scar bands. Scar bands thus broken allow small collection of blood (hematoma) to form beneath the skin. After a few days the hematoma is absorbed and the scar surface is elevated.
Indications: Needle subcision is particularly effective is small pitted acne scars where is lesser amount of fibrous tissue. Particularly useful for closely placed scars. Chemical peeling following subcision gives better results
Caution: If the fibrous tissue is thick and extensive beneath, subcision method will not work. The results are not always satisfactory.

Acne Scar Removal:  Scar Revision

Each acne scar is approached on its own merit and surgical scar correction (known as acne scar revision) is performed.
The following are some of the common acne scar revision methods employed by dermatologists and cosmetic surgeons:

  • Local Undermining or Subcutaneous Incisionless (Subcison) surgery. (See above) 
  • Punch Excision and Closure   
  • Punch Incision and Elevation(Punch Float)   
  • Punch Excision and Graft Replacement

Ask your dermatologist for the most suitable procedure for your scar.

Indications:

  • Small Pitted Scars 1-2 mm: Subcision
  • Depressed scars up to 2 mm diameter: Punch excision and closure
  • Depressed scars 2-5 mm with normal skin texture: Punch float.
  • Depressed, pitted scars up to 4.5 mm:Punch Excision and grafting

Caution: Hematoma formation, infection, graft rejection, allergic reactions to dressing and scarring may occur following these procedures. In punch excision and grafting, cobble stone appearance when the graft heals is a real problem. Some amount of color discrepancy is also present at the graft site.

Acne Scar Removal: Laser Scar Treatment: Laser ablation, laser resurfacing

Laser scar treatment, though introduced recently is fast picking up as an effective option to treat acne scars. Its effectiveness varies from patient to patient.

Indications: The energy and tissue penetrating capability of lasers are put into use in treating scars.

NdYAG laser, with its deep penetrating ability is used to treat deep irregular scarring.

The infrared beam produced by carbon dioxide laser helps in tightening the collagen fibres in the dermis and help in elevating depressed scars.

Caution: The laser treatment is quite expensive. The side effects are scarring, pigmentary and texture changes in the skin and infection.

Acne Scar Removal: Cryoslush & Cryopeel

This is a comparatively simple and safe office procedure. Application of cryoslush (CO2) produces an immediate lowering of the applied skin to -20˚C. This results in superficial peeling and subsequent remodelling of the skin.
Indications: When combined with subcision, cryoslush or cryopeel is very effective in treating depressed, bound down acne scars and depressed and distensible acne scars.
Caution: Hematoma, infection, color changes and keloid formation in predisposed individuals.

Acne Scar Removal: Soft Tissue Augmentation: Fillers

Soft tissue augmentation means filling the defect in the dermis through infiltration of certain substances known as fillers. This will correct atrophic scars. Previously collagen or fat from another part of body were injected beneath the scar to raise the skin to the surface level. Now a days many artificial fillers are available.

There are many types of injectables used for augmentation. It has been shown that once they are injected into the skin, they can raise the surface of the scar. 
The disadvantage of soft tissue augmentation is that it has to be repeated every 6-10 months’ intervals.

Acne Scar Removal: Intra-lesional Steroid Injections
For hypertrophic and keloid scars, injection of intra-lesional steroids followed by laser ablation is beneficial.

Acne Scar Removal: Excisional Surgery

Excision with or without a punch can be useful in shallow and medium depth acne scars.

Acne Scar Removal: Related Articles

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD


Laser Treatment for Acne Scars

Lasers are effective in treating acne scars through resurfacing and soft tissue augmentation.

Laser Treatment for Acne Scars available at Cosmolaser Sharjah
Laser Treatment is available for Acne Scars at Cosmolaser Medical Centre, Sharjah

Different types of laser, including the ablative, non ablative and fractional lasers are very useful in treating superficial and medium depth acne scars.

The mechanism of action of lasers in acne scars is twofold:

  1. Lasers remove the superficial scar tissue, known as laser resurfacing.
  2. Laser energy stimulates new collagen formation in the dermis which results in tightening and firmness of the skin, which restores the depressed ace scars to the surface

The combination of these effects makes the acne scars smoother and less visible.

Types of Lasers Used in Acne Scar Treatment

Depending upon the type of action, lasers are divided into two types: the ablative or non-ablative.

  1. Ablative lasers used in acne scar treatment. These cause removal of the damaged scar tissue through melting, evaporation or vaporisation. Examples of ablative lasers are Carbon Dioxide laser and Erbium YAG laser. These abrade the surface and also help tighten the collagen fibers beneath. Ablative lasers are best avoided in darker skin types as the possibility of post inflammatory pigmentation is very high in such individuals. 
  2. Non ablative lasers used in acne scar treatment. There are different types of non-ablative lasers available; the most commonly used are the NdYAG and Diode lasers. These do not remove the tissue, but stimulate new collagen formation and cause tightening of the skin resulting in the scar being raised to the surface. They are not as effective as ablative lasers in the treatment of acne scars.
Advantages of Laser Treatment in Acne Scars

Acne scar laser treatment, though costly, through ablative lasers is one of the best options available to treat scarring caused by acne.

  • Ablative lasers, through emission of high energy at extremely short pulses vaporise the targeted scar area with limited damage to the surrounding healthy tissue. This makes it a better option than chemical peels and dermabrasions for the treatment of medium depth and deep acne scars.
  • The carbon dioxide lasers have been shown to achieve 50-80% improvements in atrophic scars. The depth achieved with CO2 laser is 20-60micrometer and a thermal damage diameter of 20-50 micrometer.
  • Pulsed Erbium YAG produces less thermal damage than the CO2 laser, but has lesser efficacy. Hence useful in treating superficial atrophic scars.
  • If the acne scar is superficial and non-fibrous, good results are achieved with a single treatment. In most cases, though, multiple treatments are necessary to achieve the desired results.
  • After the laser surgery, skin returns to normal in 2-4 weeks, depending upon the depth of penetration of the laser energy.

Ablative and non ablative fractional lasers are also effective in treating superficial to deep acne scars, with lesser complications than the conventional ablative lasers. Non ablative laser treatments combined with chemical peels give better results than either used alone in superficial and medium depth acne scars.

Laser Treatment for Acne Scars: Related Articles
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

How to Get Rid of Acne Blemishes?

Acne blemish treatment requires lots of patience on the part of both the patient and the dermatologist.

Acne Blemishes
Acne Blemishes can be treated with proper medications and cosmetic treatments

Acne Pigmentation, acne blemishes or acne spots: Whether brown, red, or later black, pigmentary or colour changes caused by acne should not be classified as acne scars, as actual scarring does not occur in such cases. The deposition of iron pigment and stimulation of melanin pigment as a secondary response to dermal inflammation are the reasons for acne pigmentation or acne blemishes or acne spots. These are temporary colour changes and are completely reversible.

As expected, the acne blemish treatment differs from the acne scar treatment in a number of ways.

There are two types of acne blemishes:

  1. Pseudo-scars: Flat, reddish or brown spots, which remain when inflamed lesions regress after treatment. This flat discolouration of skin, known as macule, may remain up to 6 months. When the macules disappear with or without treatment, no mark will remain.
  2. Post inflammatory pigmentation: When the inflammation is severe and deep, even after the inflammation disappears, there is a dark pigmentation in the skin for a prolonged time. This is specially evident in dark skinned individuals. Sun exposure will further darken the acne spots.
Acne Blemish Treatment:
  1. Medical Acne Blemish Treatment
    • Vitamin C 1000 mg daily for 3 months
    • Tretinoin 0.05% cream/gel
    • Hydroquinone or non hydroquinone lightening creams with or without Tretinoin
    • Alpha Hydroxy Acids like Glycolic Acid, Lactic Acid etc
    • Azelaic Acid
  2. Surgical/Cosmetic Acne Blemish Treatment
    • Chemical Peels
      • Trichlor acetic acid(TCA:10-35%)          : Full Face
      • Glycolic Acid (GA:20-70%)                    :  20-70% Spot/Full Face
      • Cosmelan, Mela peels etc: Commercially available peels
      A combination of chemical peels followed by medical treatment(after healing) with a combination of tretinoin plus lightening creams gives the best results in acne blemish treatment.
  3. Q Switched Laser treatment and Fractional laser treatments are also effective options available for treatment of acne pigmentation or acne blemishes, often combined with topical applications and chemical peels as above.
Acne Blemish Treatment: Related Articles
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

Acne Scars: Medical or Non Surgical Treatment

Medical or conservative treatment is suitable for superficial or shallow acne scars and acne skin blemishes.

Medical Treatment with peels and creams may be tried for superficial acne scars
Superficial Acne Scars: Medical Treatment effective in some.

It is fair to state that the medical or non-surgical treatment of acne scars is far from satisfactory. These conservative types of treatments are limited in their usefulness due to the superficial mode of action of the topical applications.

Acne Scar Medical Treatments

Most superficial acne scars are skin colored, but some of the scars may be brownish or grayish black in color. The aim of medical or non-surgical treatment of acne scars  is twofold: one, to reduce the pigmentation, if any; and, two, to gently abrade the skin to remove the superficial scars and stimulate regeneration of new skin underneath.

Topical Applications Useful in Acne Scars

Most topical applications used to treat superficial acne scars are exfoliants which remove the superficial cells in the skin and cause mild abrasion of the skin to smoothen the surface out.

  • Topical Tretinoin: Topical tretinoin has a dual role to play in acne scars. It acts against normal acne bumps and also straightens out mild superficial acne scars. It loosens the epidermal debris and dead cells and removes them to give the skin a fresh, shiny appearance. By affecting the epidermal cell turnover, tretinoin help prevent blockage of the sebaceous and hair ducts and also plays a role in inhibiting inflammatory response within. Topical tretinoin is not effective in deep and medium depth acne scars.
  • Glycolic Acids, from strengths 20-70%, are used as chemical peels and are useful in superficialacne scars.
  • A combination of mandelic acid and salicylic acid is used as a peel and is useful in some types of superficial acne scars.
  • Tap water iontophoresis with added tretinoin, estrogen and associated electric stimulation of skin (ESS) was found effective in reducing acne bumps and also fading superficial acne scars.
  • Ablation of the scars with sterile needles followed by application of copper peptides improves the appearance of acne scars by stimulating collagen production.
  • Topical steroids under occlusion may be used for short lengths of time for hypertrophic acne scars. These has to be used very carefully as they may initiate fresh attacks of acne bumps.
  • Intralesional steroid injections and silastic gel sheeting are effective to reduce the size of keloidal acne scars.
  • Hydroquinone 2-4%, Kojic acid 4%, Liqorice extract 10-40%, Arbutine 1%, Azelaic acid 15-20% are used in combination with the exfoliants to reduce the pigmentation of the scars. Topical tretinoin is sufficient in most cases to get rid of the pigmentation in acne scars, though.
  • Finally, there are a number of camouflage creams available in the pharmacies which would hide the ugly acne scars and blemishes temporarily. The technique of application for camouflage creams for acne are similar to the camouflage of vitiligo patches, though tackling the depth is an important differentiating factor.

In addition to the above, there are many OTC products and home remedies purported to be effective for acne scars, the claims about the usefulness of most of them are unfounded and unpredictable. Some, like citrus fruit juices, contain alpha hydroxy acids which cause superficial exfoliation; but at the natural strengths, are unable to produce much improvement in acne scars.

Systemic Medications to Treat Acne Scars

Oral medications are not very useful in the treatment of acne scars, but they are effective in preventing scar formation by limiting the severity of acne inflammation. Treatment with oral isotretinoin does help in reducing the depth of acne scars by smoothening out the collagen tissue beneath, but is of little value once the scars are fully formed.

Medical Treatment of Acne Scars: Related Articles
Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD