Category Archives: Dermatology

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

Acne Scar Treatment: An Overview

Acne scar treatment depends upon the depth, extent and the type of the pimple scars.

Most affected teens approach their dermatologist or physician for treatment of acne scars while they are still suffering from fresh eruptions of acne bumps. It is useful to remember that one should put out the fire and then, only then, set out repairing the damaged house!

Acne Scar Treatment Principles
 Acne Scar Treatment requires patience and perseverance.
Acne Scar Treatment requires patience and perseverance.

Treatment of acne scars is not a simple exercise that yields immediate results. A practical and realistic approach is required to obtain satisfactory results. Whatever treatment modality is tried, it is practically impossible to get back the pre-acne smoothness, softness and freshness of the facial skin.

The first step in deciding about the most appropriate acne scar treatment is to analyze why the acne scar is there in the first place. Was the acne treated properly? Are there still acne bumps on the face? Is there any hormonal imbalance (irregular periods and hair growth in females)? If you are a female-have you ruled out polycystic ovarian disease? Do you have unhealthy life style and food habits? Stress? Pinpointing the cause of the acne scars will help prevent further occurrence of the devastating scars.

Next, assess the types of acne scars present. Are they superficial and shallow? Or deep and pitted? (Here is a tip to know whether the acne scar is superficial or not- stretch the scar between thumb and forefinger: the superficial scar will disappear). Atrophic or hypertrophic? How long have they been present? Do you have any keloidal tendency? Anyone else in the family has scarring tendency following acne? Are you diabetic or suffer from any immune compromising diseases?

Learn about the different treatment options available for your type of acne scar. Is it worth it? Most insurance companies do not cover acne and acne scar treatments. Could you afford the cost of treatment procedures for acne scars? Do you have access to an experienced dermato-cosmetologist or plastic surgeon?

Finally, remember that prevention is better than cure in acne scars! The best treatment available for acne scars is to avoid getting it. Getting access to timely, proper and persistent treatment for acne eruptions is an important factor in preventing the occurrence of acne scars in majority of acne sufferers.

Acne Scar Treatment Options

Acne scar treatment options may broadly be divided into medical and surgical therapeutic interventions.

Medical or Conservative Treatment for Acne Scars.

These are more effective for shallow and superficial acne scars and acne blemishes and involve use of creams, gels and solutions.

Surgical or Cosmetological Acne Scar Treatments.

For medium or deep scars, there are a number of surgical or cosmetological options available. A plastic surgeon or a dermatologist who has professional training and experience in treating acne scars are the doctors whom you should approach for these procedures:

  1. Chemical peels for acne scars
  2. Dermabrasion for acne scarring
  3. Exoderm lift
  4. Needle subcision of individual acne scars
  5. Acne scar revision
  6. Laser resurfacing of scars
  7. Cryoslush
  8. Soft-tissue augmentation
  9. Intralesional steroid injection
  10. Excisional surgery in selected cases

There are many effective techniques to get rid of acne scars. The choice of treatment modality depends upon the age and sex of the sufferer, type of the acne, extent and depth of the scars, affordability and cost effectiveness of the procedures, and, finally, the expertise and facilities available at the treatment center.

The whole spectrum of treatments are available at our Cosmolaser Medical Centre in Samnan, Sharjah. Please call 06 5678 200 for appointments  or Visit the page to set up an appointment.

Read More about the Treatments available for Acne Scars:

Related Reading on Acne Scars
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

Types of Acne Scars

Acne scars may be divided into different types according to the morphology, depth, extend and tissue response to inflammation.

Hence, Classification of Acne Scar Types may be done in different ways:

  1. Depending upon depth
    • Superficial Acne Scar
    • Deep Acne Scar
  2. Depending upon tissue response
    • Atrophic Acne Scar
    • Hypertrophic Acne Scar
  3. Depending on the extent of involvement
    • Localised Acne Scar
    • Scattered Acne Scar
    • Extensive, Disfiguring Acne Scar
  4. Depending on the site of involvement
    • Facial Acne Scar
    • Body Acne Scar
  5. Depending upon the severity and duration of acne scar
    • Temporary Acne Scar: Very superficial scars, which fill out and gradually disappear over time.
    • Permanent Acne Scar
  6. Wrong Category!
    • Acne Pigmentation, acne blemishes or acne spots: Whether brown, red, or later black, pigmentary or color 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 color changes and are completely reversible. As expected, the acne blemish treatment differs from the acne scar treatment in a number of ways. 

Whether acne scarring is deep or superficial, extensive or scattered, the esthetic result can be less than desirable and even disturbing. By causing loss of elasticity and smoothness of the skin, the acne scars contribute to an aged look to the skin.

Acne scars form mainly two Acne Scar Types

  1. Acne Scar types with loss of tissue beneath the epidermis: These scars are depressed scars also known as atrophic scars and cause acne pits. These are caused by loss of support due to tissue damage in the dermis.
  2. Acne Scar types with increased tissue regeneration in the dermis: These are similar to hypertrophic scars and Keloids. They are typically raised, firm, reddish, and, at times, painful and itchy scars.

Atrophic Acne Scar Types:

Atrophic Acne Scarring: Pitted and Ice Pick Acne Scars
Pitted (depressed) and Ice-pick Acne Scars
  • Ice-pick acne scars , as the name indicates, are similar to ice pick wounds: steep sides and a broader base than the surface of the scar. They may either be deep or superficial, soft or hard. The size is usually small, from 1 mm to 2 mm in diameter.
  • Depressed fibrotic acne scars are similar to large and deep scars caused by chickenpox. Superficial and deep scars, soft or firm, they have a sloping edge, which gradually merges with the skin surface.
  • Atrophic Macular Acne Scars: Seen usually in body acne, the chest and back. These are small, flat, soft, papery white and thin scars . Sometimes the color may be bluish, violacious or brownish depending upon the skin texture, color and underlying blood vessels which become visible through the thinned epidermis. The atrophic macule type of acne scars gradually fade over time and become less noticeable after a few months or years.

Hypertrophic Acne Scar Types

Atrophic and hypertrophic Acne Scars in the back
 Atrophic and hypertrophic Acne Scars in the back
  • The scars caused by increased tissue formation are called hypertrophic acne scar types and Keloids. Overproduction of collagen in response to tissue injury caused by acne inflammation in the dermis is the cause. Excess deposition results in raised, thickened, and, at times, itchy and painful bumps.
Deep Acne Scars
Deep Acne Scars
  • While hypertrophic scars are self limiting and can occur in anybody, the keloidal acne scars tend to continue to grow. Keloidal tendency is hereditary and is thought to be due a deficient enzyme which is supposed to stop the collagen synthesis when optimum tissue repair is achieved. The result is uncontrolled collagen generation leading to thick, raised, fibrous and tender scars.

The Hypertrophic and Keloid acne scar types in turn can be of three types:

  • Soft Scars: The connective tissue is dispersed loosely with elastin fibres interspersed within collagen fibres and the scars are soft to the touch
  • Firm Scars : Loose but a little dense packing of collagen fibres with sparse elastin fibres. Firm to touch
  • Hard Scars: Densely packed ‘glassy’ collagen fibres with little or no elastin fibres. Hard, rocky feeling to touch. Toughest acne scar to treat.

As can be surmised, the treatment of atrophic and hypertrophic varieties of acne scars differ from each other.

Related Articles on Acne Scars:

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 Causes

Acne scar is caused by improper and delayed treatment of inflammatory acne.

Healing of inflamed acne lesions result in acne scars. The greater the inflammation, the deeper the scars. Skin repairs itself after any injury, including inflammation, by generating new collagen underneath. This deposition of new connective tissue causes acne scar . The main cause of acne scar is uncontrolled disease activity causing continuous inflammatory response within the dermis. The damaged skin repairs itself with scarring.

The Sequence Events Leading to  Acne and Acne Scar Formation

The sequence of  events leading to acne and acne scar formation is shown in the figure . The blockage of sebaceous duct due to altered keratin deposition in the walls leads to blockage of the hair follicle opening and retention of sebum. This is how comedones are formed. (Grade 1 or mild acne).

The injury to the dermis leads to an inflammatory response. An increase of the resident bacteria within the duct increases the inflammation resulting in papules (grade 2 acne) and pustules (grade 3 acne). Further retention of sebum and release of enzymes causes rupture of the sebaceous gland into the dermis.

This further adds to the inflammatory response and inflammatory cells accumulate deep in the dermis, leading to the nodule formation (grade 4 acne). Many such affected glands become confluent, resulting in the accumulation of pus, fluid and bacterial and glandular debris forming large acne cysts.

Acne Scar is caused by delayed or improper treatment of inflamed acne
Delayed or improper treatment of acne results in acne scar

When such inflamed lesions and cysts heal after rupture or absorption of fluid, with or without treatment, acne scars are formed. Severe, inflamed, cystic acne almost always leaves scars following healing, and in some people even superficially inflamed acne can result in scars. The size and pattern of acne scars will depend upon the size of the acne lesions as well as personal susceptibility to scar formation.

The  acne scars form two pattern of scars:

  1. Acne Scar with loss of tissue beneath the epidermis: These scars are depressed scars also known as atrophic scars and cause acne pits. These are caused by loss of support due to tissue damage in the dermis.
  2. Acne Scar with increased tissue regeneration in the dermis: These are similar to hypertrophic scars and Keloids. They are typically raised, firm, reddish, and, at times, painful and itchy scars.
Acne Scars: Related Reading
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: Why Prevention is Better than Cure!

Acne Scars: Prevention Better Than Cure!
Acne Scars: Treatment at early stages can prevent formation of scars.

Early, appropriate treatment of pimples is best to minimise or prevent acne scars, a major concern of teens with acne.

Most studies on acne and its effects on the teen age population point out that the prospect of scarring is the primary concern of a patient with acne.

Healthcare Implications of Scarring Caused by Pimples

There is a wide variation in results in studies about the occurrence of scarring in acne patients. Goodman, in 2000, reported 11% of males and 14% of females with acne had scars as assessed by the dermatologists treating them. A survey conducted in 2001 in France among female patients by Poli F et al revealed that 49% of patients thought they had scarring from acne.

Body Acne Causes more Scars in Males than Females.
Body Acne in Males Causes more Scars than in Females.

In the extreme end of the spectrum, Layton et al studied 185 patients in 1994 and found that almost 95% of patients in their study had some degree of acne scarring. They also noted that body acne caused scarring in males more often than females. Another important inference from their study was that the severity of acne scars was related to the delay in taking treatment after the onset of acne eruptions.

It would be interesting to analyse why an acne sufferer would approach a doctor for the treatment of acne scars in the first place. There are two main reasons why an individual would seek treatment for his/her acne scar problem.

Acne Scars Treatment Available at Cosmolaser Sharjah
Acne Scars have psychological implications.

Cosmetological reasons. Removing scars or at least changing the appearance of scars so that it becomes less visible is the main reason a patient would seek out treatment for the acne scars. It is always wise to keep a realistic expectation, though, so as to avoid future disappointments.

Psychological reasons. Recurrent acne eruptions and the resultant blemishes and scars could be emotionally upsetting to any teenager. At times the psychological impact may be disproportional to the extent of the acne scars themselves. Depressive illness and anxiety coupled with a loss of confidence creates an inferiority complex and self imposed social isolation in a number of acne scar sufferers. In such cases, proper counselling should be included as part of the acne treatment protocols.

Why Prevention is Better than Cure in Acne Scars

An update from the global alliance of dermatologists to improve outcomes in acne management published as a supplement to the May 2009 issue of the Journal of American Academy of Dermatology reached the consensus opinion that ‘Early, appropriate treatment is best to minimise the potential for acne scars’. The authors, headed by Diane Thiboutot from the department of dermatology, Pennsylvania State University College of Medicine and Harald Gollnick from the Otto-von-Guericke University, Magdeburg recommended the acne treatment be continued as long as necessary to prevent acne scars.

The above study conducted by dermatologists from across the globe links two modifiable key factors to the formation of acne scars:

  • Time delay between onset of acne and starting effective and appropriate treatment according to the specific type of acne. The longer the delay to get the most appropriate treatment, more the chances of getting irreversible acne scars. This is a warning to those teenagers who do not take the initial outbreak of acne seriously and resort to home remedies and OTC treatments for their pimples till it is too late to prevent the damage.
  • The extent and duration of inflammation caused by acne breaks before these are controlled. More the inflammatory reaction and the longer it is allowed to damage the facial dermal layer, the deeper and larger will be the resultant acne scars.

In some acne affected teens, progression to scarring despite conventional treatments has been cited as a primary rationale for early institution of oral isotretinoin.

The unfortunate fact is that, whatever mode of therapy is instituted for the treatment of acne scars, it is virtually impossible to get back the normal consistency and appearance of the skin as compared to the pre-acne state.

Hence it is always wise and cost effective to prevent the acne scar formation by taking appropriate effective medications to treat the acne right from the initial stages of the disease activity.

Acne Scars Prevention: 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: Diet Recommendations

A well balanced nutritious food is essential for getting rid of acne.
A well balanced nutritious food essential for getting rid of acne.

Diet recommendations are essential in the effective management of acne. Dermatologist Dr Hanish Babu provides expert advice on acne diet recommendations and valuable tips on which food to avoid in acne. He also outlines an acne action plan before you make your first appointment with your dermatologist for the pimple problem.

In the previous article “Does Food Affect Acne” we have seen some pretty persuasive evidences that point towards a certain relationship between acne and food. This brings us to the next question to be considered: which are the food items that have to be avoided by acne sufferers or persons with acne prone skins? And, which food can be consumed without worrying about the facial eruptions?

Which food to avoid in acne?

Based on the studies mentioned and similar studies published and personal observations, the following suggestions seem proper:

  • Reduce your intake of sugar (including excessive amounts of fruit juices), sweets, processed flour, baked goods, and trans or hydrogenated fats. Examples include donuts, cookies, pastry, ice cream, pies, etc. You may use natural sweetener rather than sugar. Regularly eating breads, cakes, chips and other staples of Western culture is likely to promote acne.
  • Aerated drinks are a significant source of sugar. Switch to water, herbal teas, and vegetable juices.
  • Reduce intake of nuts, including brazil nuts, walnuts, almonds, and filberts. Peanuts and peanut butter may provoke acne in some individuals. If you eat nuts, limit your intake to small amounts and preferably eat raw nuts.
  • Reduce intake of milk products, including ice cream and cheese.
  • Reduce intake of chocolates and sweet drinks: High sugar and milk content will definitely aggravate acne.
  • Avoid Vitamin E & B complex supplements. Many patients have noticed aggravation of acne after taking vitamin E and B complex supplements. Hence it is safe to avoid supplements with high contents of these vitamins.
Acne Diet Recommendations
  • For skin health, food rich in Essential Fatty Acids should be consumed often as it helps dilute sebum and decreases chances of clogged pores on the skin. Omega 3 fatty acids are found in wheat germ , evening primrose oil, soybean oil and fish oils. Although tuna, salmon, sardines etc are also EFA rich, they contain high amounts of iodine which is not good for acne. Fresh water fish is a good alternative.
  • Increase intake of fresh vegetables, preferably organic. Eat a wide variety each day. Have 3-4 helpings of fresh vegetables and low sweet fruits every day.
  • Take lean meat like chicken, preferably grilled. Always include lots of fresh green salad when you eat any type of meat. This will neutralise the negative effects of the hormones and iodides contained therein.
  • Eat wholegrain bread, pasta and legumes which have a low glycemic index and do not aggravate acne.
  • Increase water consumption Drink 2-3 glasses of cold water immediately after you wake up and brush your teeth in the morning. This will improve blood circulation to vital organs and also help in bowel motions. Drink 10-15 glasses of water per day, double the amount in hot weather. Plenty of fresh water intake not only will help you to maintain the health of your body and skin it will also improve your brain and other vital organs’ functions.
  • Finally, eat everything in moderate amounts only.
An Acne Action Plan before seeing a Dermatologist
  • If you are suffering from recurrent acne that comes back despite treatment and is dotted by flare-ups and remissions, you can help your dermatologist to manage your acne much better by following these steps:
  • Keep an acne diet Diary: For a full month or two, write down all the food and the contents of food that consume on a daily basis. If you notice any flare ups, mark these days in red. If you find improvement, mark with green.
  • Make a note of all medications consumed and applied with ingredients
  • Also note the make up used and the ingredients. Face wash? How many times?
  • Write down a small note on your emotional status during these days. Put a red mark on high stress days when everything went wrong and you lost your temper! When you had a peaceful, calm and quiet day, mark the stress column in green.
  • If you are a female, write down if you noticed any flare ups before, during or after your menstrual periods.

Follow this acne diet action plan for best results to get rid of your acne.

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