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Management of Acne and Acne Scarring: Current options

Insights from the American Academy of Aesthetic Medicine article by Dr Anoob Pakkar-Hull, Dr Sushant Shetty & Agnes Kuzniak


Acne – an annoying little thing that causes stress to many all over the world at some point in their life. Acne is prevalent in up to 80% of all young adults and adolescents and it can leave behind significant psychological impact on the individual. In this article will give you some key insights into some of the options there are to manage acne and its after effect, acne scarring.


What is Acne?


Acne Vulgaris (scientific name for acne) results from overactive sebaceous glands causing: excessive sebum production, excessive development of keratin in hair follicles that result in rough cone-shaped elevated papules, increased epidermal proliferation, along with the presence of Propionibacterium Acne (the most abundant bacterium on human skin) and resulting inflammation.




Acne Scarring


Following inflammation caused by Acne, scarring can result from the injury to the sebaceous follicle in your skin. The most common variety of acne scarring is called Atrophic acne scarring, which can be sub-classified further into Ice Pick scar, Boxcar Scar or Rolling Scar, based on its depth, width and shape. Atrophic scars are more prominent in the face area while hypertrophic and keloid scars are seen on the trunk.


Structure of Acne Scarring



Management options for Acne


Topical

  • Topical retinoids remain the first choice for mild to moderate Acne.

  • NICE guidelines recommend the use of Adapalene alone or in combination with Benzoyl peroxide ( BPO ) as the first line treatment.


Systemic

  • Oral Antibiotics has been the mainstay of treatment for moderate to severe Acne usually given for a term of 3-6 months. Doxycycline, lymecycline minocycline, and tetracycline, are the most used.

  • Isoretinoin: Is used for severe nodular-cystic acne and popular-pustular acne that is refractory to conventional treatment.

  • Anti-Androgens : Since acne is androgen dependent, this is an alternative and can be used in combination with topical treatments.

  • Corticosteroids are indicated in severe nodular-cystic acne, conglobata, and fulminans. The most commonly used are prednisone, prednisolone, dexamethasone and methylprednisolone.


Aesthetic Treatments

  • Chemical Peels: Superficial chemical peels are a useful conventional treatment option targeting comedonal and papular-pustular acne. There is often a requirement for repeated sessions rather than a one off treatment for optimal results.

  • GFIT with Microneedling: Growth factor Induced Therapy (GFIT) using growth factors is a more novel technique used for treating active acne. A case study using AQ growth serum is demonstrated in the image below.




Light or LED Treatment

This is a relatively new addition. Blue or Red LED exhibits anti-inflammatory effects. It can be used in conjunction with other treatments as an add on to be an effective treatment. Although this is a promising field, more controlled studies are required before it joins the mainstay of your treatment armoury.


Management of Acne Scarring

Treatment of Acne scars depends on the type of scars as mentioned above. A multimodal approach to treatment is often required preceded by a detailed consultation discussing the various options as well as expectations.


Microneedling

Over recent years, this has grown in popularity particularly with the added benefit of Mesotherapy where Growth Factors, hormones, plant extracts and vitamins have been used to induce and stimulate wound healing. The skin needling per-se enable the healing process. The advantages of this treatment is minimal downtime and is very less invasive. Results are seen from about 6 months onwards.




Chemical Peels

Superficial peels are not going to be effective, but medium to deep peels are used to treat scar tissue. You should use caution with deep peels.


Lasers

This method uses a concentrated beam of light to cause a skin ‘burn’ to a specific depth, leading to a controlled exfoliation of the skin. Repeated sessions lead to a reduction in the appearance of scars with an improvement in texture.


Micro-needling Radio Frequency (MnRF)

This novel procedure combines two methods: microneedling and Radio Frequency (RF) energy. RF energy is run through the needles, boosting the effect of the microneedling, leading to great collagen stimulation within the skin. It’s recommended that you get it done once a month. There is a good reduction in all types of acne scars and downtime is minimal.


Subcision

Surgical subcision is also an option – this involves removing the acne scar from with a needle, followed by volume replacement to replace the collagen loss.


Summary

There are plenty of Acne and Acne Scarring treatment options out there - amongst the multitude of options, we recommend seeking a medical professional who will take a patient-centric approach, discussing your personal goals and realistic expectation of results. Prompt treatment of Acne will lead to a reduction in the incidence of scarring. So if you are suffering from the effects of acne, feel free to reach out to us and we’d be very happy to guide you in the right direction.


Insights from the American Academy of Aesthetic Medicine article by:

1. Dr Anoob Pakkar-Hull MB BS, MRCA, EDRA, DAAAM Board Certified with AAAM Aesthetic Consultant Director of Laila Aesthetics, UK


2. Dr Sushant Shetty MB BS , MD Consultant Dermatologist Head of Medical Operations, Kaya Clinic, India Director of Laila Aesthetics


3. Agnes Kuzniak Aesthetic Dermatology Trainer Aestderm, UK

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