Cheshire Cosmetic

Acne & Scarring

What is acne?

Acne is the inflammation of sebaceous (oil producing) glands of the skin hair follicles. Acne is a common skin disorder affecting mostly young people, which peaks around age 13-19. However people aged between 20 -30 may also be affected by acne. Surveys have revealed that nearly 30% of teenagers suffer from severe acne and receive acne treatments and treatments to prevent scaring. Acne is a common skin disorder equally among men and women. Spots appear mostly on the face, back and chest. There are two types of acne: inflammatory acne and non - inflammatory acne. Inflamed Acne can damage skin and cause scarring. It is better to get treatment for acne before it gets worse.

What causes acne?

• Acne is caused by an increased production of the male sex hormone (androgens) during puberty that stimulates the sebaceous glands to produce more sebum.
• Increased production of sebum makes the opening of the sebaceous glands narrower, preventing the sebum from escaping. This causes the glands to swell, resulting in comedones (whiteheads) and blackheads (oxidised sebum).
• A common skin bacteria (Propionebacterium acnes) feeds on the sebum and produces waste products and fatty acids, which irritate and inflame the sebaceous gland. This results in redness and spots.
• Greases, oils, cosmetics, humidity, sweating may block the pores.
• Menstruation it is one of the most common causes of acne. Women may get acne 2 -7 days before their menstrual cycle begins.
• Some medicine increases the oil production and blocks the pores, which in turn causes acne
• Very often squeezing, picking or repeated cleansing may damage the skin and worsen the inflammatory process.

What are the treatments for Acne?

There are two main types of acne treatments; topical acne treatments, which means applying something onto the skin and oral medicine for acne. Mild acne can be controlled through self -care and topical acne treatments, but more severe acne will need an oral medicine. Severe acne conditions may require repeat treatments for 6-8 weeks to see visible results.

Acne treatments vary depending on the severity as illustrated below.

Serverity	Treatments	How it works
Mild acne	Benzoyl peroxide (eg Panoxyl gel)	Prevents narrowing of sebaceous gland opening
Mild / moderate acne	Erythromycin + Zinc (eg Zineryt solution)	Topical antibiotic (reduces bacteria)
Mild / moderate comedonal acne	Adapalene (eg Differin gel)	Topical retinoid (reduces sebum)
Moderate / severe inflammatory acne	Minocycline / Doxycyline capsules	Oral antibiotic (reduces bacteria)
Moderate / severe acne (women)	Dianette tablets	Oral anti-androgen (reduces sebum)
Severe cystic acne (Hospital only)	Isotretinoin (Roaccutane capsules)	Oral retinoid (reduces sebum)

If you are unsure of the best treatment for you, discuss with Dr Raj Acquilla, our Dermatologist at Cheshire Cosmetic Ltd for which is the right acne treatment for you

What causes acne scarring?

Scarring can occur at the site of an injury to tissue. In the case of acne, the injury is caused by the body's inflammatory response to:

• Sebum
• Bacteria (Propionebacterium acnes) and their debris
• Plugging of the sebaceous gland

Variations in the severity of scarring can be seen from person to person. In general, the more severe (eg. nodulocystic acne) the acne, the greater the tendency for scarring. Acne scars arise when spots become inflamed or sometimes do not heal properly.

There are two types of acne scars; pigmented scars and ice pick scars. Pigmented scars are a purplishbrown mark once the blemish goes away and ice pick scars are small holes in the skin. Normal white heads will not cause for scars, because it does not become inflamed. Picking at acne increases the chances for scarring as it can introduce bacteria, causing an infection.

Types of acne scarring

There are 3 broad categories of scarring:

• Post-Inflammatory Hyperpigmentation
  Post-Inflammatory Hyperpigmentation is redness or darkening of the skin around an acne lesion and tends to last between 6-18 months, depending on the skin type.
• Increased tissue formation (eg Hypertrophic / Keloid)
  This is generally caused by excessive production of collagen and can persist for years. Steroid injections can be used to help, but such scars are notoriously difficult to treat.
• Loss of tissue
  • Ice pick scarring - usually on the cheeks.
  • Depressed scarring - soft or hard with rolled edges.
  • Atrophic scarring - soft with a wrinkled base.

Treatments for acne scarring

Acne scarring can cause embarrassment and emotional distress. The best form of acne scar treatment is prevention by early consultation and treatment for acne as outlined above. Scarring can be treated as follows:

• Chemical Peels
  Effective for treatment of pigmentation and mild depressed scarring. May require 2-3 separate procedures.
• Laser and IPL
  Effective for pigmentation and improves mild / moderate depressed scarring. Usually requires 5-6 treatments. Laser treatment for acne scars is one of the most popular treatment methods now.
• Dermal fillers
  Used to lift depressed scars and stimulate collagen production.
• Microdermabrasion
  Using a vacuum and crystals to remove the surface layer of skin cells. Useful for rejuvenation but unlikely to help with deeper acne scarring.
• Dermaroller®
  Thousands of microscopic needle columns stimulate skin repair including new collagen formation and improved skin texture.
• Skin surgery
  Subcision - surgical release of the fibrous base of depressed scars.
  Excision - surgical removal of the scarred tissue.

Type of scarring	Treatment	Price
Mild / superficial	Microdermabrasion	from £55
	Dermaroller®	From £295
Post inflammatory hyperpigmentation	Obagi Nu-Derm skin care	£40-300
	Chemical peels	£500-1100
	IPL / Laser	£100-300
Loss of tissue	Dermal fillers	from £150
	Subcision	£230
	Sculptra™	from £390

Book a free consultation with Dr Raj Acquilla our Dermatologist at Cheshire Cosmetic Ltd for best acne scars treatment for you