Treatment of Acne Scars

Chemoexfoliation (chemical peeling)
This refers to the use of chemicals to induce severe peeling of the skin and in the process, superficial scars are also removed. Chemicals such as trichloroacetic acid and phenol are used. However, there are dangers associated with the improper use of chemoexfoliation - scarring and pigmentation, especially in dark-complexioned individuals, may result. For these reasons, discuss with your doctor first before agreeing to such treatment.

Dermabrasion
This method works in the same way as sandpaper. Indeed the earliest form of this treatment for acne involved sandpapering the face by hand. Nowadays, dermabrasion is performed with motor-driven abrasive wheels to remove the epidermis and upper dermis down to the level of the scars. The face is usually converted into a more solid phase by first applying a freezing agent such as carbon dioxide slush. Considerable bleeding and swelling follow and eventually a crust forms. This peels off to leave raw, reddish, tender, new skin. Normal skin returns after eight to twelve weeks. Complications include infection, milia (small cysts), keloid and pigmentation especially in darker skinned individuals. In experienced hands, dermabrasion can produce reasonably good results.

Punch Crafting
The methods above are more suitable for shallow acne scars, but not for deep ice-pick scars. Ice-pick scars can be surgically excised and replaced by a graft taken from the skin behind the ear. This is called punch grafting. Sometimes, the edges are just stitched together without replacing the defect with a graft.

Implants
In contrast to dermabrasion, this method involves elevating depressed scars by injecting a substance. It is useful for treating scars with gradual sloping edges but not for scars with steep edges such as ice-pick scars. Paraffin and silicone were used in the past but they caused undesirable reactions. Collagen (one of the connective tissues in the dermis) implants of cattle origin are used nowadays. Zyderm is one such implant that has been around for a number of years. It is normally injected into the skin with a small amount of anaesthetic to reduce the pain. In the skin it condenses into a fibrous mass. On condensing it shrinks which is why a larger volume needs to be injected. Because of this, it is sometimes difficult to estimate the correct amount to inject into a particular defect. Some patients also develop an allergy because the collagen is of cattle, and not human origin. A test does must be given first to exclude an allergy. Furthermore, the correction is not permanent - collagen is a protein and the body gradually breaks it down. Therefore, treatment needs to be repeated at least every three years.



NO MORE PIMPLES, A SELF-CARE GUIDE, DR. LIM KAH-BENG