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Re: Question
Mar 24, 2001
Hope this helps, a quote from a dermo describing acne scarring and ways to treat it.

Acne is an inflammatory condition involving hair follicles. Hair follicles become plugged with keratin and oil produced by the sebaceous glands, which is acted upon by the acne-causing bacteria, creating compounds that are irritating to the skin. Those compounds cause irritation in the hair follicle, resulting in a massive inflammatory reaction. If inflammation is too great, the skin surrounding the hair follicle is damaged.
Normally that damage is repaired quite easily without leaving a scar, although a few days of an embarrassing red pimple usually result. In people who have dark skin or the ability to tan, brown pigment is often left behind. That happens because the surface layer that contains melanin pigment to protect us from the sun is temporarily damaged. The pigment, which is supposed to reside in the top layer of skin (the epidermis), then falls into the deeper layer of skin (the dermis). This is especially true if the person with the pigment is constantly in the sun. Those brown marks are not usually scars.

Scarring occurs with severe inflammation that actually damages or wounds the skin. Scars are composed mostly of collagen that is arranged differently than the collagen of non-scarred skin. Acne scars are usually depressed areas of skin at the site of severe acne. They can even become deep holes, as with "ice pick"-type scars.
To treat the brown marks resulting from acne inflammation, I usually use glycolic acid-based products or retin-A. A sunscreen is a must, to prevent darkening of these spots in the sun. Bleaching agents (such as hydroquinone) do not help in my opinion. They are better for large dark areas (such as melasma) and simply produce white rings around the small, dark spots resulting from acne.

Retin-A tends to lighten these dark marks somewhat more quickly than glycolic acid in my experience, although it can cause irritation and peeling more frequently than glycolic acid. Glycolic acid peels help remove brown marks more rapidly than topical creams or gels but can be more time-consuming and expensive. If you do choose glycolic acid peels, avoid using retin-A, which could have an adverse effect on the treatments. A nice feature of using glycolic acid peels for treating brown marks is that they also improve the underlying acne itself.

For treating depressed acne scars, glycolic treatments with or without laser treatments can be effective. Glycolic treatments are beneficial for people of all skin tones, from very fair to dark black skin. Ongoing treatment is required to maintain optimal benefits, and peels are initially administered every one to two months. Initial benefits are from changes in the reflectivity of the surface layer, while later benefits (after three or more peels) are due to new skin formation.

Lasers also offer the potential for dramatic improvement for patients with acne scars. However, they are not as effective on darker-skinned patients. For lighter-skinned patients with persistent red acne scars, the pulsed-dye laser is excellent at removing the red from these scars and improving their texture. This treatment is called non-ablative resurfacing, because it does not destroy (ablate) skin. It requires no down time, and treatments are given initially about a month apart as with glycolic treatments.

Laser resurfacing is an option for patients with serious scars. Traditional resurfacing uses lasers that destroy the top layer of skin leaving a thin layer of damaged collagen behind. The newer short-pulsed carbon dioxide (CO2) or erbium:YAG lasers are able to destroy small layers of skin while leaving little damage behind. Resurfacing is often combined with the use of fillers, such as collagen or the patient's own fat, to build up depressed acne scars. Resurfacing requires about two weeks of down time, and skin may remain sensitive and pink for a number of months. Because the surface layer of skin is destroyed, very dark-skinned patients may not be candidates for resurfacing because of the risk of permanent damage to the pigment cell layer.

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