Aka acne scars, scarring, post acne, post operation, post peel, cicatrice
Introduction
Scar is area of fibrous tissue that replaces normal skin tissue after injury. It is resulted from the natural healing process of wound repair in the skin. When the fibrous tissue is not identical to the original tissue it replaced, and hence appeared as scar.
Acne scar is the product of inflamed acne and the visible remnants of acne are permanently left. Usually severe, inflamed, cystic acne leaves scars after healing, but in some people even superficially inflamed acne can cause scarring. There are many types of scars, each determined by the depth of wound and tissue response towards the inflammation of skin.
Scars contribute to a person looking older than their age as the skin loses its elasticity over the years.
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Scars almost always result from trauma of some kind, for example surgery, accident or severe acne.
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The most common scars found on face; acne scars are resulted from inflamed acne such as papules, pustules, nodules or cysts.
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The best way to prevent any acne scars from forming is to prevent more acne in the first place.
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Different forms of scars are determined by:-
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The depth of wound or damage to the skin layers
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Tissue response to inflammation or the alternation during the wound healing process
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Initial wound management
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Type of scars:-
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Raised scars (hypertrophic scars and keloids) - caused by increase tissue formation by buildup or overgrowth of collagen in the skin.
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Hypertrophic scars
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Tend to become thick, raised, red and appear swollen.
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They remain within the bounds of the wound and take longer time to heal.
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Keloid scars
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Tend to develop more prominently in the upper chest, neck and facial region.
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It is rubbery and firm and may itch.
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Individual with darker pigment tends to be at higher risk for developing keloids.
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Depressed scars - resulting from loss of tissue or collagen, it is the most common than raised acne scars.
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Ice pick scars
They are narrow, sharp, small scars with a jagged edge and steep sides; it makes the skin appear as it has been punctured with an ice pick. They may look like large open pores on face, often found on the cheeks. Ice pick scars develop after an infection from a cyst or other deep and inflamed acnes.
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Rolling scars
Occur as a result of tethering of otherwise normal appearing skin to the subcutaneous tissue below.
A wave-like appearance on the skin surface due to their wide and shallow depth.
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Boxcar scars (or fibrotic scars)
They are round to oval depressions that have sharp vertical edges, usually on the temples or cheeks, it is similar to chickenpox scars.
Scars are most often the product of an inflamed lesion, such as a papule, pustule, nodules or cysts.
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Inflamed acne occurs when the pore becomes engorged with excessive sebum, dead skin cells and bacteria P.acnes. The pore swells, causing a break in the follicle wall where the infected material spills out into the dermis, causing damage in the dermis.
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Responding to the damage, the skin forms new collagen fibers to repair the wound. When the repair job is not as smooth and flawless as the original skin, the more likely scarring is to occur.
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Overgrowth or buildup of the collagen fibers which causes raised scars, hypertrophic scars or keloid scars
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Loss of collagen fibers which causes ice pick scars; rolling scars or boxcar scars.
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Inflammation
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The greater the inflammation on the skin, the more likely scarring is to occur.
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Deep breakouts that take a long time to heal also increase the chance of scarring.
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Pinching and squeezing of the acne – this spreads the infection to nearby skin and damages unhealed tissue, which result in pit like scars. (Ice pick scars)
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Alternation or abnormal wound healing process
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The wound healing process can be classified by the layers involved
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Superficial wounds involve only the epidermis
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Partial thickness wounds involve the dermis
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Full thickest wounds reach into the subcutaneous fat of deeper
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Usually the superficial wound only causes tissue damage in the epidermis it is healed without leaving scars. The epidermis undergoes normal cell replacement process through cell regeneration process.
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The wound repairing in epidermis occurs by a process similar to physiological epidermal replacement. The cells of the stratum basale (the basal layer of epidermis) multiply, and then migrate from undamaged areas to replace damaged cells, the eventual repair has a normal structure and appearance and leaves no visible scars.
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Various factors such as the depth and size of the wound; age; heredity; even sex or ethnicity will all affect how the skin reacts to the wound healing process.
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As scar is the byproduct of an inflamed lesion or acne, you should prevent and treat your acne correctly and properly. Read more on acne.
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Don’t pick at or squeeze inflamed skin. Doing so will only extend the healing time, spread infection to other areas, worsen inflammation, and may even cause permanent scars. Allow the inflamed area to heal on its own.
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Proper skin care routine.
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Skin that is damaged by acne scars requires very gentle products.
Look for products that help in cell regenerating, repairing, remodeling that improve circulation and increase collagen and elastin synthesis.
Natural ingredients that have proven effectiveness in treating scars problems include AHAs, Aloe vera extract, Soybean oil, Rosehip oil, Gotu kola extract and etc.
3. Exfoliation
Using exfoliation on a regular basis helps reduce acne scarring. Choose an exfoliant with a low percentage of salicylic acid (BHA) to improve skin condition.
Using it for 1 to 3 times per week over an extended period of time will show results.
Initially, all scars are red because when the body starts to heal, it produces an over abundance of healing tissue and new cells. An increased number of blood vessels are formed to feed the healing tissue and new cells. This increases blood flow that prompts the discoloration.
There is nothing specific that can indicate the ultimate appearance of a scar or what type of scar it will be. The way in which a wound heals is different for every individual and is determined by genetics, environment and many other factors.
A proper wound management by preventing infection or inflammation; using proper medications and dressings; encouraging good nutrition and avoiding damage to healing tissues can help minimize the appearance of scars. However, the body's healing mechanism is the ultimate determining factor in scar development.
Many studies have now shown that vitamin E does nothing to a scar. While Vitamin E will cause harm to a scar, it is recommended that they not be used during the first two weeks after the wound occurs.
There is a possibility that darker skinned people have a higher risk of developing keloids than people with lighter skin. Further, based on medical history, some people may develop more problematic scars. Problem scarring can also be caused by improper wound care and further injury to the wound. Location of the injury, poor nutrition, skin coloration, and age are also elements that can add to problematic scarring.
The best advice is to prevent scar formation through proper cleaning and dressing of a wound, use of topical and/or systemic antibiotics, and techniques designed to reduce inflammation and potential injury to the wound. The best advice is to seek proper medical care and supervision whenever an injury or wound occurs. As for acne scars, it is best to be prevented by proper skin care regime to prevent the formation of acne.
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