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Scars are a natural part of the way our body heals itself. Whenever the dermis is damaged new collagen, which is the fibrous protein that gives skin its strength and elasticity, is formed by the skin to repair the damage. Sometimes the body produces an excess amount of collagen and the result is what we would consider “scarring”; the raised or discoloured marks that are left after we injure ourselves. Acne scars, on the other hand, are most likely to be depressed rather than raised on the skin. This is known medically as atrophic scarring, rather than hypertrophic (raised) scarring. But what damage does Acne cause on skin to produce scarring in the first place?

Acne itself is a common skin disease that is made up by a variety of skin-based symptoms, ranging from pimples, black heads & white heads, seborrhoea (scaly, discoloured skin), up to boils and cysts in severe cases; known as cystic acne. Not all of the symptoms of acne cause scarring; it is most often caused by pustules, papules or cysts, which we could collectively describe as inflamed lesions. And it is this inflammation which is the root of why acne causes swelling.

Inflammation is caused by dead skin cells, bacteria and oil collecting in the follicle or pore. This causes swelling and often results in breaks or tears in the follicle wall. If this takes place near the surface of the skin, the damage is normally quite minor and quick to heal. The real problem arises if the break is deep in the follicle wall, which takes much longer for the body to heal. All the infected material that has collected; the bacteria and dead cells & oil; spills out destroying healthy skin tissue and damaging the dermis. It is this dermis damage that causes acne to scar.

In addition to scarring, many of those suffering from the disease will notice dark pink or brownish spots appearing on the skin where acne has healed in the past. This is known as Post Inflammatory Hyperpigmentation (PIH) and is simply the natural discoloration that follows damage to the skin by inflammation. Thankfully, the effects of PIH fade over time, often between 3 months up to 2 years. For those who wish to get rid of the discoloration sooner, over-the-counter skin lightening treatments are available, as well as more serious options which can be recommended by your doctor.

The treatment of acne has been revolutionised thanks to laser technology becoming readily available over the past ten years. Initially the lasers that were used to treat acne utilised a single beam technology. These lasers were used to destroy the bacteria that brought on the inflammation which in turn causes acne to develop.

Acne can cause self confidence issues so many people seek medical assistance to try and rid themselves of this problem. Various laser treatments are available to those who wish to rid themselves of acne. Laser and light therapy is but one of these methods. Laser therapies are designed to reach deep into the skin without actually doing any harm to the surface. Early laser therapies tended to damage the surface of the skin by harming the oil glands.

Some laser therapies target the cause of acne inflammation (a bacterium known as Propionibacterium). These kinds of therapies are good at improving the texture of your skin.

Another type of laser therapy is known as Diode laser therapy. This can help the skin by attacking the sebaceous glands which is basically the thick middle layer of the skin. It does this without doing any harm to the outer layer of skin. There are some known side effects to this treatment and these include;

*Temporary redness.

*Also there might be some degree of swelling on the treated areas.

Pulsed light therapy utilises the power of heat energy to destroy p acne. This helps to decrease the oil production on the skin. There is a downside to this treatment in that it can cause redness in the treated areas of skin.

Laser acne treatment although quite costly does have quite a few benefits so it should not be overlooked particularly if an acne problem is causing confidence issues. The following are some of the benefits of laser acne treatment;

1) The treatment is fast and effective and the results will be noticeable almost straight away.

2) There is no pain associated with this kind of treatment which means that you can leave a clinic without feeling any worse.

3) Laser treatment does not have any side effects and it is completely safe.

Obviously any kind of laser treatment therapy should be administered by a qualified doctor as it is an incredibly delicate procedure.

Acne affects many people throughout the UK. Many people blame the acne on puberty. However there are many factors that can cause acne to spread.

Understanding why you have acne is one of the most important steps to take in treating it. To begin with, acne is an infection on your skin. Usually, acne is formed when bacteria makes its way in to the pores of your skin where it breeds. As soon as your skin becomes irritated, it will then react creating sores. This is the acne that is visible on your face.

Acne is usually caused by the presence of bacteria and large amounts of oils on a person’s face. Usually, these two factors are the main causes for many types of acne. However, there are many other factors that can also cause acne to occur…

• The secretion of high levels of oil can be down to a hormone imbalance that may be caused by either puberty, anxiety, health problems or other conditions.

• Bacteria can form on a person’s face due to poor levels of hygiene.

• Bacteria can also form from the dead skin cells that are not exfoliated.

• A poor unbalanced diet can also cause oily skin and decrease the body’s capability to fight off infections.

At FreedomHealth, we combine the use of the laser acne treatment with effective medical treatment as an extra weapon in the fight against acne. So, if you are interested in talking to one of our medical professionals and want to win the fight against acne then please book a consultation with a member of our team who are more than happy to help you.

Acne and Acne Laser Treatments

Acne is an extremely common condition affecting probably around 85% of adolescents and adults at some time in their lives. The common wisdom when you’re 14 years old with mega eruptions of acne on your face, back, shoulders and chest is that it will fade with time and you’ll “grow out of it”. Very many people don’t and in fact persisting acne into adulthood is common and also traumatic and troublesome. Acne is socially debilitating, depressing and associated with suicide.

Acne patients are generally long suffering and often despondent by the time they seek medical assistance. They need fairly gentle encouraging handling and with combination therapies will achieve good improvements in a short time frame. One of the main determinants of success in my experience is persuading patients to stick with a treatment protocol. Whilst its not true to say that sticking to any treatment is as successful as another, persistence brings better results.

The size of the problem can be gauged partly by looking at how many web searches are made for acne-related terms in any one month. In March 2010 a total of nearly 500,000 searches were made for acne, acne treatment and acne medicine via Yahoo. By anybody’s terms this suggests a huge problem. In the USA the estimated cost of acne in the USA is thought to be in excess of $1 billion with $100 million spent on over the counter remedies.

Social and psychological stigma associated with acne and acne scarring is colossal, with very many people withdrawing from social activity such as sports as a result. Men are inhibited from taking off their shirts in public and many of our male patients have withdrawn from high-level athletics, football and swimming as a direct consequence of acne. This generally leaves them regretful and in some instances resentful. One of the most annoying things patients report is that everybody has a solution which they are keen to offer. Drinking Guiness, sunlight, steam rooms, homeopathy, mysterious herbs ordered over the internet are all candidates put forward by well-meaning but irritating friends and relatives.

Acne is quite a complicated condition. Children rarely, if ever develop acne. Rather, it begins as puberty develops, mainly in response to the sudden development of super-doses of testosterone in both boys and girls. Acne is described in the medical literature as a follicular disease6. This means that the individual skin hair follicles become larger, produce more oil and more skin cells and then block. The blockage causes the glands to slowly accumulate oil and miscellaneous skin debris. This then makes the glands larger and eventually they are colonized with a bacteria, Propionibacterium acnes.

Teenagers with their oily skin are ideal breeding grounds for the acne bacteria. Unfortunately so are some adults who seem to be predisposed to continuing acne. Men who use anabolic steroids will often experience dramatic breakouts – effectively going through puberty all over again, each time they use.

The invasion of the acne bacteria starts a fabulous cascade to dermal hell. The immune system recognises the bacteria as foreign and lymphocytes flood into the follicles and peri-follicular area. This results inflammation and the follicle will rupture releasing bacteria, oil (sebum) and skin cell debris into the nearby dermis. The cascade ratchets up a notch with infiltration with neutrophils, lymphocytes and foreign body giant cells producing papules, pustules and nodular swellings7.

Diagnosing acne rarely presents a problem. Patients, their mothers, boyfriends and girlfriends have already correctly identified the disease before they come anywhere near a doctor. They’ve also usually spent quite a bit on miscellaneous remedies in the pharmacy, though rarely for long enough to make any sustained improvement.

Treatment

Standard treatments haven’t changed much in the last thirty years or so quite frankly and they remain mostly unsatisfactory from a patient’s point of view.There are though some glimmers of light on the horizon.

The mainstay of treatment remains oral antibiotics which require long term usage over many months. It’s estimated though that around 65% plus of acne bacteria in UK patients is resistant to commonly used antibiotics such as tetracyclines (25%) and erythromycin (50%). In addition, such antibiotic usage sometimes will trigger development of resistant commensal organisms which may then superinfect pre-existing acne lesions exacerbating the condition and allowing for paradoxical loss of disease control.

Whilst for some patients the response to oral antibiotics is good, for many it is lacklustre at best. This, coupled with increasing reluctance to take antibiotics long term, common GI side effects and photosensitivity reactions is making oral antibiotic treatment a poor option.

New formulations of antibiotics have successfully removed the “antibacterial” part of the medication whilst retaining the anti-inflammatory part which is thought to be very important. Medications such as lymecycline are highly effective and very well tolerated.

Topical antibiotics are commonly used also but in my experience are poorly effective, active only on the well applied areas and some of the preparations may give a fluorescent glow in ultraviolet light – difficult for young people in nightclubs. There are other preparations like benzoyl peroxide which have a good antibacterial effect but can be extremely irritating to the skin and will bleach coloured items such as clothing. For large hard to reach areas such as the back they are less than practical.

Retinoid creams and gels will act to regulate the follicle function and restore normality. They are useful in active inflammatory acne and also to reduce comedone formation. They will improve the general tone and look of the skin. In darker skins where inflammatory lesions leave dark hyperpigmented areas they will act to reduce the hyperpigmentation. Coupled with “blender” creams containing hydroquinone such as the Obagi Nu-Derm Blender, the dark scarred areas can be reduced markedly. Retinoid creams are prescription only items and a doctors prescription is necessary.

Roaccutane has attracted a great deal of attention recently. It works very well indeed in severe acne, but because of the side effect profile it is limited to prescription by hospital dermatologists and for very severe acne only. It works by attacking all the various pathways that lead to acne formation. It reduces the size of the follicles, reduces the formation of oil and blockages in the skin and effectively kills off the bacteria causing acne. The result is an extremely potent treatment. However, there are possible psychiatric side effects. This is difficult to tease out fully because acne alone is known to cause depression and lack of confidence. Recent evidence seems to suggest that the severity and length of duration of acne is more relevant in suicidal thoughts than the medication used to treat acne.

At Freedomhealth we’ve started using the Sciton BBL laser. The laser has two effects. The first is that the immediate impact of the laser beam on the acne bacteria is to kill the organisms, an effect similar to that achieved by exposure to sunlight or UV light. This seems to be mediated by an oxygen liberating effect with porphyrin containing organisms subjected to particular wavelengths of light. In addition the laser seems to have a immune modulating effect such that the initial response and the body’s cascade reaction to the acne sequence might be reduced leading to long term improvement overall.

Our own results at Freedomhealth have been intensely encouraging with the overwhelming majority of patients treated experiencing significant improvement with one to two treatments. It is common to experience a very immediate improvement probably due to the bacteria killing effect of the laser, followed by a short relapse 7 or so days post treatment and then a sustained improvement thereafter.

Summary

There is no doubt that acne is a demoralizing and depressing condition whether it’s on the face or back or both. There are some very basic rules to follow which will minimize the damage, because its not only the red spots which can disfigure but the scars which result from inappropriate picking an squeezing.

Try and keep your fingers away from your spots. If you must squeeze, then restrict it to the spots with yellow heads or blackheads only. Don’t squeeze the blind red ones because you’ll just double the result. Wash the to-be-squeezed areas well and scrub your finger nails with a brush before attempting the squeeze.

Dietary factors are said to be irrelevant but from personal experience I know that certain foods make my acne worse. Try and identify your own troublemakers and keep them to a minimum.

Seek advice from an interested doctor early rather than late. This will save you months of angst and also a fair amount of money in terms of potions and lotions.