Post-acne scars. Methods of treatment and correction

Igor Safonov is a dermatovenerologist, chief physician of the Center for the Treatment and Correction of Scars at the Institute of Dermatocosmetology Dr. Bogomolets (Kiev) .

Time to heal, time to adjust

Acne scars occur due to destructive inflammation in the dermis. Most often, atrophic scars are formed, less often keloid scars. The formation of a particular type of scar depends on many factors, such as skin type, intensity of inflammation, extent of the process, adequacy of treatment, severity of the immune response, etc.

Both atrophic and keloid scars respond better to treatment than to correction (we are talking about treatment while the scar is young and its age does not exceed 1 year; we are talking about correction when the scar is a year old or more).

Both treatment and correction are a complex, lengthy task and do not always lead to a satisfactory result.

Many articles, manuals and books have already been written that reveal the processes that occur in the skin during the formation of a scar. But despite this, scars still form and create great psychological problems for their owners.

So, what should be the tactics, and what methods of treatment and correction of scars can be in the arsenal of a cosmetologist?

Keloid scars: effective techniques

Let us first dwell on keloid scars, or keloids (from the Greek chele - “claw of cancer”). Keloids have favorite localization sites and are formed mainly in the décolleté, shoulders, upper back, and scapular areas. On the face, this is the area of the cheeks and lower jaw. Keloid scars can be divided into two groups: active and inactive.

Signs of keloid scar activity:

• gradual slow (and sometimes fast) growth of the scar;
• change in the color of the scar due to temperature changes (after a sauna or bath it becomes purple, in the cold it becomes bluish);
• painful or unpleasant sensations when palpating the scar;
• itching, especially at night;
• hyperemia at the poles of the scar (growth zone).

If these signs are absent, then the scar is inactive and does not require your participation, but if there are signs of activity, then the scar must be treated. Typically, keloid scars are treated for 1 to 1.5 years, in rare cases longer. In a beauty salon, the following methods can be used: injections of corticosteroids into the scar, cryotherapy (cryodestruction), wearing silicone coverings. Local application of gels, ointments, creams (any!), as a rule, has no effect, but can promote the growth of keloids.

I would like to dwell in more detail on cryodestruction (freezing the scar with liquid nitrogen). The method is old, inexpensive and quite effective. However, a positive result can only be achieved with prolonged contact (30–40 seconds) at a constant negative temperature (-196o C). The “reed” method (using a cotton or gauze swab tightly twisted on a wooden stick and soaked in liquid nitrogen) is contraindicated in the treatment of keloids, and here’s why. When treating scars using the “reed” method, you have to constantly dip the tupper into a vessel with cryogen, which does not make it possible to create a long exposure with a constant low temperature. As a result of such treatment, fibroblasts will not die, but will be excited: they will begin to produce collagen with redoubled force, which will lead to even greater growth of the scar. Often patients after such cryodestruction do not see the effect and abandon this method. This is how one of the main standard methods of treating keloid scars is discredited.

Thus, in order to carry out cryodestruction to the proper extent, it is necessary to have special equipment and at least a minimum set of Teflon attachments, which are applied to the scar and create a constant temperature of about -188o C; - 192o C.

Among physical procedures, electrophoresis with lidase or longidase in alternation with phonophoresis gives a good effect - but only on scars located in the facial area.

On the shoulders, back and décolleté, the listed physical procedures can, on the contrary, provoke the growth of keloid scars. The same applies to other methods widely used in cosmetology, such as peelings of any level, all types of dermabrasion, laser resurfacing, mesotherapy, massage.

Atrophic scars: new opportunities

If the picture with the treatment of keloid scars is more or less clear, then the situation with atrophic scars is much worse. The fact is that those methods of treatment and correction of atrophic scars that are used in salons do not give any significant result. We could put an end to this... But let's try to understand why this happens and what methods can still give an effect, and therefore attract potential patients (clients).

The bottom of the atrophic scar is located in the reticular layer of the dermis. None of the applied cosmetic methods, except mesotherapy, can reach the bottom of the atrophic scar, and therefore cannot solve the problem. As for mesotherapy, the introduction of fillers (fillers) gives a temporary and not in all cases satisfactory result.

Subcision, or cutting of the scar, gives a good and permanent result. The essence of the method is as follows. During the maturation of an atrophic scar, connective tissue fibers develop in it, which fix the bottom of the scar, plunging it into the dermis. Using a needle, the connective tissue cords are cut, and the bottom of the scar, freed, rises up. The defect is leveled out.

The disadvantage of subcision is the duration of the procedure, even with a small amount of scarring. The following complications are also possible: intersection of blood vessels (hematomas), intersection of nerves (muscle paresis), pain in the area of intervention; if the rules of asepsis and antisepsis are not followed, inflammation and infection are possible. Therefore, cosmetologists with medical education and sufficient work experience can carry out subcision.

In order for the atrophic scar to tighten and the effect to be long-lasting or permanent, it is necessary to force fibroblasts to synthesize their collagen. For this purpose, transdermal induction of collagen synthesis is carried out. The method is relatively new, but has already gained popularity all over the world. Today this is know-how in dermatocosmetology and aesthetic medicine.

Even old, long-term acne scars can be corrected in a fairly short period of time - from 2.5 to 6 months. In this case, only 1–3 procedures will be required with an interval of 1.5–2 months.

Table. The main components of powder and their properties

First published : KOSMETIK international journal, No. 4(38), 2009, pp. 32-34