Acne and Acne Scars
Acne vulgaris is a chronic inflammatory skin disease that occurs due to blockage of pilosebaceous unit (i.e hair follicle with sebaceous gland). Since face, chest and upper back have the highest density of these pilosebaceous units, acne presents most commonly in these regions. Most common age group involved is 15-30 years, however it may also present in later stages of life.
Clinical presentation
Acne can present as
- Comedones (blackheads & white heads)
- Papules
- Pustules
- Nodules.
Inflammatory lesions, if not treated early can heal with pigmentation and scarring. Acne scars can be
- Atrophic (depressed scars) or
- Hypertrophic (elevated scars)
Types of atrophic scars:
- Ice pick
- Rolling
- Box car
Management
Although acne vulgaris is a clinical diagnosis, investigations are advised in special cases :
- In individuals suspected of acne resulting from hormonal imbalance- a PCOS profile can be advised.
- In resistant/ unresponsive cases, a culture may be taken from the lesion to rule out gram negative folliculitis.
Management of acne depends on the type of lesions present and the grade.
- Grade 1 (mainly comedones, few papules): topical retinoid/ benzyl peroxide
- Grade 2 (mainly papules, few pustules): in addition, topical anti bacterial is added
- Grade 3 (many papules, pustules, few nodules): oral antibiotics along with topical
- Grade 4 (nodulocystic) : oral antibiotics, oral retinoids and topical treatment.
Supplementary modalities of treatment include
- Comedone extraction
- Superficial chemical peels : salicylic/ glycolic acid peels
- Photodynamic therapy
- Intralesional steroids for nodulocystic lesions
Management options for acne scars include:
- Aesthetic approach: chemical peels, microdermabrasion, fillers
- Surgical approach: subcision, punch excision, dermal grafting, fat graft, microneedling, TCA-CROSS
- Laser resurfacing: ablative, non ablative, fractional.
The choice of treatment depends on the type and depth of acne scars. Sometimes different therapies need to be combined for each patient, to achieve optimal results.
