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Acne is caused by the complex effects of androgen hormones and bacteria (Propionibacterium acnes) on the sebaceous glands in the skin. Androgen hormones stimulate the sebaceous glands to overproduce sebum on which the bacteria interact, causing clogging of the skin pores and inflammatory responses. Skin pores are clogged and inspissated keratin and lipid debris become trapped in the skin leading to the formation of whitehead and blackhead. Further inflammatory processes lead to papule, pustule, nodule and finally scarring of the skin. While acne eventually will heal and subside, acne scars are often permanent.


Acne scarring on the face usually consists of a mixture of different types of scars that are described as boxcar scar, ice pick scar, rolling scar, depressed scar, and atrophic scar. The two main problems of acne scarring are uneven skin texture and scar pigmentation. The uneven texture and ‘cratered' skin surface make acne scars standout and difficult to cover with makeup. Scar pigmentation, which is caused by post-inflammatory hyperpigmentation, make the acne scars even more visible.


Management of Acne

Treatment of acne scars should start with the control of active acne. Specialized cleansers and serums are available that help to clear clogged pores and remove excess surface oil and sebum. For mild cases, topical agents that contain antibiotics, benzoyl peroxide or retinoid are effective to control acne. For more recalcitrant cases, oral antibiotics can be used to control the actions of the bacteria. Oral retinoid is reserved for the most severe cases that failed to respond to other treatments. It is recommended that oral retinoid to be prescribed only by a specialist due to potentially serious side effects. Laser is an adjuvant therapy that is effective for moderate to severe active cases.



Management of Acne Scars

Recurrent and chronic acne will eventually lead to acne scarring. Once they are formed, acne scars cannot be reversed. However, treatments are available that can make acne scars less noticeable and easier to cover with makeup. Treatment options for acne scars are depending on their morphology and severity.

1. Fractional lasers: Currently the gold standard of acne scar treatment because of its effectiveness and less downtime. The lasers produce microthermal zones in the skin that induce coagulation and collagen rearrangement which improve the acne scars. Depends on the severity, laser treatment may require one session only or multiple sessions. Numbing cream is used for anesthesia. The duration of each laser session is 5-10 minutes. The average downtime is 3-5 days. Post laser care and sunlight protection are required.


Post Laser Care:

What to Expect:

·      Skin redness, burning sensation and itchiness may occur for first few days. Do not scratch the skin.

·      Oozing of yellow fluid may occur during the first few days. Gently wipe with clean cotton.

·      Multiple tiny scabs on the skin will peel off in a few days and replace by new skin.

·      Full recovery usually in 5 to 7 days.

Skincare protocol:

·      Clean the face 3 times a day with a mild facial cleanser

·      After cleansing, apply the prescribed moisturizer

·      After the moisturizer, apply the antibiotic cream (only for the first week)

·      After the antibiotic cream apply the prescribed sunblock twice a day

·      Sun protection is necessary. Use of physical sun protection such as an umbrella, hat, and sunglasses while under the sunlight.


2. Excision, punch excision and subcision: usually reserved for individual boxcar scar, ice pick scar or depressed scar.


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Jalan Perubatan 1, Pandan Indah, 55100
  Kuala Lumpur, Malaysia

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