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Acne Basics
Report - One
DISCLAIMER

This information is not presented by a medical practitioner and is for educational
and informational purposes only.
The content is not intended to be a substitute for professional medical advice,
diagnosis, or treatment. Always seek the advice of your physician or other qualified
health care provider with any questions you may have regarding a medical
condition. Never disregard professional medical advice or delay in seeking it
because of something you have read.
Since natural and/or dietary supplements are not FDA approved they must be
accompanied by a two-part disclaimer on the product label: that the statement has
not been evaluated by FDA and that the product is not intended to “diagnose, treat,
cure or prevent any disease.”

Acne Facts And Fictions
Acne is far from an uncommon ailment. Many of us struggle with this harmless, yet
aggravating condition. Fallacies about acne are abundant, as well. Hopefully this article will
help you sort out the fact from the fiction.
Fact: Acne is caused by oil secreted by the skin
Yes, it is true that one of the major components of acne is oil secreted by sebaceous glands,
which are found in the skin of all mammals.
Fact: Acne is caused by blocked pores
Yes, dead skin cells and excessive oil secretions combine to block the pores in the skin. These
blocked pores then begin to grow the bacteria Propionibacterium acnes. The body may then
have an allergic reaction to these bacteria. These factors combine to cause an inflammatory
response by your body, which is what we call acne.
Fiction: Acne is caused is by improper hygiene
While it is true that acne is caused by blocked pores, better hygiene cannot prevent acne. All
of the scrubbing in the world cannot unblock or prevent the blocking of pores, because the
blockage is well below the surface of the skin.
Fiction: Acne is cause by diet
While acne is caused by excessive oil secretions, changing your diet to exclude oilier foods is
not likely to help. These oil secretions are not diet related, but hormonally controlled.
Fact: Acne is related to hormones
The causes of acne are largely controlled by hormones, so acne is often triggered by
hormonal changes, such as puberty. Hormonal changes and imbalances can cause the
excessive oil secretions, and other factors that are related to the causes of acne.
Fact: Acne may be caused by medications
Yes, there is evidence to show that Acne can be caused or triggered by certain medicines or
chemicals, including Anabolic steroids, any medication that contains halogens, and exposure
to high amounts of chlorine compounds.

1

A Guide To Acne Skin Care
Acne is a problem faced primarily by teenagers across the world. However, it is not
uncommon to find acne in individuals aged between twenty to forty years. Acne is a skin
problem characterized by blackheads, whiteheads, pimples, and lumps. It generally occurs on
the face, neck, upper arms, and shoulders.
Bacteria, excessive oil, dirt, make-up, and sweat are some of the factors that cause acne.
Therefore, acne skin care must be targeted at keeping the skin clean and reducing its
oiliness. Individuals with acne should wash their faces with warm water and soap or face
wash that is specially manufactured for acne-prone skin. Products containing tea tree oil are
supposed to be beneficial. While application of a sunscreen with SPF of 15 or higher is
essential while going out during the day, night cream should be avoided. Astringent can be
used to cleanse and tone the skin, followed by the application of a mild, water-based
moisturizer.
Pimples should not be touched frequently or squeezed, as this often aggravates the problem
and leaves behind stubborn marks. Tomato, mint, or cucumber juice can be applied on the
face and the neck. They provide a blemish-free complexion. In addition, a weekly face mask
made of almond powder, milk, and rosewater can prevent pimples and lead to glowing skin.
Oil-based make up should not be used on acne-prone skin. Although a variety of concealers
are available in the market to hide skin blemishes, they offer only a temporary solution. In
fact, some concealers add to acne problems. Apart from following a skin care regimen based
on suitable products, diet needs to be controlled to prevent or cure acne. This is because
acne also results from digestive disorders. Intake of fried food, sweets, tea, coffee, soft
drinks, and alcohol should be cut down. Instead, fresh lime, tomato, or carrot juice can be
taken in-between meals. These help to cleanse and hydrate the body internally, and only a
healthy body can possess flawless, glowing skin. Therefore, a mix of internal and external
care is required to combat acne.

2

Adult Acne
You breezed through your teenage years with a zit or two and never thought about it. Now
you look into the mirror in horror. What happened? How is it possible to develop acne in your
mid 30's, isn't this supposed to happen to teenagers? You find yourself embarrassed and
confused.
The unfair fact is that adult acne will affect 25% of men and 50% of women in their adult
lives. We know that teenage acne is due to hormonal changes which causes an increase in oil
production. The causes of adult acne aren't as clear. There isn't just one cause. Acne in adult
women can be linked to cosmetic use and some hair products. It can be brought on by the
hormonal fluctuations associated with pregnancy. Certain types of prescription medications
can cause adult acne. Acne vulgaris which is the type of acne that affects adults generally
doesn't happen after the age of 40. Unlike teenage acne that starts on the forehead and
cheek area adult acne tends to show more on your chin, jaw and neck area.
The treatment you receive for your acne will be based on the severity of the acne outbreak.
Mild acne outbreaks can be treated with topical and over the counter products that contain
benzoyl peroxide, salicylic acid or glycolic acid, the same creams that teenagers use. If you
acne is more severe your dermatologist may prescribe oral antibiotics. These antibiotics treat
the bacteria causes of acne.
Micro dermabrasion and acid peels can be used to help diminish any scarring that might occur
with adult acne.

Brief Overview Of Baby Acne
Small babies may develop acne because of the lingering maternal hormones after delivery,
which may cause stimulation to the baby's sebaceous glands. Your baby receives these
hormones from the placenta, after the delivery.
Don't worry if your baby has pimples. About 20% of the newborn babies are affected by baby
acne, also known as acne-neonatorum.
Let’ know the various aspects of this peculiar type of acne. First things first, the treatment for
infantile acne is not the same as that of acne treatment for any other age group.
Infantile acne is gender-biased. Male babies are more affected than their female
counterparts. Normally babies have the acne attack at the age of 3 weeks. Some babies have
it from the time of delivery. Generally the types of acne you find in infants are papules and
pustules. Papules are red bumps and pustules are whiteheads. They have a collection of pus.
Some babies also have acne on the scalp. Acne in babies does not require treatment as such.
The lesions will take care of themselves within a period of four months. But do take the
normal care of the baby as you would take care of its other body parts.

3

Use mild baby soap and gently clean the face once in a day with water. Do not try harsher
methods by using oil and other lotions which you think are good.
They may at times, worsen the condition. Know for certain that infantile acne will disappear
when it has to.
In your anxiety to photograph the baby, don't stuff his/her cheeks with cosmetics and if at all
you need to have the touch-ups, do it in an imaginative way.
If you or your family doctor feel that the baby has severe acne, treat it with benzoyl
peroxide, keratolytic agents or topical creams like retinoids.
The ways of acne are indeed mysterious. If you have a family history of acne, that doesn't
mean that your baby will have acne. And just because the baby has acne, it doesn't mean
that, it will suffer from the attack of acne, when it grows up. Acne has its own working style
and attacking strategy.
Infantile acne, which normally appears after the age of three months in a baby, quietly
disappears after the age of 12 months. No special efforts of treatment are required. In some
babies, the condition may last up to three years. It is due to the genetic makeup of your
baby. You have something to contribute to it, as the hereditary part.
You have nothing to do with the infantile acne, relating to the treatment part. Just observe its
arrival and departure. Well, arrival with anxiety and departure with pleasure!

4

Does Sunshine Help Acne?
Acne has many treatments. Being a very common problem, people have found their own
ways of treating acne. Some of them don’t cure acne but may further damage the skin. Many
of us believe that acne can be treated by getting exposed to sun, but is it true? Let us find
out the truth.
Once we know about what causes acne, we can find out if sunshine affects any of them. The
causes of acne are very simple. Because of hormonal changes and sometime pressure or
chemicals, body produces more sebum. The gland keeps on producing sebum, but the gland
opening gets closed with dead skin. This makes the gland expand like a balloon. The bacteria
P.acnes infects the gland and inflames it. This gland forms the acne. If the infection is not
severe you will call it black head or white heads, otherwise pimples, cystic acne etc.
Every acne treatment tries to address one or more of the causes of acne formation.
Sunlight does not address any of the causes. What it does is to either burn the skin or tan it.
With tanned look, acne looks less apparent and we believe that it is going away. But that is
not true. Rather sun damages the skin and may cause early wrinkles, aging and even cancer.
Please consult your doctor about acne treatment and stop believing that sun can cure it.

Some Acne Imposters
Some are simply unpleasant tagalongs, like dandruff; some may actually be mistaken for
acne, but require a different course of treatment. Of course, only your dermatologist can
make a conclusive diagnosis. But learning a little about these conditions may help you
formulate questions for your doctor.
Acne cosmetica. As its name suggests, this mild and relatively common form of acne is
caused by cosmetics. Since it's triggered by topical products, it can strike anyone — even
people who are not physiologically prone to acne. It typically consists of small, itchy or rashy
pink bumps on the cheeks, chin and forehead, developing gradually over the course of a few
weeks or months. It may persist indefinitely, but usually does not cause scarring. How can
you avoid it? When shopping for make-up and skin products, look for products that are "noncomedogenic." These products are less likely to cause irritation or clogging of the pores.
Dandruff (or Seborrheic Dermatitis). For reasons we don't know, dandruff often accompanies
acne, especially in adolescents. The causes are similar. For dandruff sufferers, the natural
process of scalp-cell renewal is accelerated when fighting off P. ovale, a normal fungus found
on every human head. This causes dead cells to slough more quickly, creating the symptoms
we know as dandruff — flaking, scaling and itching of the scalp. In some cases, dandruff
involves tiny pimples on the scalp. Climate, heredity, diet, hormones and stress can also
impact dandruff. Most cases can be managed with non-prescription shampoos containing
zinc, coal tar or salicylic acid. Stronger shampoos can be prescribed by your doctor if the
problem continues. Dandruff isn't caused by overwashing of the hair, so it's okay to shampoo
every day. In contrast, scratching or picking the scalp can worsen the condition.

5

Dermatitis (or Eczema) is characterized by a rapidly spreading red rash which may be itchy,
blistered and swollen. Atopic dermatitis is related to asthma and hay fever-type allergies, and
is often seen in early childhood.
Contact dermatitis is usually caused by contact with irritants (detergents or harsh chemicals)
or allergens (substance to which the patient is allergic, like rubber, preservatives or a
particular fragrance). Individuals with chronic dermatitis will have a longstanding history of
irritation in the affected area or areas.
The eyelids, neck and hands are most commonly affected in adults. The skin in these areas
may be darker than surrounding skin, and thickened from persistent scratching. This form is
thought to be hereditary, but may be influenced by environmental factors as well. Dermatitis
may come and go throughout a person's life.
Enlarged pores. Before the onset of puberty, most people have relatively small pores and
smooth skin. Pores tend to become larger in adolescence as sebum production increases.
Then, as we continue to age, sun damage decreases the skin's elasticity, making pores
appear larger. As an adult, the size of your pores is determined by genetics; some people
retain the small pores of their youth, while others develop larger pores.
Individuals with larger pores may complain of small grayish blackheads on the nose and
cheeks. Contrary to popular belief, these "blackheads" are nothing more than normal sebum
doing its job: lining the pore. Since the sebum is meant to be there, squeezing is an exercise
in futility — the oil comes back the next day, and frequent handling over time may actually
damage the pore, causing it to enlarge permanently.
Epidermal Cysts. Unlike cystic acne, which occurs within the confines of an infected follicle,
an epidermal cyst is a sac-like growth in the deeper layers of the skin. The cyst sac is filled
with a soft, whitish material that may remain indefinitely.
Small cysts (less than 5mm in diameter) don't usually need treatment; they can be a
nuisance, but are generally harmless. Larger cysts have a higher probability of becoming
infected; this is very painful and can lead to scarring.
Epidermal cysts are often permanent; even if the material is extracted, the sac remains and
the cyst may return. In these cases the entire cyst sac must be excised to prevent
recurrence. While cysts are typically benign, it's wise to consult a physician about suspicious
lumps and bumps.
Favre-Racouchet Syndrome. Because this condition is caused by severe, progressive sun
damage over the course of many years, Favre-Racouchet Syndrome is most prevalent among
men and women over 50. Patients are afflicted by large coalescent comedones (blackheads)
around the eyes and on the upper cheeks. Unlike acne blackheads, Favre comedones do not
regress if left untreated; they must be surgically extracted or treated with topical retinoids.

6

Keratosis Pilaris. Common among teenagers, keratosis pilaris is characterized by patches of
tiny, red, kernel-hard bumps on the backs of the arms, shoulders, buttocks and the front of
the thighs. Occasionally it occurs on the cheeks as well, with numerous bumps in the affected
areas. Unlike acne, keratosis pilaris is usually painless and feels spiny to the touch. It tends
to be more severe during the winter months when humidity is lower, and is more prevalent in
arid climates.
Milia. These tiny, white bumps are found mostly in the area around the eyes. Cystic in nature,
they are hard to the touch and deep in the skin. Milia may last for weeks or even months; if
they are particularly troublesome to you, consult your dermatologist for professional, safe
removal.
Peri-Oral Dermatitis. Primarily affecting women in their 20s and 30s, this condition is
characterized by patches of itchy or tender red spots around the mouth. The skin bordering
the lips may appear pale and dry, while the chin, upper lips and cheeks become red, dry and
flaky. It can also affect the skin around the nose.

Pseudofolliculitis barbae. Pseudofolliculitis barbae is just a fancy name for the acne-like
breakouts commonly called "shaving bumps." As hairs begin to grow back after shaving,
waxing or plucking, they get trapped inside the follicle and cause irritation and swelling. Not
everyone gets shaving bumps; people with curly hair are more susceptible, but anyone can
take steps to prevent them. If you can, use an electric razor. If you prefer blade shaving, use
a new, single-edge blade every time you shave. Prep the area with warm water and use a
rich shaving cream. Always shave with the grain, not against it. Then, after you're done,
apply a mild toner or antibacterial gel. Get more information on shaving.
Rosacea. Frequently mistaken for acne, rosacea is a skin condition most commonly found in
adults between 30 and 60 years of age. Unlike acne vulgaris, rosacea does not involve
comedones, and appears only in areas that are likely to flush when we're embarrassed,
excited or hot — primarily the face, neck and chest. The skin is bumpy, red and oily in
appearance, and may also involve papules and pustules. Rosacea begins as an episodic
inflammation, or a temporary annoyance. Left untreated, however, it can become a chronic
condition, causing facial scarring. If you think you may have rosacea, it's best to contact a
dermatologist right away.

7

Flaxseed Oil and Acne
Whilst there have not been many flaxseed oil and acne studies carried out, flaxseed
supplements remains a popular acne treatment, with both natural therapists and acne
sufferers.
Flaxseed is traditionally used as a natural laxative, providing bulk to the stool as well as
lubrication. But flax oil has many other benefits, which derive from its richness in the omega
3 essential fatty acid. Essential fatty acids are so named because we must get them from our
diet - our bodies do not make them. They are important for normal growth and development,
brain function, and help prevent chronic illnesses like arthritis and heart disease.
Essential fatty acids come in several forms, the most commonly known being the omega 3
fatty acids and the omega 6 fatty acids. Omega 6 fatty acids are more common in our
Western diets, being found in oils like safflower, sunflower, corn, sesame, and other oils. It is
possible to have a deficiency of omega 6 fatty acids if relying only on omega 3 fats, like flax
and fish oils, as the main type of fat in the diet. Or if taking the omega 3 fatty acids in
greater quantities for a period of one and a half, to two years, to restore an omega 3
deficiency. But the more likely scenario is that an excess of omega 6 fatty acids is being
consumed in relation to the omega 3's.
Symptoms of omega 3 fatty acid deficiency include dry skin, sticky platelets, and tissue
inflammation. Given that inflammation is of particular concern for acne sufferers, it becomes
easier to see why increasing the amount of omega 3 fatty acids in the diet remains a popular
natural acne treatment.
Omega 3 fatty acids can be found in certain types of fish like salmon and mackerel, and
flaxseed oil. And as well as reducing inflammation, omega 3's speed up healing - again,
important for acne sufferers - and reduce platelet stickiness. Platelet stickiness becomes
important beyond heart health when you consider that the blood cells carry the supply of
oxygen to cells, including cells in our skin, and the cells that are involved in healing.
There are 3 types of omega 3 fatty acids that are significant. These are alpha linolenic acid
(ALA or LNA), eicosapentaenoic acid (EPA), and docosahexanoic acid (DHA). ALA (or LNA, as
it is often abbreviated to) is converted into EPA and DHA by the body. EPA and DHA are the
forms in which the omega 3's are most easily used by the body. Supplementation with ALA
has been found to reduce inflammation and improve dry skin.
Flaxseed oil is a very good source of ALA, containing an average of 55% and higher. But to
carry out the conversions into EPA and DHA, the body needs to have good levels of zinc,
magnesium, vitamin C, vitamin B3 and vitamin B6.
The recommended intake of ALA is about 2,220 mg per day. Higher doses are recommended
to treat deficiencies, or some conditions. There is no real standard recommendation for acne
sufferers simply because not enough studies have been done in relation to acne. But doses of
3000 to 6000 mg per day are used to prevent and treat some chronic conditions.

8

Acne and Vitamin Supplements
Due to the incredibly unhealthy diets that have become the norm in modern day America, it
is no wonder that vitamin deficiencies are so rampant. Only about 10-20% of Americans
consume the recommended amount of the important vitamins and minerals on a daily basis.
This vitamin deficiency has led to many problems in the bodies of Americans, and obviously
the skin, the largest organ of the body, is affected by this deficiency as well.
There are many vitamins that can all contribute to fighting and preventing the formation of
acne on the skin. Different vitamins have different uses ranging from antioxidants (clearing
the skin of harmful toxins) to antibacterial (fighting bacteria which can cause acne, helping to
prevent it from forming) and more. This article will help to point out and explain which
vitamins can be used to help against acne and what it is that they do.
The main vitamins that help to combat acne are Vitamin A, the B Vitamins, Vitamin E,
Vitamin C, Chromium and Zinc. Each of these vitamins helps to fight acne in a different way
and when used in conjunction they can help greatly to reduce the affects of acne and even
prevent its breakout altogether. If you decide to use these vitamins, most likely through form
of supplements since trying to consume the right amounts through dieting can be difficult, it
is extremely important to follow the dosage instructions and to never take too much of any
vitamin. Taking too much of many vitamins can be toxic and can lead to illness and worse
problems, so always be careful and patient.
Vitamins A and E are strong antioxidants and help to promote healthy skin. Zinc is also an
antioxidant but more importantly it helps to regulate the production of oil in the oil glands.
Chromium aids in reducing the infections in the skin which can prevent acne from spreading.
The B Complex vitamins and Vitamin C are more like super-vitamins. Both of these have
countless functions in maintaining a healthy body and involving these in your daily diet is
only too important.
The main reason that each of these vitamins is so important is not only their assistance to
fighting and preventing acne but also the simple fact that a deficiency in any single one of
these vitamins can lead to acne breakouts. Because of this, the importance of consuming the
correct amounts of these vitamins every day through either diet, which can be very difficult,
or in supplement form is simply undeniable. By being knowledgeable of these vitamins and
by attempting to meet the recommended amounts each day, a person can combat acne much
more effectively and help to prevent it from occurring altogether.
Since the majority of the worlds population suffer from acne at some point in their lives,
there is no surprise that such efforts are invested in finding out how to it. While there have
been some definitive answers on whether acne is hormonally induced (yes), and what can be
done to prevent it (prescription drugs, certain herbal remedies, etc), there are still many
unknown factors that cause acne.
However, of all the many acne questions that science is yet to find answers to, the most
controversial is whether or not diet has an effect on acne.
Historically, diet was thought to be linked to acne. Doctors and housewives alike believed that
a high fat content in ones diet would cause an oilier complexion, and this in turn would create
acne breakouts.
9

However, as time went on, science found no directly link between a diet high in lipids (fat),
and acne. Since acne is caused by a bacterial growth in sebum trapped in clogged pores,
there is no such thing as “extra oil secretion”. So, for at least the last 15 years, western
medicine has claimed there is no connection between diet and acne.
However, a study conducted in 1997 has rekindled the flame in the “diet causes acne”
argument, and this time, with a bit more heat.
This study, conducted by Dr. Lit Hung Leung, states that Acne breakouts are because the
body cannot create enough of Coenzyme A to break down the fatty acids that create sebum.
The reason is, Coenzyme A is probably the single most needed enzyme in the body. This
Coenzyme-A is what synthesizes sex hormones, and what breaks down fatty acids.
The only part of Coenzyme-A that the body does not produce itself is vitamin B5. So, if there
is a shortage of B5, there is a shortage of Coenzyme-A. And if there is a shortage of
Coenzyme-A, the body will use it to synthesize sex hormones, not break down fatty acids.
So, you can see where this is going
more fatty acids, more sebum production, more acne.
Now, the interesting thing is that Dr. Lit Hung Leung substantiated this claim by testing it on
100 people. The group took 10 grams or more per day of pantothenic acid ( B5 ), and used a
B5 topical cream of 20% by weight. After 2-3, sebum production was reduced, and many
people with acne noticed a reduction. For those with more extreme acne, a higher dosage of
B5 was used (approx. 15-20 grams per day), and treatment was prolonged to see an effect,
sometimes up to 6 months.
So, while one study does not definitively prove whether B5 can prevent or reduce acne, it
may well be worth considering, particularly for those who want a natural or herbal cure for
acne, and do not want to use chemicals such as benzoyl peroxide, or other prescription acne
treatments.

As with any medical treatment, it is best to consult a doctor before trying
a B5, or any other supplement regimine.

10

Acne Scarring
A detailed and comprehensive discussion of acne scars starts with causes of scarring,
prevention of scarring, types of scars, and treatments for scars.
Before talking about scars, a word about spots that may look like scars but are not scars in
the sense that a permanent change has occurred. Even though they are not true scars and
disappear in time, they are visible and can cause embarrassment.
Macules or "pseudo-scars" are flat, red or reddish spots that are the final stage of most
inflamed acne lesions. After an inflamed acne lesion flattens, a macule may remain to "mark
the spot" for up to 6 months. When the macule eventually disappears, no trace of it will
remain—unlike a scar.
Post-inflammatory pigmentation is discoloration of the skin at the site of a healed or healing
inflamed acne lesion. It occurs more frequently in darker-skinned people, but occasionally is
seen in people with white skin. Early treatment by a dermatologist may minimize the
development of post-inflammatory pigmentation. Some post-inflammatory pigmentation may
persist for up to 18 months, especially with excessive sun exposure. Chemical peeling may
hasten the disappearance of post-inflammatory pigmentation.
Causes of Acne Scars
In the simplest terms, scars form at the site of an injury to tissue. They are the visible
reminders of injury and tissue repair. In the case of acne, the injury is caused by the body’s
inflammatory response to sebum, bacteria and dead cells in the plugged sebaceous follicle.
Two types of true scars exist, as discussed later: (1) depressed areas such as ice-pick scars,
and (2) raised thickened tissue such as keloids.
When tissue suffers an injury, the body rushes its repair kit to the injury site. Among the
elements of the repair kit are white blood cells and an array of inflammatory molecules that
have the task of repairing tissue and fighting infection. However, when their job is done they
may leave a somewhat messy repair site in the form of fibrous scar tissue, or eroded tissue.
White blood cells and inflammatory molecules may remain at the site of an active acne lesion
for days or even weeks. In people who are susceptible to scarring, the result may be an acne
scar. The occurrence and incidence of scarring is still not well understood, however. There is
considerable variation in scarring between one person and another, indicating that some
people are more prone to scarring than others. Scarring frequently results from severe
inflammatory nodulocystic acne that occurs deep in the skin. But, scarring also may arise
from more superficial inflamed lesions.
The life history of scars also is not well understood. Some people bear their acne scars for a
lifetime with little change in the scars, but in other people the skin undergoes some degree of
remodeling and acne scars diminish in size.

11

People also have differing feelings about acne scars. Scars of more or less the same size that
may be psychologically distressing to one person may be accepted by another person as "not
too bad." The person who is distressed by scars is more likely to seek treatment to moderate
or remove the scars.
Prevention of Acne Scars
As discussed in the previous section on Causes of Acne Scars, the occurrence of scarring is
different in different people. It is difficult to predict who will scar, how extensive or deep scars
will be, and how long scars will persist. It is also difficult to predict how successfully scars can
be prevented by effective acne treatment.
Nevertheless, the only sure method of preventing or limiting the extent of scars is to treat
acne early in its course, and as long as necessary. The more that inflammation can be
prevented or moderated, the more likely it is that scars can be prevented. (Click on Acne
Treatments for more information about treatment of mild, moderate and severe acne). Any
person with acne who has a known tendency to scar should be under the care of a
dermatologist.
Types of Acne Scars
There are two general types of acne scars, defined by tissue response to inflammation: (1)
scars caused by increased tissue formation, and (2) scars caused by loss of tissue.
Scars Caused by Increased Tissue Formation
The scars caused by increased tissue formation are called keloids or hypertrophic scars. The
word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars
are associated with excessive amounts of the cell substance collagen. Overproduction of
collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous
masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar.
The typical keloid or hypertrophic scar is 1 to 2 millimeters in diameter, but some may be 1
centimeter or larger. Keloid scars tend to "run in families"—that is, abnormal growth of scar
tissue is more likely to occur in susceptible people, who often are people with relatives who
have similar types of scars.
Hypertrophic and keloid scars persist for years, but may diminish in size over time.
Scars Caused by Loss of Tissue
Acne scars associated with loss of tissue—similar to scars that result from chicken pox—are
more common than keloids and hypertrophic scars. Scars associated with loss of tissue are:
Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged
edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep,
and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard
ice-pick scars cannot be stretched out.
12
Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base
of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars
over time.
Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges

that merge with normal skin. They are usually small, and either circular or linear in shape.
Atrophic macules are usually fairly small when they occur on the face, but may be a
centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may
be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars
change from bluish to ivory white in color in white-skinned people, and become much less
obvious.
Follicular macular atrophy is more likely to occur on the chest or back of a person with
acne. These are small, white, soft lesions, often barely raised above the surface of the skin—
somewhat like whiteheads that didn’t fully develop. This condition is sometimes also called
"perifollicular elastolysis." The lesions may persist for months to years.
Treatments for Acne Scars
A number of treatments are available for acne scars through dermatologic surgery. The type
of treatment selected should be the one that is best for you in terms of your type of skin, the
cost, what you want the treatment to accomplish, and the possibility that some types of
treatment may result in more scarring if you are very susceptible to scar formation.
A decision to seek dermatologic surgical treatment for acne scars also depends on:
* The way you feel about scars. Do acne scars psychologically or emotionally affect your
life? Are you willing to "live with your scars" and wait for them to fade over time? These are
personal decisions only you can make.
* The severity of your scars. Is scarring substantially disfiguring, even by objective
assessment?
* A dermatologist’s expert opinion as to whether scar treatment is justified in your
particular case, and what scar treatment will be most effective for you.
Before committing to treatment of acne scars, you should have a frank discussion with your
dermatologist regarding those questions, and any others you feel are important. You need to
tell the dermatologist how you feel about your scars. The dermatologist needs to conduct a
full examination and determine whether treatment can, or should, be undertaken.
The objective of scar treatment is to give the skin a more acceptable physical appearance.
Total restoration of the skin, to the way it looked before you had acne, is often not possible,
but scar treatment does usually improve the appearance of your skin.
The scar treatments that are currently available include:
Collagen injection. Collagen, a normal substance of the body, is injected under the skin to
"stretch" and "fill out" certain types of superficial and deep soft scars. Collagen treatment
usually does not work as well for ice-pick scars and keloids.
13
Collagen derived from cows or other non-human sources cannot be used in people with
autoimmune diseases. Human collagen or fascia is helpful for those allergic to cow-derived
collagen. Cosmetic benefit from collagen injection usually lasts 3 to 6 months. Additional
collagen injections to maintain the cosmetic benefit are done at additional cost.

Autologous fat transfer. Fat is taken from another site on your own body and prepared for
injection into your skin. The fat is injected beneath the surface of the skin to elevate
depressed scars. This method of autologous (from your own body) fat transfer is usually used
to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat is
reabsorbed into the skin over a period of 6 to 18 months, the procedure usually must be
repeated. Longer lasting results may be achieved with multiple fat-transfer procedures.
Dermabrasion. This is thought to be the most effective treatment for acne scars. Under
local anesthetic, a high-speed brush or fraise used to remove surface skin and alter the
contour of scars. Superficial scars may be removed altogether, and deeper scars may be
reduced in depth. Dermabrasion does not work for all kinds of scars; for example, it may
make ice-pick scars more noticeable if the scars are wider under the skin than at the surface.
In darker-skinned people, dermabrasion may cause changes in pigmentation that require
additional treatment.
Microdermabrasion. This new technique is a surface form of dermabrasion. Rather than a
high-speed brush, microdermabrasion uses aluminum oxide crystals passing through a
vacuum tube to remove surface skin. Only the very surface cells of the skin are removed, so
no additional wound is created. Multiple procedures are often required but scars may not be
significantly improved.
Laser Treatment. Lasers of various wavelength and intensity may be used to recontour
scar tissue and reduce the redness of skin around healed acne lesions. The type of laser used
is determined by the results that the laser treatment aims to accomplish. Tissue may actually
be removed with more powerful instruments such as the carbon dioxide laser. In some cases,
a single treatment is all that will be necessary to achieve permanent results. Because the skin
absorbs powerful bursts of energy from the laser, there may be post-treatment redness for
several months.
Skin Surgery. Some ice-pick scars may be removed by "punch" excision of each individual
scar. In this procedure each scar is excised down to the layer of subcutaneous fat; the
resulting hole in the skin may be repaired with sutures or with a small skin graft. Subcision is
a technique in which a surgical probe is used to lift the scar tissue away from unscarred skin,
thus elevating a depressed scar.
Skin grafting may be necessary under certain conditions—for example, sometimes
dermabrasion unroofs massive and extensive tunnels (also called sinus tracts) caused by
inflammatory reaction to sebum and bacteria in sebaceous follicles. Skin grafting may be
needed to close the defect of the unroofed sinus tracts.
Treatment of keloids. Surgical removal is seldom if ever used to treat keloids. A person
whose skin has a tendency to form keloids from acne damage may also form keloids in
response to skin surgery. Sometimes keloids are treated by injecting steroid drugs into the
skin around the keloid. Topical retinoic acid may be applied directly on the keloid. In some
cases the best treatment for keloids in a highly susceptible person is no treatment at all.

14

In summary, acne scars are caused by the body’s inflammatory response to acne lesions. The
best way to prevent scars is to treat acne early, and as long as necessary. If scars form, a
number of effective treatments are available. Dermatologic surgery treatments should be
discussed with a dermatologist.

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