Scar revision
Many patients are very self-conscious about the pitted and craterlike scars that remain as a permanent record of previous inflammation. Some people will endure any procedure and spare no expense to rid themselves of the minutest scar. A variety of procedures is available to remove or revise scars. A dermatologic or plastic surgeon is best equipped to perform such procedures. Dermatologic surgeons are proficient at many innovative techniques to correct all types of acne scars.
Generally, it is advisable to wait until disease activity has been low or absent for several months. Scars improve with time as they become atrophied. The color contrast is often the most troublesome aspect of acne. Inflamed lesions may leave a flat or depressed red scar that is so obvious patients mistake the mark for an active lesion. The color will fade and approach skin tones in 4 to 12 months. The following techniques are those most commonly used for scar revision.
Dermabrasion.
Dermabrasion has been practiced for years and when performed correctly is a valuable technique for decreasing the depth of pitted scars. The epidermis and part of the dermis is planed away with a high-speed, motor-driven, finely abrasive brush or wheel. A major portion of the face may be treated during a single session. Reepithelialization takes 3 to 4 weeks. The procedure may have to be repeated one or two times to obtain optimum results. Adverse effects include the creation of additional scarring and permanent loss of pigment. The creation of hypopigmented areas is a common side effect, and for this reason many surgeons advise against using this technique for patients with dark skin.
Scar excision.
Many pitted scars are too deep to be planed by dermabrasion. These deep or "ice pick" scars may be excised and closed carefully with gratifying results. Some dermatologic surgeons remove the scars with a punch biopsy. The plug is removed and the scar is separated from the subcutaneous tissue. The remaining round core of fat and dermis is replaced in the round hole and held at the surface with a Steri-strip. The autograft is rapidly fibrosed into place, and the epidermis subsequently regenerates. There are many modifications of this technique.
Gelatin matrix collagen implant (Fibrel).
Fibrel is a porcine collagen suspension that is injected intradermally to correct depressed cutaneous scars. Fibrel is composed of absorbable gelatin powder (denatured collagen types I and III) and epsilon-aminocaproic acid (EAC) in a lyophilized form. Fibrel is reconstituted with equal amounts of the patient's plasma and 0.9% sodium chloride for injection. The reconstituted Fibrel suspension forms a fibrin network within a gelatin matrix, which initially restores the skin's contour. Over a period of months, the implant is colonized by the patient's own connective tissue cells.
Scars should be distensible by manual stretching of the scar borders. A custom needle is supplied with the Fibrel kit and is used for undermining fibrotic scars prior to injection. Improvement is maintained for up to 1 year in 85% of the treated scars. "Ice pick" or extremely fibrotic scars do not respond.
Bovine dermal collagen implants (Zyderm, Zyplast).
Zyderm and Zyplast are bovine collagen suspensions indicated for the correction of scars and wrinkles. A processing technique renders collagen nonantigenic and suitable for augmenting scars in humans (see Chapter Twenty-seven). Collagen is supplied in preloaded syringes for intradermal injection. Soft, distensible lesions with smooth margins are the most amenable to correction, whereas "ice pick" acne and tiny, punched lesions do not respond as well. Zyplast, a newer cross-linked collagen product, can be placed deeper than Zyderm. The duration of correction is shorter than that of Fibrel.
Acne on back and the appearance industry
Being preoccupied with appearance, the acne on back sufferer usually have a negative self image, and may develop psychological problems.
Because the color, texture, and appearance of the skin, are important physical factors contributing to outer beauty; and when many people are more concerned with physical beauty, though inner beauty is more pleasing to the mind, real beauty would cease to matter. Needless to say that, it is not a person’s skin that makes them attractive but a combination of all the unique characteristics that they are.
The media, and television in particular, actively promote levels of attractiveness related to appearance and particular physical properties. Attractiveness has thus shaped people attitudes in favor of physical beauty in many life aspects, such as employment, social opportunities, friendship, s*xual behavior, and marriage. The media transmit messages concerning physical beauty, perfection and disfigurement, and usually offer suggestions and practical advice as to how the influence of these aspects can be reduced or altered. As they are promoting certain products, they are creating markets for advertisers at the same time. the media have propagated the idea that perfection is a normal thing in society and that those who are unattractive can easily gain this supposedly ‘normal’ appearance.
The concept of body image defined as our perception of the way that others see us, is therefore affected by any physical changes to the way that we look.
As acne develops in adolescence, a time when people are generally most sensitive about their appearance; symptoms such as depression or social anxiety reflect their real concern over body image.
The costs of treatment may also complicate the problem and can cause great distress.
The visibility of acne on back may attract attention in certain social situations, thus making the individual feel that they can’t keep their condition private or personal.The sufferer may find that some people react negatively towards them or treat them differently because of the way that they look.
Negative misconceptions about acne are still there; some people still think it is associated with a person’s inability to ‘properly take care of themselves or a lack of cleanliness and reactions to this can range from curiosity to rejection therefore, acne sufferers become socially withdrawn...to be continued.
Wednesday, June 25, 2008
Acne Scar Treatment
