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Keloid Scars & More: Understanding All Types Of Acne Scars Acne can have a number of unwanted consequences, including scarring long after your breakout has subsided. In fact, there are a number of different types of acne scarring. You may have heard of some of these, such as keloid scars. Some people with acne won’t experience any acne scars developing at all. However, most acne sufferers will have to cope with acne scars at some point, which is why it’s a good idea to find out more about the different types of acne scars and how to treat them. Different types of acne scarring such as keloid scars need different treatments. Click through to our dedicated page that discusses what causes acne and how to prevent it. You can also take a look at our in depth acne guides for more information about the condition and the different acne treatments available. Types of acne scars Some people with acne won’t experience any acne scars developing at all. However, many people do. Scarring may occur for a number of different reasons, such as the sufferer picking their spots, infections, or as a result of the skin’s natural healing process. Most commonly, it happens because severe types of spots (nodules and cysts) burst and damage surrounding skin. Here are the five most common types of acne scars: - Keloid scars - Ice pick scars - Boxcar scars - Rolling scars - Post-inflammatory hyperpigmentation These different types of scars can be split into two main categories: - Atrophic scars: these are caused by a loss of tissue in the top layer of skin (the epidermis), which sometimes extends into a further layer (the dermis), resulting in depressions or indentations in the skin. - Hypertrophic scars: these are caused by an excess of tissue growth where the acne once was, forming raised lumps of scar tissue. In the sections below, we’ll be taking a closer look at these different types of acne scars — including what causes them, what they look like, and how to get rid of them. You can find more general information on how to get rid of acne scars here (including the best acne treatments for scars and alternative home remedies). Keloid scars Keloid scars (or keloids) are a type of hypertrophic scar, which means they are caused by excessive growth of thick scar tissue, creating raised lumps. Unlike typical hypertrophic scars, which are the same size as the acne that caused them, keloid scars spread beyond the original damaged area of skin. As well as being raised, a keloid scar can be pink, red, skin-coloured or darker than the surrounding skin. Keloid scars are also normally shiny (though they may be bumpy), hairless, hard and rubbery. They may fade in colour over time, going from red or purple in appearance to brown or pale in colour. We don’t know exactly what causes keloid scars, but it is thought to be a result of the body trying to heal itself post-inflammation, causing an overproduction of collagen (the skin's protein). Keloid scars can appear anywhere on the body but they are more common in areas such as the chest, back, shoulders, jawline and earlobes. They are also more common in people with darker skin. How to get rid of keloid scars There are a few different types of keloid scars treatment: - Steroid injections - Topical steroid creams - Topical silicone gels - Steroid-impregnated tapes - Freezing with liquid nitrogen (usually used for early keloid scars to stop growth) These treatments tend to work towards flattening the keloid scar, rather than getting rid of it completely. Alternatively, laser treatment may be used to reduce the appearance and redness of the scar (though this won’t flatten the scar). Surgery is sometimes used to remove keloid scars, but there is a risk that the keloid will come back (and potentially become even bigger). Ice pick scars Ice pick scars are atrophic scars, an indented scar that heals below the normal layer of skin tissue, caused by a loss of tissue. Ice pick scars are narrow, deep holes in the surface of your skin. The best way to describe ice pick scars is that they look like the skin has been punctured with a sharp object like a needle. Ice pick acne scars are usually the result of cystic acne — the most serious type of acne which causes deep cysts and incredibly painful pimples. Ice pick scars can develop after an infection from a cyst; the skin tissue is destroyed, leaving a long, narrow scar that goes deep in the skin. Typically, ice pick scars appear on the cheeks, jawline or chin. How to get rid of ice pick scars Ice pick scars tend to be very tricky to treat and often require persistent and aggressive treatment. However, it’s not impossible and there are multiple different treatments that may work to remove these acne scars. These are the types of ice pick scars treatment available: - Chemical peels: the top layer of skin is removed by the peel and new skin grows back, hopefully healing over the ice pick openings (this can, however, sometimes make scarring worse) - Punch excision: the scar is cut out of the skin, and the skin is sealed back together - Punch grafting: the scar is removed and the wound is plugged with a skin graft (usually taken from behind the ear) - Resurfacing therapies (including laser treatment): skin over and around the scars is removed to encourage the growth of new and healthier skin cells - Microneedling: tiny needles are inserted into the skin surrounding the scar to stimulate collagen growth and reduce the appearance of acne Hypertrophic scars Hypertrophic scars are very similar to keloid scars: they occur when scar tissue builds up from acne. However, hypertrophic scars are the same size as the acne that caused them. Not as much collagen is produced in hypertrophic acne scars in comparison to keloids, which means that they don’t extend beyond the boundaries of the original acne spot. Hypertrophic scars are raised and firm in appearance. They are usually red to start with but tend to become flatter and paler over time. Hypertrophic acne scars are more common in areas such as the chest, back (take a look at our guide on how to get rid of back acne), shoulders, neck and face. How to get rid of hypertrophic scars Most hypertrophic scars will gradually become paler and flatter over time, reducing in appearance. However, if you want to know how to flatten hypertrophic scars or how to get rid of hypertrophic scars completely, there are a few different treatment options. Hypertrophic and keloid scars are generally treated in a similar way: - Steroid injections - Topical steroid creams - Topical silicone gels - Steroid-impregnated tapes - Freezing with liquid nitrogen - Laser treatment - Surgery These treatments can help to flatten the hypertrophic scar and reduce the appearance. Boxcar scars Another type of atrophic scar, boxcar scars are round, oval or ‘box-like’ craters in the skin. These depressions are usually broader and more shallow compared to ice pick scars. However, they have sharper, jagged edges (unlike rolling scars, which we will come onto next). Boxcar acne scars tend to be a result of inflammatory acne (red, inflamed and irritated spots). They occur when a breakout destroys the collagen in the skin, which leaves the skin without enough support, creating a depressed area. Boxcar scars normally form in areas where the skin is relatively thick, such as the lower cheeks and jawline. How to get rid of boxcar scars There are a few different options when it comes to boxcar scars treatment: - Punch excision (like ice pick scars) - Punch elevation: similar to punch grafting, except the base of the scar is raised up to make the skin more even - Dermal fillers: injected into the scar which helps to raise depressed areas to make skin more level. This type of treatment is not permanent, lasting for around two years - Laser therapy - Microneedling - Chemical peels Rolling scars Rolling acne scars have smooth sloping edges and are normally more shallow than other types of atrophic scars. This gives the surface of the skin a rolling or wave-like uneven appearance. Rolling scars are usually a result of long-term inflammatory acne. This type of scarring is caused by bands of scar tissue that form underneath the skin. These bands pull the epidermis — the top layer of skin — giving the skin a rolling and uneven texture. This type of acne scar can become more obvious or severe as you get older (this is because your skin loses its natural elasticity and tightness). How to get rid of rolling scars There are a few rolling scars treatment options that you can try to get rid of this type of acne scar: - Subcision: this is a surgical treatment where the upper layer of the skin is removed from the underlying scar tissue, allowing blood to pool under the affected area. This helps form connective tissue which pushes up the rolling scar to make skin more level - Dermabrasion: this involves removing the top layer of skin using lasers or a specially-made wire brush - Microneedling - Chemical peels Post-inflammatory hyperpigmentation Post-inflammatory hyperpigmentation can happen naturally as part of the skin’s healing process after inflammation caused by acne. Hyperpigmentation isn’t a true type of acne scar — it’s a patch of skin that is darker or discoloured. With hyperpigmentation, the affected area is flat (neither raised or pitted). It can also range in colour from pink to red, purple, brown, or black, depending on skin type. It can happen as a result of more severe acne or the sufferer picking spots. As the skin heals, it produces too much melanin (the pigment that gives skin its colour) which leaves a darker area. People with darker skin or people who produce more melanin are also more likely to experience post-inflammatory hyperpigmentation. How to get rid of post-inflammatory hyperpigmentation In the majority of cases, post-inflammatory hyperpigmentation doesn’t need to be treated — it often fades and disappears on its own over time. However, if you want to speed up the process, there are a few post-inflammatory hyperpigmentation treatments you can try: - Prescription topical retinoids - Topical treatments which use azelaic acid or salicylic acid - Creams containing hydroquinone - Chemical peels Some of these treatments are available over the counter and some will need a prescription. Summary Acne scars can be an upsetting and long-lasting complication of acne. There are a few different types of acne scars, which can be split into two main categories: atrophic scars (depressions caused by a loss of skin tissue) and hypertrophic scars (raised lumps of scar tissue caused by excessive tissue growth). The five most common types of acne scars are keloid scars, ice pick scars, boxcar scars, rolling scars and post-inflammatory hyperpigmentation. There are different ways to treat these types of acne scars, but treatment can be difficult for certain types (in particular, keloid scars) and it isn’t always successful. However, many people do have success getting rid of acne scars using either medical treatments or natural home remedies. Treating acne in the first place will reduce the likelihood of acne scars appearing. There are many treatment options available at The Independent Pharmacy that can be used to prevent or get rid of acne, including topical and oral treatments. The treatment that is most appropriate for you will vary dependent on the severity and type of acne. The Independent Pharmacy offers a range of acne treatments such as Duac Gel, Skinoren Cream, Tetralysal Capsules and Acnecide Gel. Start your free online consultation today to find out which treatment is best for you. Sources - https://www.nhs.uk/conditions/acne/complications/ - https://www.nhs.uk/conditions/scars/ - https://www.nhs.uk/live-well/healthy-body/keloid-scars/ - https://www.verywellhealth.com/keloid-scars-2328343 - http://www.acnesupport.org.uk/scarring/keloid-scars-test/ - https://www.medicalnewstoday.com/articles/319211 Related Guides Need something else? We stock 633 treatments for 80 conditions Or browse all treatments or conditions
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Ožiljci Iz iskustva Melite Petrović, mag.pharm. Ozljedu je teško predvidjeti i izbjeći, no ako se pravovremeno i stručno obradi prikladnim antiseptikom, ranim zatvaranjem rane dobrim kirurškim tehnikama i kvalitetnim materijalima, najbolje će se prevenirati nastanak i obujam ožiljaka U ljekarni ponekad dobijemo upit za pomoć oko zacjeljivanja ili prikrivanja ožiljka, nastalog primjerice nakon kirurškog zahvata, ozljede ili opekotine, akni… Koža je naš najveći organ, a njen besprijekoran izgled doživljava se kao znak dobrog zdravlja te pridonosi osjećaju samopoštovanja. Ako je iz nekog razloga izgled kože narušen brazgotinama i ožiljcima, pogotovo ako su na vidljivom mjestu, problem može postati ne samo estetski već i psihološki. Ožiljcima nazivamo vidljive promjene na koži, koje zaostaju nakon njena oštećenja, odnosno cijeljenja rane nakon ozljede ili upalnog procesa, opekline, kemijskih pilinga, dermoabrazija, tretmana laserom, nakon kirurških zahvata ili akni, a predstavlja prirodni proces cijeljenja s ciljem obnavljanja zaštitne funkcije kože. Rastom novog vezivnog tkiva organizam nastoji nadoknaditi nastalo oštećenje, pri čemu se nastali defekt nikada ne može potpuno ukloniti. Zbog stvaranja novog tkiva koža ima drugačiju strukturu od prvobitne i zato izgleda drugačije. Čak i nakon što je rana zarasla, tijelo nastavlja usmjeravati kolagen na pogođeno mjesto, što tijekom vremena rezultira povećanjem veličine i promjenom oblika ožiljka. Ožiljak koji nastane nema dobru cirkulaciju, ponekad je neujednačen i manje je elastičan, a moguće su i varijacije u boji. U početku ožiljci izgledaju crveni i zadebljani, a potom s vremenom postupno blijede. Osobine su im da nikad ne potamne (jer u procesu cijeljenja ne dolazi do regeneracije melanocita) i da se na mjestu nastanka ne obnavljaju dlake, lojnice i znojnice. Također, elastičnost ožiljka je smanjena, a javlja se i sklonost otvrdnuću i kontrakcijama (ako su ožiljkom zahvaćene veće površine ili se nalazi u predjelu zgloba) što može ograničavati kretnje ako se ožiljak nalazi u blizini zgloba. Razlikujemo nekoliko vrsta ožiljaka. Atrofični ožiljci tanke su površine i često lagano uleknuti, mogu biti hiperpigmentirani (smećkasti) ili hipopigmentirani (bjelkasti). Nastaju obično uslijed lošeg cijeljenja rane, najčešće na leđima kao posljedica uklanjanja madeža. Nasuprot atrofičnim ožiljcima, proces cijeljenja kože nakon ozljede može rezultirati hipertrofičnim ožiljcima i keloidima. Hipertrofični ožiljci uzdignuti su iznad razine okolne kože i mogu zauzeti veću površinu od ishodišnog oštećenja kože, crvene su boje, mogući su početna bolnost ili svrbež, a s vremenom dolazi do izravnavanja ožiljka i gubitka crvene boje. Razvija se ubrzo nakon traume ili kirurškog zahvata, a nastaje kao rezultat prekomjerne proizvodnje kolagena tijekom cijeljenja rane. S vremenom dolazi do blagog poboljšanja, no ne može sasvim nestati bez tretmana. Još su veći problem keloidi, posljedica patološkog cijeljenja rane, kod kojih se stanice umjesto da odumiru, nekontrolirano i pojačano množe. Mogu uzrokovati estetske i funkcionalne deformitete, bolni su i ponekad svrbe. Za razliku od hipertrofičnih ožiljaka koji nastaju u ranoj fazi iza traume, keloidi se razvijaju nekoliko mjeseci ili godina kasnije, a posebno su veliki kod dubokih opekotina. Hipertrofični ožiljak ostaje unutar granica ožiljka, dok keloid raste preko te granice. Odsijecanje hipertrofičnog ožiljka često pogorša problem, pa ožiljak postane keloid. Ozljedu je teško predvidjeti i izbjeći, no ako je ona pravovremeno i stručno obrađena prikladnim antiseptikom, ranim zatvaranjem rane dobrim kirurškim tehnikama i kvalitetnim materijalima, najbolje će se prevenirati nastanak i obujam ožiljaka. To je posebno važno kod djece u fazi rasta, jer je elastičnost ožiljka smanjena, a javlja se i sklonost otvrdnuću i kontrakcijama. Karakteristike prema kojima se ožiljak razlikuje od okolne kože mogu biti manje ili jače izražene, a ovisno o intenzitetu određuju se kozmetska i funkcionalna svojstva ožiljka te daljnji tretman. U svrhu uklanjanja ili smanjenja vidljivosti ožiljaka, današnji razvoj medicinskih tehnologija raspolaže s više vrsta plastično-rekonstrukcijskih tehnika. Primjenjuju se metode krioterapije („zamrzavanje" površine ožiljka, što katkad dovodi do smanjenja veličine ožiljka, a najčešće se primjenjuje u terapiji ožiljaka nakon akni), laserska terapija i kemijski piling. Terapije se provode kod dermatologa, a izbor metode ili tretmana ovisi o vrsti ožiljka. Koriste se i farmakološke metode, injekcije kortizona koje mogu smekšati i stanjiti keloide. Injekcije kolagena i hijaluronske kiseline koriste se za tretman uleknutih ožiljaka i bora. Kirurško liječenje keloida primjenjuje se samo kod onih bolesnika kod kojih konzervativnim načinom nije postignut željeni učinak, no keloidi se nakon kirurškog liječenja opetovano javljaju u velikom broju slučajeva. Za liječenje ožiljaka od akni ponekad je potrebno kombinirati više raznih metoda da bi se oni uklonili. Može se reći da je danas metoda izbora laser. Osim više vrsta postupaka kod specijalista dermatologa, za tretman manjih ožiljaka u ljekarnama se mogu nabaviti različiti medicinski proizvodi. Za prekrivanje se mogu koristiti korektivni puderi, a od ostalih neinvazivnih tehnika savjetuje se primjena različitih neutralnih lokalnih pripravaka ili onih s dodatkom biljnih ekstrakata. Upotreba tih preparata ima dobar učinak na proces obnove kože i postiže se kozmetski učinak. Gel koji sadrži ekstrakt luka, heparin i alantoin registriran je kao bezreceptni lijek - cikatrizant, tj. sredstvo za poticanje cijeljenja rane. Ima antiinflamatorno i antiproliferativno djelovanje, omekšava strukturu kolagena i potpomaže regeneraciju. Heparin ima svojstvo vezivanja vode i omekšava ožiljak. Ukoliko je ožiljak posljedica kirurške intervencije, preporuča se njegova upotreba 10-14 dana nakon skidanja konaca, a kod opekotine poslije reepitelizacije, tj. kada se rana nalazi u fazi proliferacije. Primijenjen na vrijeme, osim što će djelovati preventivno na stvaranje keloida i hipertrofičnih ožiljaka, gel će ubrzati i zarastanje rane, smanjiti edem i svrbež. Taj gel pokazao je i dobar učinak kod svježih i tek nastalih strija kao i kod trudnica koje su ga koristile preventivno. Zbog svojih svojstava i učinkovitosti danas se kao metoda izbora u tretmanu ožiljaka preporučaju silikonski preparati. Po kemijskom sastavu to su sintetski polimeri, a na tržište dolaze kao gelovi ili silikonske pločice. Pravilnom i dovoljno dugom primjenom silikonskih preparata postiže se smanjivanje više neugodnih simptoma koji prate pojavu ožiljaka - smanjenje volumena, poboljšanje elasticiteta, smanjenje crvenila, boli i svrbeža. Posebno su prikladni za primjenu kod manjih ožiljaka na izloženim dijelovima tijela. Gel se nanosi 2-3 puta na dan, proziran je i brzo se suši, pa se preko njega može nanositi i kozmetičko sredstvo za prikrivanje ožiljaka. Na našem tržištu postoji više silikonskih gelova, jedan od njih primjerice pored visokog sadržaja silikona sadrži i ester vitamina C koji kao antioksidans olakšava sintezu kolagena u tkivu i pomaže da ožiljci postanu glatki; drugi s dodatkom vitamina E za održavanje uravnotežene hidratacije kože te poboljšanje izgleda ožiljaka; ili silikonski gelovi s dodatkom prirodnih ekstrakata (luk, gotu kola, aloja…). Postoji i silikonski preparat u obliku stika koji sadrži i beta-glukan te UVA i UVB filtere za zaštitu od UV-zračenja. Jednostavno se koristi, stvara nevidljivi, prozirni, tanki film koji čini zaštitnu barijeru za cijeljenje ožiljka i pridonosi održavanju uravnotežene vlažnosti kože. Koristi se na ožiljku koji mora biti zatvoren, čist i suh, i to bez utrljavanja. Nanosi se 2-3 puta na dan. Kod ožiljaka veće površine prednost imaju silikonske pločice. Silikonski preparati koriste se za hipertrofične i keloidne ožiljke, a važno je napomenuti da u primjeni treba biti strpljiv, jer se učinak očekuje tek nakon nekoliko tjedana ili mjeseci. Krema koja sadrži superoksid dismutazu (SOD) - enzim dobiven iz zelene rajčice - koristi se kao antioksidans za kožu, za zaštitu kože od djelovanja slobodnih radikala, a ima povoljan učinak i na ublažavanje ožiljaka. Terapija također traje mjesecima. U ubrzavanju i poboljšanju postupka reepitelizacije i obnove tkiva kod površinskih rana (raspuklina, ogrebotina, abrazija, osipa, opeklina prvog i drugog stupnja, površinskih porezotina…) te nakon postupaka pilinga, epilacije i lasera, kirurških rana i rana od dekubitusa, korisni su i preparati s hijaluronskom kiselinom. Zaključak Svi lokalni pripravci za tretiranje ožiljaka djeluju na hipertrofične i keloidne ožiljke, ali nemaju učinka na atrofične ožiljke. Pacijentima je važno naglasiti da je važno svaki ožiljak tijekom prvih nekoliko mjeseci štititi od sunca i koristiti preparate s visokim zaštitnim faktorom. Posebnim specijalističkim tretmanima i upornim nanošenjem preparata, izgled ožiljka može se poboljšati, ožiljak se može smanjiti, ali ne i u potpunosti nestati, jer vezivno tkivo ožiljka nikad ne može imati izgled i strukturu zdrave kože. Zbog toga je za uspješno liječenje ožiljaka važno da liječnik i pacijent definiraju što pacijent očekuje i što mu najviše smeta. Sukladno tome odabire se najbolji način liječenja, ali i ovisno o lokalizaciji i veličini ožiljka, dobi bolesnika i prethodnom odgovoru na terapiju. Najčešće se po preporuci dermatologa preporuča kombinirana primjena različitih oblika liječenja, i to individualno za svakog bolesnika.