Acne appears to affect 90% of adolescents and young people. It also affects a significant percentage of people as they enter middle age, which has been estimated between 12 and 14%. Many of these people develop scars as a result of their inflammatory process. Acne, after all, is an inflammatory process that can destroy the gland and leave an undesirable scar in its place.
It is unknown exactly how many people suffer from acne scars in the general population, but Capitano and colleagues published a study in 2010, in the Journal of the American Academy of Dermatology, conducted on 2,133 people, between 18 and 70 years of age, and showing that approximately 1% of the general population has scars they would want to treat. This does not mean that these scars necessarily have to be unaesthetic; It is estimated that only one in seven of these patients has really severe scars. This study highlights that the general population does not give much importance to the impact that acne
and its scars can have.
There is a classification of acne-induced scars into two main groups:
A) Atrophic scars, where there is a loss of connective tissue and collagen in the skin.
B) Less frequently, hypertrophic scars or even keloids.
These scars occur mainly on the face, back and chest. These regions are the ones with the highest concentration of sebaceous glands.
Atrophic scars are more common in acne, especially on the face, and occur three times more often than hypertrophic scars. They have been classified into three sub-types: ice-peak (or iceberg peak), boxcar and rolling (roller).
According to Dr. Yacob and collaborators in a study published in 2001 in the Journal of the American Academy of Dermatology, it seems that iceberg-shaped scars represent between 60 and 70% of all scars induced by acne. On the contrary, boxcar scars would represent between 20 and 30% and rolling scars represent 15 or 25%. In our personal experience, atrophic or rolling type scars are much more common.
Iceberg scars are narrow spots 2 mm deep that open in a “V” shape. They are especially difficult to treat. When they are a little larger and have a diameter between 4 and 5 mm and look like the craters on the lunar surface, these scars are called boxcar. These scars are circular or oval and have a slightly wavy appearance at the bottom or have an inverted “M” or “U” shape.
Rolling type scars present as a depression on the skin, which otherwise appears normal, are larger than 4 to 5 millimeters and have abnormal fibrous tissue underneath that pulls the skin inwards.
Normally the three types of scars coexist on the same skin.
Goodman et al. proposed a qualitative scale of four scar grades. In the first degree we have non-depressed or macular scars, where a change in texture or color of the skin is seen. The second degree would be the mild one with some depression of the skin. The third type are moderate and the fourth severe, where greater depressions and involvement of the dermis occur.
There is also another method of scar evaluation called ECCA (échelle d’évaluation clinique des scars d’acnée), where if the scars are more severe, they have more importance in the grading.
Scar treatment: Microdermabrasion
Microdermabrasion, like dermabrasion, is a mechanical facial resurfacing procedure, in which superficial layers of the epidermis are removed to promote skin re-epithelialization.
Although skin exfoliation is a common part of both procedures, a completely different system is used in dermabrasion than in microdermabrasion: dermabrasion removes completely the entire epidermis and penetrates into the level of the reticular or papillary dermis. This induces a remodeling of all the protein structures of the skin and can be observed clinically with bleeding. In microdermabrasion, on the other hand, the procedure is much more superficial, because the system only removes the most superficial layers of the epidermis, accelerating a natural exfoliation process.
Both techniques are especially effective in the treatment of scars and produce significant clinical improvement of the skin. Dermabrasion is performed under local or general anesthesia. Years ago, a head made of aluminum oxide or sodium bicarbonate crystals was used, into which small diamond crystals were inserted. Patients with darker phototypes may experience a change in skin color or permanent hypopigmentation. On the contrary, microdermabrasion technique uses a vacuum cleaner or a jet of aluminum crystals or salt that exfoliates the skin. Microdermabrasion can be performed repeatedly in short periods of time, does not induce pain and does not require anesthesia, and complications are extremely rare. Microdermabrasion is also less effective on scar remodeling.
There is a study published in 1995 in the journal Dermatology Surgery by Said and collaborators from Chang Hospital in Taipei in Taiwan, where the effectiveness of the microdermabrasion technique in the treatment of facial scars was studied. Forty-one patients were included in this study over a two-year period and all of them experienced good to excellent improvement with an average of nine sessions. The authors consider that this procedure is also especially safe in an era of viral infection, HIV and COVID.
There is another very interesting study carried out by Elle and collaborators from the North Eastern University in Ohio, published in 2001 in the journal Dermatology Surgery, which included 25 patients with acne lasting between one and two years. Patients received eight microdermabrasion treatments at weekly intervals. 72% of patients experienced good to excellent results and 17% experienced moderate results. Finally, 96% of patients expressed that they were happy with the result of microdermabrasion and would recommend it to other patients.
In conclusion, we can say that microdermabrasion, which is a procedure widely used in medicine and dermatology to improve the skin in different processes, is also useful in the treatment and improvement of acne scars. However, because microdermabrasion is used more as a skin exfoliation procedure to limit clogging, we recommend limiting its use to active acne.
Microdermabrasion is a comfortable procedure that is free of major adverse effects, is painless and allows people who undergo it to lead a normal life.
At the De Felipe Dermatology clinic we propose to perform microdermabrasion sessions every two weeks to improve acne and another series of skin conditions, such as melasma, spots, or aging.
