The acne of adolescence often leaves a deep and lasting impression – so preventing scars is important before they stay for life.
Adolescent acne is an unavoidable part of growing up for many. In fact, many adults still bear the scars of uncontrolled acne from their youth with scarring that ranges from shallow dents to deep craters and visible bumps. Although much can be done nowadays to treat acne scars, these marks can only be reduced but can’t be made to disappear. So it is much better to control acne to prevent scars, than to rely on scar treatment after the damage is done.
Acne scars may lead to loss of confidence, low self-esteem, and even depression. Some may find it more difficult to secure employment, especially for women and men in front-line jobs, or where a premium is placed on looks, such as cabin crew, models and sales staff .
Acne most often affects adolescents, and over 90% of adolescents have acne at some stage. It starts in the pre-teens as comedones and can last into the early 20s. Good face hygiene and a consistent skin-cleansing routine are important. Twice-daily face washing and over-the-counter acne creams such as benzoyl peroxide are helpful in mild cases. For cases that involve many red or pus-filled pimples and numerous comedones or scarring, professional help should be sought. Large red nodules or large pus-filled cysts have a higher chance of causing scarring, and an early consultation with a dermatologist is recommended.
About a quarter of adult women will continue to have adult acne after adolescent acne subsides. Adult acne may also start anew in adulthood without previous adolescent acne, particularly in the 30s and 40s, when hormone levels change. Adult acne occurs around the mouth and jawline, compared to adolescent acne which often affects the forehead, cheeks and T-zone area. Adult female acne often worsens just before and during menstruation due to hormones.
Other causes may include using comedogenic or acne-genic skincare products, taking oral medications, excessive use of steroids, excessive levels of hormones from underlying hormone-secreting tumours or occupational exposure to fluorinated hydrocarbons.
The development of acne
Acne often starts as a clogged pore (a blackhead or whitehead) which becomes a red, swollen or pus-filled pimple after bacteria acts on it.
Most people recognise pimples by the characteristic plugging, progression, tenderness on pressing and sometimes, a mild itch. Eczema is usually itchy and the red bumps are finer, not plugged, and often join up to form larger red areas. Acne-like conditions such as rosacea and folliculitis are not associated with blackhead or whitehead formation (comedone) but begin as red or pus-filled bumps.
Rosacea is linked to symptoms such as easy flushing, or the use of strong steroid creams on the face. Th e latter is the reason steroid creams, particularly the higher-potency ones, should not be used indiscriminately on the face without medical supervision.
A multi-pronged approach is important to reduce the physical impact and psychological burden of acne. It is important to treat acne early to prevent scarring; treat it adequately and seek medical help; and treat scars after the acne is brought under control.
To improve depressed scars, treatments such as laser resurfacing, fractional ablative radiofrequency, scar excision, subcision or filler injections may be used alone or in combination. To improve the appearance and itch or pain of raised keloid scars, steroid injections with or without laser treatment are usually effective. Psychological support and advice on makeup is important, while more serious cases which have led to depression can necessitate a psychiatrist referral.
There is no need to suffer in silence, as effective treatment is available.
3 tips for acne sufferers
- Treat early to prevent scarring
- Treat adequately – do not hesitate to seek medical help or inform your doctor if you think the treatment is not working after a reasonable length of time
- Treat scars only after the acne is brought under control