Other Treatments
Treatments for Post-Acne Scarring
Acne is almost always treatable and early intervention is recommended to avoid the complication of scarring. An array of treatments exists, reflecting the diversity of acne and post-acne scarring conditions.
Acne is aesthetically unpleasant and embarrassing and may cause severe physiological distress. According to several studies, employment prospects can be decreased and interpersonal difficulties are common.
Acne is so common that it is often thought of as a normal stage in human development but with early treatment, subsequent scarring can be averted. Post-acne scarring is particularly devastating and often represents the failure of adequate and timely medical treatment.
The nature of post-acne scarring
Acne scarring is either a problem of excess tissue (hypertrophy) or of loss of tissue (atrophy). In addition, scars may be obvious because of their colour.
Scars with excess tissue are seen in people who are predisposed to this type of scarring. They are difficult to treat, and many different types of treatment may be necessary.
Scars that result in a loss of tissue are much more common. Post-acne scarring often involves the deeper structures, rather than the surface of the skin, leading to the appearance of indentations. These indentations may appear as depressed scars, or as sharp-walled 'ice-pick' scars. There may also be pigmentation changes in the skin. Hyperpigmentation (an increase in colour) is more common in olive-skinned patients, and will fade in 3-18 months if sun protected. New scars may also be red and will mature in time, losing their colour.
Treatments for post-acne scarring
A number of different procedures may be employed in the treatment of indented acne scarring. Laser resurfacing of the area is commonly performed; often in conjunction with other techniques such as fat transplantation, photodynamic therapy, blood transfer, punch grafting and skin rolling. If the scars are particularly indented or are in areas with a loss of tissue, subcision or Fraxel® laser treatment may be favoured.
Treatments for Hyperhidrosis (Excessive Sweating)
Several relatively simple treatments are available for the treatment of excessive sweating.
Muscle relaxants
The injection of a muscle relaxant is now being used for the effective treatment of excessive sweating from the armpits (known as primary axillary hyperhidrosis) and hands (known as palmer hyperhidrosis). It targets sweating at its source, inhibiting the release of acetylcholine: the chemical in the body that is responsible for signaling perspiration. The advantages are that it is a safe and effective technique and solution; the disadvantages are that it is a temporary treatment lasting approximately 6-8 months with a possible compensatory increase in sweating at other sites.
Other options
Other options include 20% aluminium chloride hexahydrate, iontophoresis, cervical sympathectomy and oral medications.
The procedure
Muscle relaxants
A topical anaesthetic cream is usually applied half an hour prior to the treatment to help minimise any discomfort. The product is then administered via small injections and approximately 7-10 days later, sweating may be noted to have decreased.
A review is recommended approximately 2-3 weeks after the initial treatment. A further smaller treatment may be necessary to any areas where the product may not have been fully effective.
TCA Cross Method
This is a safe and highly effective treatment for acne scarring; particularly 'ice-pick' scars.
High concentration TCA has the effect of increasing the body's production of collagen (your skin's building blocks) while also thickening the skin, thus allowing scars to reconstruct themselves. The advantage of the CROSS (Chemical Reconstruction of Skin Scars) method is that it allows these significant benefits to be embraced. It does this by greatly reducing the potential for subsequent scarring that is otherwise associated with higher concentrations of TCA.
The procedure
There is no full-face chemical resurfacing in this procedure. Rather, it is just the acne scars themselves that are treated.
The healing process
Results of this procedure have been excellent. Traditional TCA complications for darker-skinned patients, such as hyperpigmentation (darkening of skin colour) and hypopigmentation (lightening of skin colour), are averted.
Laser and Non-Laser Hair Removal
Long-term hair removal can be achieved with a minimum of discomfort or inconvenience with our long pulse Alexandrite (Elite) hair-removing laser.
How is hair removed by laser?
The laser emits a powerful beam of light that passes harmlessly through the skin, but is absorbed by the hair follicle. By selectively absorbing the laser energy, the hair follicles are disabled, impairing their ability to grow hair.
This is a safer, faster and more effective way to eliminate unwanted hair than traditional methods of depilation. Laser hair removal is most effective when the hair colour is significantly darker than the skin, e.g. dark hair on fair-skinned individuals, or black hair on darker skin colours.
What other methods are available to remove hair?
Epilation is another effective technique when undertaken by a professional. It incorporates fine wire diathermy, which is a treatment that works by passing a small electric charge down a hair-like needle into an unwanted spot, causing the spot to shrivel and disappear. It does so over the following few days to weeks depending on the body part treated and the amount of current used. In this procedure, insulated needles are passed down the hair follicle to the hair bulb. These insulated needles only expose the tip of the needle; the rest is coated in a sleeve that does not conduct electricity. Thus they do not injure the surrounding skin in the process of destroying the hair bulb.
Modern fine wire diathermy should not be confused with the rather gross diathermy delivery systems of the past. Correctly used, this is a most elegant technique and one that gives uniformly good results.
Over the years, various other methods have been used to remove unwanted hair such as shaving, waxing, plucking and depilatory creams. These methods only remove hair temporarily and some may be painful or cause inflammation of the hair follicle. Electrolysis offers more long-term hair removal, but takes months or years of treatment and innumerable sessions since it requires the placement of a needle at each hair follicle. This process is tedious, and impractical for large areas.
The advantages of laser hair removal
- Fewer treatments required;
- suitable for large areas;
- more accurate (unlike electrolysis, laser light can't 'miss' the follicle);
- non-invasive (no risk of needle-transmitted disease).
Laser treatment provides long-term hair removal for large or small areas, without the difficulties or commitment involved with other methods. The laser is designed to selectively treat only the hair follicle, leaving the surrounding tissue unaffected. The laser uses pulses of light to remove the hair, so there is little irritation to the skin.
Is the laser treatment comfortable?
The treatment consists of a number of laser pulses accompanied by a tingling or slight burning sensation. Anaesthetic cream is applied to the area 30 minutes prior to treatment to ensure this sensation is minimal. Within about 30 minutes of treatment, the areas may become pink or red, and feel like mild sunburn for a day or so. Because the laser does not damage the skin, no bandages are necessary.
How long does it take?
Each laser pulse treats about a half-inch area, which can contain ten or more hairs. The amount of time needed depends on the size of the area to be treated. The lip usually takes less than one minute; other areas such as the leg may take significantly longer.
How many treatments will be necessary?
The laser works by affecting the hair follicles, which are in the growing (anagen) phase. At any time, some hair follicles are in the resting (telogen) phase and won't be treated by the laser. Therefore several visits may be necessary for total treatment. We now know that the hair removal lasts at least 18 months.
About the treatment
The treatment is only available to those with sufficiently dark hair - blonde, red and grey hair do not respond well. A consultation with one of our specialist nurses is required to determine your suitability for the treatment. Information about the time involved to treat various areas of the body can be given to you at this time and an appointment made for your test patch. Do not wax or pluck the area to be treated for one month prior to laser hair removal. The area should be shaved three days prior to laser hair removal.
Hypertrophic and Keloid Scar Treatments
These scars are the result of the body's over-zealous attempt to heal and replace lost or damaged skin. The means of correcting such as a scar depends upon its specific characteristics.
Not all scars are alike. In fact, there is a wide range of different scar-types, some of which protrude above the skin. One such scar is the keloid scar: an overgrowth of fibrous tissue/collagen that the body produces in response to an injury. These scars may appear anywhere on the body. Keloid scars extend beyond the borders of the original wound and they do not regress spontaneously.
The cause of keloid scars is unknown, but they appear more frequently in darker-skinned people. They tend to occur primarily in people aged between 10 and 30 years of age.
Treatments
The treatment of keloid scars is complex. All scars are permanent and there is no single technique to remove them completely. However, with treatment, the keloid scars may become smaller, softer, less tender and less red in colour. Attempts to surgically remove keloids are fraught with danger as they tend to reform and become bigger than before. As no single therapeutic method has been demonstrated for all keloid scars, the type of therapy used will depend on several factors, some of which relate to the scar's characteristics (location, size, colour, etc.), and others to the patient herself (the person's age, and past response to treatment).
Several treatment modalities are available to treat these scars. These include:
- intralesional cortisone or injections of other agents such as fluorouracil (5FU) or bleomycin;
- laser therapy;
- cryotherapy (liquid nitrogen);
- topical creams and dressings.
Spray-On Skin
Spray-on skin for repair of areas that have lost their normal colour through disease or injury
ReCell® is the only product available that enables a surgeon to collect skin cells from the patient and reapply them on a separate area of the body without delay. It can be used for repigmentation and post-operative healing, and for the treatment of burns and other wounds.
The procedure
In ReCell®, specific cells are collected from a small sample of your skin (biopsy) and processed with a natural substance called Trypsin for reapplication upon an area that needs healthy skin cells. The skin cells are sprayed on and can cover a much larger area than the area of the biopsy.
The healing process
A dressing is applied after the procedure. This is usually removed after three to five days. A topical cream may be required at this point, depending on the reason for treatment. Your doctor will advise you about the appropriate action to take.
In patients seeking repigmentation, the improvements will occur slowly over several months as the cells begin to produce melanin.
Skin Rolling
A treatment for assisting the skin's own reparation of acne scars.
The procedure
In this procedure, small needles are rolled over the area of skin, puncturing its outermost layer. The skin's natural reaction to being wounded is thereby triggered: it begins producing collagen - the building blocks of healthy skin.
In the clinic, this procedure is primarily used for undermining the appearance of acne scars, though it has many other benefits. Skin becomes thicker and more youthful looking as fine lines and dilated blood vessels are reduced. Plus, the benefits of topical skin care become more pronounced given the greater access to the dermis: the deeper skin layer that is most receptive to treatment.
Anaesthetic cream is applied beforehand. The needles on the roller create very small wounds, but they become more significant because of the proximity of the holes. The area of skin is rolled over thoroughly to ensure proximity of the holes.
The healing process
Bleeding stops soon after the procedure's completion as the clefts heal quickly. After the bleeding has stopped, topical treatments may be given by the doctor to assist the healing process. Applying vitamins A and C after the procedure further promotes the skin's own production of collagen.
bruising can occur immediately after treatment but returns to normal soon after.
mild flush. By day 4 to 5, the skin will have returned to a mild flush, before normalising soon after.
It is advised to take between 3-7 days off work.Sundry Procedures
Minor and adjunct procedures that are also used in the practice
Fine wire diathermy
This treatment works by passing a small electric charge down a hair-like needle into an unwanted spot, causing the spot to shrivel and disappear. It does so over the following few days to weeks depending on the body part treated and the amount of current used. It should not be confused with the rather gross diathermy delivery systems of the past. Correctly used, this is a most elegant technique and one that gives uniformly good results.
Fine wire diathermy may be used in many situations. These include the treatment of dilated blood vessels on the face and any fine vessels on the upper limbs or trunk. It has a major role in the treatment of minor skin blemishes such as small skin tags, milia, syringomas, seborrhoeic warts and sunspots. In this role, it is similar to a CO2 laser in its effects (see page 00). It is also used effectively as part of a hair removal technique called epilation (see page 00).
The healing process
Wounds and scabbing. After the procedure with non-insulated needles, a scab forms after an initial sore. This wound is usually inconsequential, but if a larger area has been treated then a significant sore may be seen and this may need a night-time topical antibiotic or antiseptic ointment (preferably greasy) for seven to ten days on the face or longer if elsewhere.
Makeup and sunscreen are usually permissible after the procedure.
Sun avoidance. It is important to protect this treated area from the sun whilst the spot is healing. Otherwise the spot may preferentially tan and stay that way for weeks.
Side-effects
Scarring and other side effects are very unusual.
Hearing aid and pacemaker malfunction. Caution is usually advised for people who use these devices as some of the older diathermy units have been known to stop them from working. The newer diathermy machines, which we use, don't really have this problem and most modern pacemakers also protect the patient from this rather nasty situation.
Cautery
Hot cautery is similar to diathermy except instead of electricity this technique uses straight heat to remove lesions. A wire loop is heated to red hot and, usually with local anaesthetic, the spot is cooked and left to fall off over time. This is an effective technique for treatment of brown spots on hands or anything that is entirely growing on the surface of the skin.
Another very good use for the hot cautery is in the treatment of skin cysts. With this type of spot the cautery tip is inserted into the cyst centre and the contents of the cyst melted. The lining also comes away with this technique and the cyst is often able to be delivered through a very small cut which becomes virtually invisible.
Side-effects
White spots may be left behind when hot cautery is used upon darker-complexioned patients. It is considered a less useful procedure for this group.
Liquid nitrogen
This chemical is most natural: it is around us all the time and represents 80% of the air that we breathe. The only difference is that once made into a liquid it has an incredibly low temperature of close to -200ºC. This low temperature allows us to selectively destroy anything that we aim it at. It affects the top layer of skin much more than the second layer, and given that scars are formed from injury to the second layer of skin, this approach can successfully treat large surface spots without scarring if correctly applied.
Liquid nitrogen is a traditional dermatologist's tool and is used widely to remove all sorts of lesions but especially sunspots and seborrhoeic keratoses. It is also particularly good at treating brown age spots on the backs of hands and faces. It is either applied with a swab on a stick dunked into the liquid nitrogen or it is sprayed on or applied with a cold probe.
The healing process
Blistering and scabbing. Whichever delivery method is used, the end result is the same. It produces localised frostbite which readily forms a thick blister that may break or remain intact and slowly evolve into a scab. This scab lifts in a week on the face and longer if applied elsewhere or for a longer time.
Colour resolution. After the healing time, the patch is often transiently red then white and finally in most cases returns to its normal skin colour.
Side-effects
Pain. There is some discomfort with liquid nitrogen application; a peculiar sensation whereby the body can't quite work out if this substance is cold or hot or just painful. The pain, however, is fleeting.
Scarring and changed skin colour. These undesired effects are not common if the procedure is carefully performed.
Skin shaving, snipping
These are two extremely simple but very effective techniques used for skin lesions such as acrochordans, seborrhoeic warts, cherry angiomas and moles.
Skin shaving is a technique in which the skin is inflated a little with local anaesthetic and the razor bowed so that it takes off the spot with a minimum surround of normal skin. The level of control that one can exert using this simple but exquisitely sharp instrument is very fine indeed. The edges of the wound are sometimes further bevelled with fine wire diathermy if necessary and the result, if the removal is kept superficial, is excellent. This technique is particularly effective on the nose and on the concave areas of the face such as the temples, around the nose, eyes and ears.
The snipping procedure is appropriate for any spot that has begun to hang from the skin surface such as a mole or skin tag. It is often done without local anaesthetic as the snip is so swift that it is not felt. This painlessness is also attributed to the extreme sharpness and special design of the scissors.
Spot peeling
This technique uses strong caustic substances such as Trichloacetic acid and Phenol usually in relatively high concentrations. The substance may either be painted on the skin such in treating xanthelasma around the eyelids or it may be applied in point fashion down the centre of either a dilated oil gland (sebaceous hyperplasia) or down a dilated pore or deep ice pick scar.
The healing process
Time. If painted on, the resulting healing will generally follow the same time frame as that seen with the more general chemical cosmetic peeling process.
Scabbing. If point peeling is performed healing will produce a very small sometimes miniscule scabbing.
The painting is usually performed with a cotton swab after cleansing of all skin oils with acetone. The point peel is often done with a sharp instrument such as a toothpick dipped in the peeling solution.
Side-effects and complications
Side-effects are rare.
Scarring is occasionally seen with painting but such a small area is being done that this is not usually visually obvious even if it occurs.
A need for repetition. The main problem with point peeling is that it doesn't always work and it may need to be repeated.
Curettage
This instrument is very versatile despite being mainly used for skin cancer treatment. It has been used for acne cysts and its newer use is in lipoma removal. It gently scrapes away seborrhoeic warts and other surface lesions that have been loosened with glycolic acid or other peeling agents or after fine wire diathermy.
The curette can not be used in areas of loose or very thin skin such as around the eyelid. But correctly used in the treatment of non-cancerous spots, it is a very useful instrument.
Cortisone injections
This very simple technique is useful in the therapy of scars and cysts.
A dilute local mixture of local anaesthetic and cortisone is sufficient treatment for early scars after sugery or acne or other inflammatory cysts. More entrenched or thickened scars may require stronger concentrations of cortisone to settle these down.