Topical management of acne scars: The uncharted terrain

Abstract

Majority (80%-90%) of patients who develop acne scars have atrophic scars associated with loss of collagen compared to a minority who show hypertrophic scars and keloids. 1 Loss of dermal matrix in the form of collagen breakdown during the inflammatory stage leads to atrophic scars. The ratio of MMPs (Matrix Metalloproteinases) to tissue inhibitors of MMPs determines the development of atrophic or hypertrophic scars. Inadequate deposition of collagen leads to formation of an atrophic scar while, if the healing response is excessive, a hypertrophic scar is formed. 2Current treatment options for atrophic acne scars are dominated by non-pharmacological, invasive procedures which may not be suitable or affordable to all patients. To the best of our knowledge, there are only few studies evaluating the role of topical preparations in the management of acne scars.The various topical agents that have been tried in the management of acne scars as enumerated in Table 1 are described as follows along with their levels of evidence according to the Oxford Centre for Evidence Based Medicine. | INDIVIDUAL AG ENTS | Tretinoin (level of evidence: 4)Tretinoin 0.05% is used in the treatment of keloid scars, but there have been scarcity of reports of its use in the less aggressive acne

How to Promote Skin Repair? In-Depth Look at Pharmaceutical and Cosmetic Strategies

“…In fact, this study supports the hypothesis that hydration or water impermeability may be responsible for its effective healing results and the inhibition of fibroblasts proliferation, together with inhibition of collagen and glycosaminoglycan production in the hydrated group and no apparent change in fibroblast activity in the silicone-treated group [90]. Silicone also causes immunological alterations, namely downregulating fibrogenic cytokine TGFβ2 [91], TGF-β [92], or increasing basic fibroblast growth factor and IL-8 levels [93,94]. Since silicone is inert, it is not capable of inhibiting microbial growth, but it can act as a bacterial barrier [81].…”

“…It is also associated with a reduction of mast cell activity, edema, and excessive extracellular matrix formation. Silicone also contributes to the right alignment of collagen deposition by increasing temperature, oxygen tension, and electrostatic properties [81,92].…”

Skin care for scars: Where we have been and what's new

“…The consequential collagen breakdown in this scar subtype is due to the loss of dermal matrix producing the atrophied appearance observed. 5…”

“…Results showed improved texture in the silicone gel application areas. 5 A metastudy of 27 trials showed silicone gel sheeting to be a successful and safe approach. It has shown the ability to improve old scar elasticity in comparison to untreated scars.…”

“…In contrast to hypertrophic and keloid scars, collagen loss is associated with the majority of atrophic scars. The consequential collagen breakdown in this scar subtype is due to the loss of dermal matrix producing the atrophied appearance observed 5 …”