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DERMAROLLERS IN ACNE SCARS Scar treatment is done by Dermatologists. Acne scars may be cosmetically disfiguring and aesthetically unpleasant. They may lead to a loss of self-esteem, career options and other psychosocial sequelae. Acne scars may be broadly classified into 2 main groups: 1. Acne scars involving tissue loss 2. Acne scar involving tissue excess. Usually the scars are atrophic or depressed. This means the scar base is below skin level. Due to the edges of the scar, the tissue in and around the scar is less pigmented and looks pale. In darker skinned individuals the acne scars are often associated with pigment spots. Rolling scars, box scars, dystrophic scars, distensible retractile scars, non-distensible superficial. medium or deep scars can be ameliorated or even healed by using Derma roller. Regardless of the classification almost all types of acne scars can be successfully treated with a device called derma roller (except keloid scars). The derma roller is a device, which has both cosmetic and medical applications. Its mechanism of action is through collagen induction in the deeper layers of the skin. Collagen is a fibrous protein found in deeper layer of skin, and contributes to the thickness and mechanical strength of the skin, it is more in youth, less in old age and reduced or lost in depressed scars. Percutaneous collagen induction is the process during which we initiate the physiological collagen production of the dermis (deeper layer of skin) without causing any permanent damage to the epidermis of the skin. The epidermis is the upper visible layer of the skin . The best way to achieve this is by using a derma roller (which contains 192 needles of 0.5mm length). This process has been formerly described as skin needling. Before the acne scar treatment with derma roller, 1 principle has to be followed- acne must be completely healed. The fine but extreme sharp surgical needles perforate the scar bed and scar edges. After cleansing the area to be treated, local anesthetic is applied and left for 45min-1hour. Each skin part is dermarollered about 15-20times in order to achieve an intensive perforation, without any pain. This takes off the tissue tension and softens it. The needle only penetrates through the epidermis and does not remove it, so the epidermis is only pierced and will rapidly heal in a matter of hours, since the keratinocytes are highly elastic and flexible.. Keratinocytes are the cells that make up the epidermis. This procedure causes micro- bleeding which usually stops within a few minutes. This procedure also perforates and breaks down the fibrotic fibres that often connect the scar base to the deeper layers, keeping the skin tethered down. Soon after scar perforation new capillaries and fibroblasts migrate in the scar crater. Fibroblasts are the cells that produce collagen. This results in re-vascularization. and a normalization of the previously pale colored surrounding tissue. Revascularization means formation of new blood pipes in the skin. After several treatments the former ‘acne scar crater’ is filled with new collagen layers, this brings the previous depressed scar to normal skin level. Even the brown spots associated with acne to an extent are cleared. The appearance of the face immediately after a derma roller session is pinkish to red. A special sticker type dressing that is skin colored is advised. Depending upon the skin type, the redness will disappear in 1-2 days. After 1-2 days patients can resume their work, following application of a camouflage cosmetic, if required. Follow up is required after 3weeks. Depending on the skin response to derma roller repeat treatments may be advised by the Dermatologist, taking into account the severity and depth of scarring. Advantages of derma roller - complete preservation of epidermis during procedure - no permanent damage to the skin, no pain during procedure - no bleeding, infection, discoloration or other complications on the treated area (response varies with each individual) - Only 24- 48hrs healing period , next day patient can go to work or study.( response varies in different individuals) - Only 3- 5 days of protection from Ultraviolet light required - Leads to softening of the scars The derma rollers can not be used on pustular acne lesions, keloid acne scar tissues, Active herpes outbreaks or any acute infection or inflammation of the skin. The derma roller is a breakthrough device, simple in concept but yielding gratifying results.