痤疮平复后,可能会留下痘疤,有些是黑色或红色的痘印,有些则是凹陷或凸起的疤痕,其中黑色或红色痘印源于皮肤发炎后的色素沉着,会随着时间变淡至消失,不算是真正的疤痕。而凹陷和凸起的疤痕是真性疤痕,不会自行消退,往往需要采用医疗手段进行控制和治疗。

起因:

色素沉着

色素沉着

皮肤在经历急性或慢性炎症过程后可能会出现色素沉着,皮肤创伤以及多种皮肤病都可能引起。 痤疮是引起炎症后色素沉着的一个常见因素[1-3]。痤疮愈合后,可能会因为色素沉着而留下红色或黑色的痘印。这样的痘印并不是疤痕,它不是永久性的,虽然可能会持续数月至数年,但会随着时间变淡直至消失[5]

预防:

首先,不要用手按压或挤压痤疮周围的皮肤,否则会增加色素沉着的风险。另外如果需要挤痘,要采用正确的方式,不正确的挤痘方法更容易留下痘印。
其次,要注意防晒[1,4,6],因为紫外线也是引起色素沉着的一个重要因素。
当然,防止痘印形成,最根本的方法还是在于对痘进行有效的治疗[7]

治疗:

由色素沉着引起的红色或黑色痘印一般无需进行治疗,这种痘印在痤疮得到控制后会慢慢消退。不过有些可能需要很长时间,如果有心理压力,可以咨询医生采用正确的方法进行治疗,比如一些外用药(维甲酸等)可以加速痘印的恢复,另外,激光疗法、冷冻疗法、化学剥脱术、微晶磨皮等医疗手段也用在痘印的治疗中。

外用药物:

比如维甲酸、壬二酸、氢醌等。其中外用维甲酸有控制痤疮炎症后色素沉着和改善痤疮疤痕的功效[8]。壬二酸和氢醌对黑色素有抑制作用,可以控制黑色素的合成[2-3,9-10]

激光治疗:

当外用药物疗效不明显时,医生有时会建议尝试激光治疗[11-12]

化学剥脱术:

也称为化学换肤,即使用果酸、水杨酸、三氯乙酸、Jessner’s溶液等作为剥脱剂,破坏原有的疤痕皮肤,促进皮肤的更新和修复[1-3,9]

冷冻疗法:

即利用干冰或液氮等冷冻剂使病变部位的皮肤冷冻,破坏局部细胞和血液循环,从而使皮肤组织坏死、脱落。

微晶磨皮:

即利用微小的晶体磨削掉皮肤表层,促使皮肤再生[2-3]

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起因:

痤疮疤痕和炎症反应有关,容易出现二次炎症反应的患者,留下疤痕的可能性更大。

分类:

痤疮疤痕有两种基本类型:萎缩性疤痕(凹陷型)和増生性疤痕(凸起型)。其中萎缩性疤痕比较常见,其出现的比例要远高于增生性疤痕(二者出现的比例约为3:1)。
根据疤痕的外观表现,又可以分为:碾压型、车厢型、冰锥型和凸起型,其中前三种都属于萎缩性疤痕,最后一种凸起型属于增生性疤痕。如下图示:

碾压型

碾压型较常见

碾压型疤痕由皮肤表皮以下的损伤引起,外观呈波浪形,疤痕较宽且深度浅。

车厢型

车厢型 较常见

车厢型疤痕有垂直的边缘,或浅或深,常出现在脸颊和鬓角处。

冰锥型

冰锥型 较常见

冰锥型疤痕通常较窄,但深入皮肤内部,类似冰锥的结构。


凸起型

凸起型 不常见

凸起型疤痕属于增生性疤痕,表现为隆起的块状,常出现在背部或胸部,不过颈部和面部也可能出现。这种类型的疤痕一般是由比较严重的痤疮(结节或囊肿)引起,可能会随着时间变小。

预防:

预防留疤有两个关键点:一是在痤疮初期就采用正确的方法对痤疮进行治疗,防止痤疮进一步发展;二是不要用手去触碰或挤压皮肤,很多疤痕的形成并不是因为痤疮本身,而是对皮肤的按压或挤压,导致炎症反应加剧,从而引起疤痕。

治疗:

痤疮疤痕是永久性的,难以完全清除,不过采取有效的治疗方法可以使其得到改善。

目前,对于萎缩性疤痕(凹陷型)采用的治疗方法主要包括化学剥脱术、机械磨皮/微晶磨皮、激光治疗、疤痕切除术、皮肤移植、组织填充、微针等。

化学剥脱术:

也称为化学换肤,即使用果酸、水杨酸、三氯乙酸、Jessner’s溶液等作为剥脱剂,破坏原有的疤痕皮肤,促进皮肤的更新和修复。

机械磨皮/微晶磨皮:

即通过机械磨削掉皮肤表层,促使皮肤再生。

激光治疗:

不同类型的激光器对于治疗痤疮疤痕是一种有效的方法,车厢型疤痕和碾压型疤痕的患者都适用于这种治疗方法。

疤痕切除术:

疤痕切开缝合技术,以及组织填充,为痤疮疤痕的治疗提供了更多的精确度和有效性。

皮肤移植:

皮肤移植术是对疤痕的手术治疗,即去除疤痕组织后,将移植皮肤植入疤痕部位。

组织填充:

比如脂肪组织填充,即注入脂肪填充疤痕组织,从而改善疤痕轮廓。还有其它一些填充剂,比如自体胶原蛋白、牛胶原蛋白、透明质酸等也可以用做组织填充剂应用在凹陷疤痕上。不过由于填充剂的副作用发生率很高,目前推荐使用的材料是透明质酸(玻尿酸)。

微针:

微针是一种新的技术手段, 它是利用微针滚轮上的针头刺破皮肤, 促进皮肤新生。但对于正在进行抗凝血治疗、皮肤感染、胶原蛋白注射、或半年内进行过其它组织填充、以及瘢痕疙瘩等患者禁用。

图3 微针治疗

微针治疗

综合疗法:

这是一种新型的组合疗法,即将多种治疗方法联合使用,首先用三氯乙酸换肤,然后经表皮剥离术将疤痕皮肤与底层皮肤分离,分隔部分被新胶原填充,导致疤痕变平,最后使用点阵激光治疗。这种综合疗法对于各种凹陷疤痕来说是一种安全并且有效的治疗方法。


对于增生性疤痕,常采用的治疗方法有硅凝胶治疗、类固醇激素注射、冷冻疗法、激光治疗、外科手术等。

硅凝胶治疗:

硅凝胶常用于増生性疤痕的预防和治疗,它有抑制疤痕生长和增生的作用,适用于任何年龄和人群的疤痕治疗。 类固醇激素注射:在疤痕内注射类固醇激素类药物,可以通过抑制瘢痕成纤维细胞的增生、减少胶原和氨基葡聚糖的合成、以及抑制炎症介质等作用来减少瘢痕的形成。

冷冻疗法:

即利用干冰或液氮等冷冻剂使病变部位的皮肤冷冻,破坏局部细胞和血液循环,从而使皮肤组织坏死、脱落。 脉冲染料激光治疗:对于增生性疤痕,激光治疗成功的案例并不多见,但脉冲染料激光是个例外,在过去十年中,脉冲染料激光在治疗增生性疤痕方面取得了较好的效果。

外科手术:

比如疤痕切除缝合、皮肤移植等,对于大面积的面部疤痕,W-整形术(W-plasty)是一种较为理想的治疗方案。

不管哪种类型的疤痕,还有一种通用的“治疗方法”,那就是自我接受。没有人是完美的,接受自己的不完美,保持积极乐观的心态才能实现更好的“治愈”。

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