Dr. Perricone Discusses

Healing Acne Scars


Many of my patients ask me what I recommend to make scars look less visible. I've seen excellent results from topical alpha lipoic acid (ALA). When applied regularly it can reduce the appearance of nearly all types of scars. This unique ingredient also shows great success in treating acne scars and the deep pitting the acne lesions can create.

The Cleft Palate Study
An interesting double-blind placebo controlled study conducted by university-affiliated plastic surgeons in Texas found dramatic results with a topical formulation of ALA. They applied the treatment to children post-operatively, after cleft-lip palate surgery. At the end of the 12 month study, it was found that those receiving the cream containing alpha lipoic acid had almost no discernible scar and no perceivable lip deformation, as compared to the children treated with the placebo, who showed no improvement.

Acne Scars
A second open study treating atrophic acne scars (scars that take the form of a sunken recess, which creates a pitted appearance in the skin) indicated that after 12 months of treatment there was an 80% reduction in the depth of these acne scars.

How it Works: Cellular Repair & Alpha Lipoic Acid
ALA first concentrates in the cell plasma membrane, where it neutralizes free radicals. It then moves on to the watery interior of the cell, known as the cytosol, where it can also quell the activity of free radicals and prevent activation of other pro-inflammatory chemicals. The cytosol is filled with a gelatinous material, which houses the nucleus, the DNA, and substances knows as transcription factors, regulatory proteins that control when genes are switched on or off.

These transcription factors act as tiny molecular messengers that can move to the nucleus of the cell to stimulate our DNA to replicate RNA and make important proteins for cell function. For our purposes, we'll concentrate on two important transcription factors: nuclear factor kappa B (NF-Kappa B) and activator protein 1 (AP-1). These transcription factors are not active in the cell unless free radicals are about to overwhelm the cell's defense mechanism. This is the state known as oxidative stress; when the cells are in a state of oxidative stress, these transcription factors are activated, where they wreak cellular havoc.

NF-Kappa B does its damage by migrating to the nucleus and attaching to the DNA, resulting in the production of pro-inflammatory cytokines — chemicals that are the so-called "serial killers" of the cellular world. ALA can prevent the activation of NF-kappa B, thus preventing gene expression of other pro-inflammatory chemicals. Simply put, ALA effectively turns off a messenger system that can cause further damage to the cell.

The other transcription factor, AP-1 is even more mischievous, as it can either damage the cell or repair it. If AP-1 is activated by a pro-inflammatory event such as sunlight, it, too, migrates to the nucleus where it causes the production of a variety of chemicals, including collagenase, which actually digests collagen. As the collagen is digested, it results in "micro-scars," which lead to wrinkles.

However, when AP-1 is activated by the powerful anti-inflammatory ALA, the cell is instructed to turn on collagenases that only digest already damaged collagen, thus repairing wrinkles and scarring. ALA is truly is a great gift for creating and maintaining youthful skin.

Alpha lipoic acid is a unique antioxidant in that it is both water and fat and lipid soluble. It can modulate gene expression by interacting with transcription factors such as NfkB and AP-1. High concentration of alpha lipoic acid in the skin activates collagen-digesting enzymes that specifically work to break down damaged collagen (scars and wrinkles).

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Related Links:

Dealing with the Aftermath of Acne
The Story of Alpha Lipoic Acid
The Pore Treatment That Works