Living with acne can be difficult but, for many, the problems continue after the papules and pustules have cleared up. Acne can leave skin marked and scarred and, if someone has experience severe acne, the subsequent scarring can be equally severe and distressing.
Thankfully, there are several options available for tackling these scars, but the best treatment is undoubtedly prevention - i.e. not getting the scars in the first place. If you are suffering from acute acne, then we recommend you consult a dermatologist as soon as possible. He or she will be able to recommend a treatment that can alleviate your acne so that scar formation can largely be avoided.
You can find out which symptoms should prompt you to see a doctor and what he or she will then do here.
Undoubtedly the most noticeable and most severe consequence of acne is scarring, but acne can leave other marks behind such as pimple marks caused by post-inflammatory hyperpigmentation (PIH, You can find out more about how to reduce and remove these in acne and hyperpigmentation.
What causes acne scars?
Try to resist the temptation to fiddle with blackheads, whiteheads and other blemishes − either with your fingers or with other implements. It’s when you squeeze blemishes too hard (especially those that have not yet fully formed) that you can damage the fine veins, glands and tissues that surround them. This can make the symptoms of acne worse and increase the risk of scarring.
Scars form when the outermost layers of skin, the epidermis, has been damaged and the deeper layers of the skin are also affected. Skin is unable to regenerate itself exactly as it was so the wound is replace by granulation tissue which is made up of collagen fibres. These fibres fill the wound from the inside out and help to heal the damaged area of skin. This replacement tissue may heal the injury, but can also remain visible.
The different types of acne scars
There are several different types of scars. The following are those most closely associated with acne:
Atrophic scarsThese are pitted or sunken scars and are sometimes referred to as `ice pick scars`. They develop when a wound does not heal correctly and too little binding tissue is formed. The scar then develops beneath the surrounding tissue and a small, visible indentation (dimple) develops.
You can recognise hypertrophic scars from an elevation in the skin or scar tissue. Where there was previously an inflamed blemish, the skin produces ‘inferior’ tissue. This doesn’t have the same structure as healthy tissue and therefore becomes thicker and sits above the surrounding skin.
When a Hypertrophic scar continues to grow and spreads into other areas of the skin it is known as a keloid. Keloid scars are raised and are a reddish purple when new but then fade. This form of scar is only occasionally caused by acne, it is more commonly associated with burns.
How do acne scars affect skin health?
An acne scar differs from the surrounding skin in the way it looks and behaves.
Oil or sweat glands cannot reform in the scar tissue, and hair is unable to grow on it. Scar tissue also has fewer elastic fibres, so skin often looks and feels harder. Circulation and moisturisation are also compromised in scar tissue, making it harder for scarred skin to maintain the levels of hydration it needs and it can dry out.
How can I reduce or remove acne scars?
Sadly, it is not possible to remove scars completely, but they can be significantly reduced and made much less noticeable. It is also possible that your skin will improve itself over the years.
If you decide your scars need treatment, there are various options available. The right option for you will depend on the nature, size and form of your scarring. Those which involve invasive treatment should be discussed with your doctor, and no treatment should start until your acne has completely healed.
Fruit Acids are frequently used to treat skin marked or scarred by acne. Milder concentrations (up to 12%) are available for home use whereas beauticians have access to concentrations up to 40% and dermatologists can use concentrations up to 70%. Your dermatologist will be able to advice on the most appropriate concentration for your skin. Several peels are normally required before results are noticeable.
N.B. Skin can be very sensitive after a chemical and/or fruit acid peel, so it’s important you avoid direct sunlight (and solariums) and apply a high sun protection factor such as Eucerin Sun Gel-Creme Oil Control Dry Touch SPF30 or SPF50+.
One option for the treatment of keloid scars is cryotherapy. This involves a doctor ‘freezing’ the skin and then injecting a cortisone formula into the scar tissue. A downside is that this treatment generally takes quite a long time, sometimes even years, to deliver results. This is because each scar must be treated individually and the keloid reduced bit by bit. It can help to alleviate unsightly scars, but you’ll need to be patient.
With laser therapy, the skin is injured in a targeted way so as to activate its natural self-healing process. Once skin is renewed, the complexion appears smoother. There is a wide range of laser variants available and this treatment should only be conducted by an experienced dermatologist in order to avoid injuries to surrounding skin. Unfortunately, again, multiple sessions are required for visible, long-lasting results.
Massage with cream
This method is undoubtedly worth a try, since it’s comparatively easy, convenient and affordable. You can massage your own skin, or have it massaged professionally if you prefer.
It can prove effective too − the moisturising products and the massage effect improve skin circulation and the suppleness of scar tissue − but you’ll need to massage regularly and be patient as results will take time.
When selecting a product be sure to choose one that is non-comedogenic so as not to promote a recurrence of acne.
There are devices available for home use, but microneedling is best and safest when carried out by a dermatologist or beautician to avoid the risk of further inflammation.
Facial skin is treated with a dermaroller. A dermaroller is a device fitted with numerous fine needles no more than 0.5 mm in length. These needles pierce the top layer of the skin, which sends a signal that there has been an injury that needs to be repaired. Skin responds by releasing more Collagen, Elastin and Hyaluronic Acid and, in just a short time, skin can appear tighter, younger and fresher.
This is a relatively gentle form of dermabrasion where the upper layers of the skin are removed mechanically with the help of small crystals. The treatment has a positive effect on the complexion and is suitable for dry skin, large pores or other scars too.
Microdermabrasion is pain-free and is usually carried out by a beautician. You’ll need to have regular treatments to achieve effective and lasting results.
Specialists (dermatologists and/or beauticians) can treat acne scars with peels. Fruit Acid, Salicylic Acid or Trichloroacetic Acid (TCA) are used, in varying concentrations, to remove the outermost layers of skin. As skin heals, scars may be less visible and your complexion will be smoother and more even overall.
Acne scars can also be treated with injections.
Hyaluronic Acid can be injected under the indentation of atrophic scars to fill them in. However, since Hyaluronic Acid is gradually broken down by the body, results will only be short term.
The benefit of injections on hypertrophic scars is normally longer term. When injected with cortisone, the scar tissue breaks down and the elevation reduces.