Last updated date: 05-Apr-2022
14 mins read
Acne scars – overview
Acne scars are the consequence of acne breakouts and their severity depends on the type of acne the person has. These scars can be permanent or not and there are several ways to treat and manage the scarring. Given the fact that acne is the most common skin condition, acne scars are also quite common, with approximately one in five people with acne also developing acne scars.
Before we dive into the subject of acne scars, let’s first look at the root of this aesthetic condition – acne.
What exactly is acne? – Acne definition
Acne is a skin condition in which the pores of the skin can get blocked with different things, such as bacteria, dead skin or sebum causing the pore to turn into what is commonly known as a pimple. While this may seem like a usual and fairly easy thing to happen, acne is diagnosed when the infection of the pores is recurrent and affects certain parts of the skin.
This skin condition, acne, is the most common one, especially in teenagers and young adults, with almost 95% of people with ages between 11 to 30 experiencing acne at some point. Usually, acne breakouts can come and go in the span of a few years and most patients’ symptoms start to improve with age. However, there are also people who can have acne well into adulthood, some of them still fighting this condition even after the age of 30 (though there is a small percentage of people who battle it this late in life – almost 3%).
Types of acne
The multiple types of acne are defined in terms of the type of breakout on the skin. As such, the acne breakouts can be non-inflammatory and take the form of blackheads or whiteheads (also known as comedones), or inflammatory, in which case the breakouts are papules, pustules, nodules or cysts. It’s important to know that one person can experience not only one, but multiple types of breakouts at once and depending on the severity of the situation, medical assistance may be required. Given that acne is a skin condition, all types of acne and breakouts can appear anywhere on the body. However, the most common places for blemishes to occur are the face, neck, chest, back and arms.
Non-inflammatory acne. This type of acne includes open comedones and closed comedones, meaning blackheads and whiteheads. These are the most common breakouts in acne and they usually don’t cause any swelling of the skin. In addition, blackheads and whiteheads are the least likely to cause scarring.
- Blackheads. Also known as open comedones, blackheads develop when a pore becomes blocked from oil and dead cells, with the tip of the pore being open and exposed to the oxygen in the air which gives it the black-like aspect.
- Whiteheads. Or closed comedones, are very similar to blackheads, the difference being that the tip of the pore is closed, right under the external layer of the skin, making it look like a small bump under the skin that has a white aspect.
Inflammatory acne. This type of acne shares a similar cause to the non-inflammatory one, but with one big difference – the presence of bacteria. Sebum, dead cells and/or bacteria cause redness and swelling of the skin which in turn causes different types of breakouts that have roots deeper down in the skin layers (compared to the non-inflammatory ones). The principal types of inflammatory acne are papules, pustules, nodules and cysts and it’s important to differentiate correctly between these four in order to treat them accordingly.
- Papules. Propionibacterium acnes or P. acnes is a type of bacteria that lives on the skin. If a pore becomes clogged or blocked with sebum, this feeds the bacterium while also forming a small bump that can rupture. If it ruptures and the bacteria infiltrates the skin tissue, the immune system will start to fight it with an inflammatory response. The inflamed patch of skin is what is called a papule. This small red bump called papule doesn’t accumulate pus (so it doesn’t have that white or yellow aspect), but if it does, then it turns into a pustule.
- Pustules. Pustules are red and inflamed blemishes that have a white head which is filled with white pus that can leak if the pustule is pierced. The pus in the pustules is caused by the white cells that are deployed by the immune system in the area to help fight the infection caused by bacteria or other factors. While the pustules have a sort of tempting calling to be popped, it is not recommended to do so since it can help further spread the bacteria while also leaving a scar in the process.
- Nodules. Nodules are a more serious type of acne blemishes that typically form in the lower layers of the skin and can last up to months until they heal. Nodules can be large and get inflamed, giving a feeling of hard patches beneath the skin. These breakouts are also caused by an excessive amount of sebum or dear cells in the pore, as well as bacteria. What makes this type of breakout serious is the larger amount of time it takes for it to heal as well as the fact that it can cause severe scars that might be permanent if the nodules are not treated adequately.
- Cysts. When sebum, dead skin cells and bacteria clog up a skin pore, the combination can lead to the formation of a cyst. These types of breakouts make up the most serious type of acne – cystic acne. While its causes are similar to the other types of acne blemishes, cysts are more likely to develop in people who have an oily skin. What also sets this type of acne apart is the pain that accompanies these breakouts at touch. In addition, cysts are the largest type of breakout and they tend to form in the deeper layers of the skin, far from the surface.
Who gets acne?
The most common (and science based) risk factors for getting acne are hormonal changes that are typical in adolescence and pregnancy, taking birth control pills or medication with corticosteroids (which also interferes with the levels of hormones) or having parents that have or had acne. In mainstream culture, eating chocolate is also considered a risk factor, but this has no scientific support. However, having a diet high in sugar and carbs has been linked with developing acne.
Given that the main cause of acne breakouts is the accumulation of oil that is directly influenced by the hormonal changes, the good news is that people usually get acne during puberty, after which the symptoms die down as soon as they enter adulthood (and the hormonal levels stabilize). However, for some people the breakouts don’t improve with age which can have quite an impact on their skin, as well as on their body image and self-esteem.
Treatment for acne
The many forms of treatment for acne depend very much on the type of acne you have and its severity. There are some at-home self-care actions you can take, but in case of severe acne, medication and other interventions might be advised by your dermatologist. Some self-care routine steps can include regularly washing your face to remove any excess sebum or dirt, not touching the face and keeping your hair out of it, using water-based make-up products and resist the temptation to squeeze or pop your pimples since this can help spread bacteria and leave a scar.
In terms of medication, for the milder types of acne, over-the-counter medication usually helps, in addition to a healthy skin care routine. This medication typically includes salicylic acid (it prevents the clogging of the pores), resorcinol (it removes the dead cells of the skin) and benzoyl peroxide (it dries out the blemishes while also killing any bacteria that can cause a breakout).
In the more severe cases of acne, your dermatologist might prescribe medication aiming to ameliorate your symptoms and reduce the chance of getting acne scars. Prescribed medication can include antibiotics (oral or topical; it targets infection and reduces inflammation), retinoic acid or benzoyl peroxide stronger than the OTC variant, birth control pills (to help regulate the hormonal levels) or isotretinoin (for severe cases of acne, such as nodular acne).
If diagnosed correctly and treated accordingly, acne breakouts can clear up quite fast. However, flare-ups are to be expected, especially until reaching adulthood so long term treatment can also be an option for prevention.
What are acne scars though?
We’ve explained what acne is, the many forms it can take and how it can be treated, but some questions remain. What’s acne scars, how do they form and are there ways to treat them? As we go on, we’ll tackle all these questions for you so keep on reading!
Acne scars are the result of acne breakouts, usually caused by the more severe types of acne. They take multiple forms and there is a variety of treatment options for them, but one thing is certain: you need to be completely acne-free before starting to consider treatment for acne scars.
What causes acne scars, how are they formed?
Simply put, acne scars are a consequence of inflammation of acne breakouts. When a pore is clogged up, its walls swell and might break down leading to a scar. Some types of acne breakouts are quite small and so the scars are superficial and can heal by themselves quickly and beautifully. Some other acne breakouts may leak into the adjacent skin tissues causing more serious, deeper scars that can be quite challenging to heal. Like all scars, acne scars can either be like an indentation on the skin or, on the contrary, like a small bump on the surface of the skin. The physiological response of the skin in case of lesion is to create collagen which helps with the healing process. Usually, when the skin produces too much collagen it causes raised or bumpy scars.
One thing that is important to consider is that not every person who has acne necessarily gets acne scars. In fact, statistics show that only one in five patients with acne also have scars. Plus, even if you get scars, most of them are not permanent and can be treated in various ways.
Acne scars types
There are two main types of acne scars – atrophic scars and hypertrophic and keloid scars.
Atrophic scars. These scars are usually either flat or depressed and they form right beneath the outer layer of the skin. These scars are typically formed when there is loss of skin tissue that the skin is unable to regenerate, leaving an indentation on the skin. Most often, atrophic scars are consequences of more severe cases of acne, such as cystic acne, but the other types of acne can also cause atrophic scars. There are three types of atrophic scars – ice pick scars, boxcar scars and rolling scars.
Ice pick scars. These are the smallest atrophic scars, usually looking like deep pores. Ice pick scars are more common on the cheeks and are quite hard to treat.
Boxcar scars. Boxcar scars, as their name suggests, are depressions on the skin that have very well defined edges and a flat bottom. They resemble chickenpox scars and are also common in varicella. This type of scars usually develops on the lower cheeks and the jaw area.
Rolling scars. These scars, unlike boxcar scars, have sloping edges and can vary in regards to their depth, giving the skin a wavy aspect.
Hypertrophic and keloid scars. The main difference between hypertrophic and keloid scars and atrophic scars is that the former present themselves as raised bumps of scar tissue once the acne blemishes are healed. This is usually the result of too much scar tissue which can be caused by too much production of collagen by the skin or by the buildup of scar tissue. While they might appear quite similar, the difference between hypertrophic scars and keloid scars is that hypertrophic scars keep the same size as the acne breakout that caused them, while keloid scars are bigger than the former acne blemish.
Where do acne scars form?
Acne scars develop in the same spots as the acne breakouts, meaning that the most common places one can get acne scars are the face (acne scars in face; acne scars on nose; acne scars on forehead), neck, chest, back, arms.
Acne scars versus post-inflammatory pigmentation
When acne breakouts heal, sometimes the skin where the acne once was changes its color. Post-inflammatory erythema means that the skin gets pink or purple, pigmentation means that the skin can get brown-ish (especially if exposed to the sunlight) or hypopigmentation means that the acne leaves a white mark. These are not scars though, they are just changes to the skin pigmentation that typically resolve on their own. To help the pigmentation disappear sooner, using sun protection helps; to prevent different changes in color of the skin, it’s recommended to not pop or squeeze the acne blemishes.
Are acne scars permanent?
The question that every person with acne has is whether or not acne scars are permanent (acne scars permanent). The short (and disappointing) answer is that yes, acne scars are quite permanent. But don’t lose hope just yet! While scars by definition are permanent changes in the skin structure, there are many resources and forms of treatment available to prevent new scars from forming and to help diminish their aspect over time (some of them can even disappear completely). We will talk about the variety of solutions available as we discuss the treatment options available for acne scars.
Acne scars treatment
What helps acne scars? Well, there are quite a few solutions for acne scars, ranging from medication, creams, laser interventions, home remedies and more! Acne scars best treatment depends on the type of acne you have and also its severity. To determine the best course of action for you, seeing a dermatologist is imperative since they can diagnose your acne properly and can guide you through the healing process. As we’ve stated before, treating acne scars can only be done after the acne breakouts are completely gone and this can be achieved by following doctor’s orders. What’s more, the process of acne scars removal might imply adapting to the various types of breakouts you can have, seeing as one person can have, for example, pustules and nodules at the same time.
We will divide the various treatment options into two categories, corresponding to the two main types of acne scars: atrophic acne scars and hypertrophic acne scars.
Atrophic acne scars – treatment
Treatment for atrophic acne scars, also known as depressed acne scars usually includes:
- chemical peels and dermabrasion– acne scars chemical peel is a form of treatment that uses glycolic or salicylic acid to remove the external layers of the skin tissue; dermabrasion is used especially for boxcar scars; this procedure levels out the outer layers of skin, reducing the depth of the scar; as we can see, both interventions are resurfacing procedures that aim to remove layers of skin tissue in order for the skin to start to make new skin cells that can help reduce scarring; these two procedures are recommended and have the best results in the case of superficial scars;
- fillers – acne scars fillers are hyaluronic acid, the patient’s own fat, collagen or other substances which are injected into the scar to help smooth its appearance; most fillers have temporary results and may need a do-over for a more lasting one; however, this is a procedure that comes with its own potential side effects, so it’s important to decide alongside your physician if this is the best course of action for you;
- laser – acne scars laser treatment has two types, ablative and non-ablative; ablative laser therapy uses light to stimulate collagen production and non-ablative therapy uses heat to stimulate collagen production;
- microneedling – microneedling for acne scars or collagen-induction therapy, aims to stimulate the body’s secretion of collagen; using an acne scars derma roller, the dermatologist creates small punctures in the scar that will stimulate collagen, smoothing out the scar’s appearance;
- surgery – it sounds drastic, but it’s not; this procedure aims to create a different scar, preferably a less visible one that can in time fade away completely.
Hypertrophic acne scars – treatment
Treatment for hypertrophic acne scars usually includes:
- corticosteroids injections – the substance is injected directly into the scar; it usually requires multiple injections, spaced out in the span of a few weeks, depending on the scar and its response to the procedure;
- surgery – just like in the case of atrophic acne scars, surgery is performed in order to reduce the acne scar and to create a less-visible one; for the best results, this procedure is usually followed by other treatment options (either injection or radiation);
- laser – ablative or non-ablative, it can help flatten a hypertrophic scar.
Acne scars home remedy
There are some ways you can treat acne scars at home, without intervention from your dermatologist. However, it’s essential that you consult with a specialist before you start using these substances in order to make sure they are appropriate for your type of acne. Some of the substances that you can use at home are salicylic acid, retinoids, alpha hydroxy acids or lactic acid.
Acne scars natural remedies
Even if there is no scientific base for the use of these substances, coconut oil, aloe vera (acne scars aloe vera), shea butter and vitamin E oil (acne scars vitamin E) are used by some to help them smooth out their acne scars. However, these can cause more harm than good in some cases, so use with precaution.
Acne scars can be quite a nuisance and can have a serious emotional toll on someone. As we’ve seen, there are multiple ways one can treat or remove acne scars so if you need help deciding what’s the best course of action for your acne scars, don’t hesitate to search for “acne scars treatment near me” (acne scars laser treatment near me; acne scars how to remove) in order to start planning for your new and improved skin!