Acne scars : Acne Treatment Guide

If there is one thing that acne sufferers dread it is acne scarring. These are more likely to develop in cases of severe acne where the person has an outbreak of nodules or cysts. Cystic acne is the worst form of acne which can attack healthy skin tissue and result in scarring.

Scars are formed from an injury or wound and are a normal part of the healing process. In most cases a wound will heal without leaving scar but if this occurs in a deeper layer of the skin –the dermis, then a scar will form.

Acne is no different.

Acne develops when too much oil is produced from the sebaceous glands. This oil or sebum combines together with dead skin cells and bacteria to form a ‘plug’which then blocks skin pores. This results in an outbreak of spots or acne.

Can squeezing or picking spots cause acne scars?

There is a risk of further spreading the outbreak and a risk of scarring. It is tempting to do this in the hope that it will remove a blackhead or pimple but it can have the opposite effect. Squeezing or picking a spot can result in the infection within it being pushed deeper into the skin. This can also cause damage to the surrounding healthy tissue.

So try to avoid the temptation to do so.

How does a scar form?

When damage occurs underneath the skin, a new area of skin grows from collagen fibres. Collagen gives the skin its strength and elasticity but unfortunately, the new area of growth isn’t smooth and perfect as before the damage.

This leaves a mark on the skin or a scar.

Types of scars

In some cases, too much collagen is produced which causes a thickened patch of tissue on the surface of the skin. This is known as a keloid scar. This type of scar has a reddish colour and a thick, rubbery texture.

Another type of scar is an atrophic scar: this is causes by a loss of tissue with the skin which appears as a small, sunken in area of the skin. It is very similar in appearance to a crater.

There are two types of atrophic scars:

• Boxcar scar
• Icepick scar

A boxcar scar is a sunken acne scar which has a round shape and steep sides. It looks similar to a chickenpox scar and can range from mild through to deep rooted scars.

Icepick scars are long and narrow in appearance which also resembles a small hole in the surface of the skin. They often develop on the face and look as if they have been inflicted by a sharp needle or ice pick – hence the name.

These can occur in cases of cystic acne.

Post-inflammatory hyper-pigmentation

There is another type of scar - although this is not considered a true scar called ‘post-inflammatory hyperpigmentation’ (PIH). This is a discolouration of the skin where an acne outbreak has occurred, usually following severe forms of acne, e.g. lesions.

If you notice dark brown spots or a discolouration of the skin following an outbreak of severe acne then it is likely to be PIH.

This discolouration will vary according to skin colour and the level of inflammation from the acne outbreak. It can range in colour from pink through to red, brown or black depending on any of these.

It is caused by an excess production of melanin which darkens the colour of your skin. This results in a dark area of skin which remains in place even after your acne outbreak has cleared.

The good news is that it often clears up on its own without the need for treatment.

The biggest factor in all of this is inflammation: the more inflamed a part of the face or body is the greater the risk of acne scars. So if you have a severe form of acne which consists of nodules or cysts then be aware that you are at risk of scarring.

Mild and moderate forms of acne which result in non-inflammatory breakouts are unlikely to cause scarring. But severe forms will due to damage to skin tissue.

If you have a severe form of acne and are worried about scarring then speak to your GP. He or she will be able to refer you to dermatologist if need be for treatment. This is important to prevent the risk of scarring.

Acne scars are usually permanent although laser resurfacing treatment is an option. Laser treatment is discussed in more detail in our acne treatment section.

If you have a severe acne breakout then you may not be able to completely prevent any scarring but you might be able to minimise the damage.

Preventing acne scars

Here are a few ways of minimising acne scars:

• Seek medical treatment (via your GP)
• Use non-aggressive skin care products. This will avoid any further irritation.
• Avoid picking or squeezing acne spots (this includes all types of acne, from mild through to severe).

Treatment for acne scars

There are some very effective forms of treatment for acne scars but you still need to be realistic about the outcome. Not every scar can be removed which is something you have to accept.

However, in most cases the outcome is very good. Your GP or dermatologist will discuss this further with you.

Treatment options include:

• Laser treatment
• Dermabrasion
• Microdermabrasion
• Steroid treatment
• Chemical peels
• Punch techniques
• Dermal fillers

Laser treatment is covered in greater detail in our acne treatment section. Basically, it involves using a laser to burn away the top layer of the skin (with the scars) which heals by growing new, scar-free skin.

Dermabrasion This involves the use of a special rotating wire brush which helps remove the top layer of the skin. Once the skin has healed the acne scars will be smaller and softer in appearance. Atrophic scars will be smaller in depth.

This is used less these days in favour of laser resurfacing treatment.

Microdermabrasion

Not to be confused with dermabrasion: this is another cosmetic procedure in which the skin is ‘sandblasted’ with millions of aluminium oxide crystals.

These are applied to the skin from a special machine and then brushed away. They exfoliate the skin by removing the top layer plus any dead skin cells. It also helps to stimulate the production of collagen.

This removes the surface layer only so it is only suitable for shallow acne scars or post-inflammatory hyper-pigmentation.

Steroid treatment This can be in the form of an injection or a corticosteroid cream. If injected into the acne scar it then shrinks or flattens the scar tissue which improves its appearance.

Another option is a steroid cream which can be directly applied to the acne scar.

Chemical peels

A chemical peel is a popular form of cosmetic treatment which involves applying chemical agents (acid) onto the skin which removes the top layer of skin.

You may be worried by the thought of an acid being applied to your skin but this is a very safe procedure and you will experience a warm, ‘tingling’sensation at best. An ice pack will be applied if this occurs.

After a short period of time the chemical peel is removed which should result in a smooth skin.

This is only suitable for mild acne scars.

Punch techniques

The name ‘punch technique’ refers to the special ‘punch tool’ which is similar to a small biscuit cutter. This tool cuts out an acne scar, usually under a local anaesthetic.

There are three types of techniques:

• Punch excision
• Punch replacement
• Punch elevation

Punch excision involves using this tool to cut or ‘punch out’ the scar from the skin before closing the treated area with stitches.

Punch replacement involves the same technique but the area where the scar inhabited is filled with a skin graft rather than stitching the area closed. Often used for deep acne scars and may take a short period of time to heal.

Punch elevation also involves using the same tool but only the base of the scar is removed, which leaves the sides intact. The base of the scar is lifted up to the same level of the surrounding skin.

All of these techniques are suitable for icepick acne scars.

Dermal fillers

A ‘dermal filler’ is a substance – often a combination of materials, e.g. restylane or collagen which is used to smooth out lines, wrinkles and scars. This is a popular cosmetic treatment.

Dermal fillers are suitable for ‘sunken in’acne scars in that it lifts the scar up to the same level as the surrounding skin.

But this is a temporary solution only. The results generally last for three to six months so further sessions will be required.

These cosmetic treatments and others are discussed in more detail in our cosmetic surgery guide.