Acne scarring, as with any other scarring, is the result of a wound in our skin. The problem of acne scarring begins first with having acne. Acne begins with our skin producing natural oil in the subaceous gland. Bacteria causing acne metabolizes this oil, which then irritates the skin. When the skin is irritated by the oil, hair follicles become plugged and collect debris.
The debris burrows into the deeper layer of skin called the dermis. The debris is seen by the body as a foreign substance and the body tries to get rid of the foreign substance through an inflammatory response. This is when you see the acne pimple.
The body struggles to rid itself of the foreign substance, the debris, with the inflammatory response, which results in a wound in the skin, which then develops into a scar when the body produces excess collagen to repair the damage to the skin.
Although acne scars are the result of a wound, like any other scar, they are also different than other scars in that they are depressed within the skin, rather than on the surface of the skin as most other scars. There are four different types of acne scars: ice pick scars; rolling scars; boxcar scars; and hypertrophic/keloid scars.
Ice Pick Scars
- Deep, narrow scars
- Form pits in the skin
- Most common
Rolling Scars
- Wave-like appearance on surface of skin
- Wide and shallow depth
Boxcar Scars
- Angular, well defined edges
- Most often found on temples or cheeks
- Similar in appearance to chickenpox scars
Hypertrophic Scars
- Raised scars in the same place as the original acne wound
- Reduce in size over time
Keloid Scars
- Overgrowths of tissue
- Expand beyond original size of acne wound
- Rubbery and firm to the touch
- Often itchy
Acne Scarring Risk Factors
Family history is the most important risk factor regarding acne scarring, as genetics influence how easily an individual scars. If an individual scars easily, they are at greater risk for developing acne scars after breaking out with acne. Since severe acne results in a greater risk for developing acne scars, those with a family history of severe acne may be at higher risk as well.
Prevention of Acne Scars
The only way to prevent acne scars entirely is to prevent acne. While a family history of acne, which leads to a higher chance of developing acne, cannot be changed, there are other factors that influence the occurrence of acne that can be managed to reduce the appearance of acne.
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The environment individuals are subjected to plays a role in acne development. Dirt, dust and pollutants in the environment can clog pores and increases the occurrence of acne if not properly cleansed. To prevent acne from occurring when environmental risk factors are high, cleansing twice a day with a gentle cleanser is imperative.
A healthy diet is extremely important to overall health. Drinking plenty of water is particularly important to skin health, as adequate hydration helps to flush toxins from the body. Therefore, in order to prevent acne, and thus prevent acne scars, a healthy diet that includes 6 -8 cups of water per day is extremely important.
When acne has already developed, there are still steps that can be taken to help prevent acne scars. Early intervention is one way to help reduce the likelihood of acne scarring. Intervention can include over the counter remedies, such as topical creams and cleansers specifically designed for the treatment of acne, or prescription medications that are more potent than those available over the counter.
If acne appears severe or persistent, the advice of a dermatologist should be sought. It is important that while acne is being treated, do not squeeze the pimples that have formed. Popping the pimple only results in spreading of the infection and often causes an open wound that is almost certain to form some type of scar.
Treatment of Acne Scars
If acne scars have already formed, all is not lost. There are now effective treatments for acne scars, and though they cannot cure the scars entirely, they can reduce the appearance and severity of the scarring. Treatments for acne scars includes: over the counter medications; prescription medication; laser treatment; dermal fillers; surgical options; punch excision and punch elevation; chemical peels; microdermabrasion; and home remedies and treatments.
Over the Counter Medications
There are many over the counter medications that can help to treat acne scarring. These are generally topical products and contain Retin-A and alpha hydroxy acid. The presence of Retin-A and alpha hydroxyl improves acne and also stimulates new collagen formation. New collagen formation improves the appearance of acne scars by helping to fill in the scar that is within the skin, rather than on the surface of the skin. In addition to topical treatments containing Retin-A and alpha hydroxyl acid, the use of sunscreen is also important.
Sunscreen helps prevent further damage to the skin from the sun, and is especially important as the skin is healing from acne. Sunscreen is also important when using topical treatments that contain Retin-A and alpha hydroxy acid, as these ingredients can cause increased sensitivity to UV rays.
Prescription Medication
Prescription medication for acne scarring is generally similar to over the counter medications and treatments. However, medications available by prescription are usually more potent and typically more effective than the over the counter topical treatments. These treatments, containing Retin-A, alpha hydroxy acid, or glycolic acids, can help remove superficial layers of the skin in order to improve skin texture. If severe acne scarring is present, seeking the advice of a dermatologist in order to obtain prescription medications may be the best option.
Laser Treatment
Laser treatment is perhaps the most effective form of treatment for acne scarring. In recent years laser technology has improved greatly, making them more effective and safe than ever. The two main categories of laser treatment are ablative and non-ablative. Ablative laser treatment, or skin resurfacing, removes outer layers of skin and burns away the scar tissue, encouraging collagen in the dermis to tighten and thus decrease the appearance of scars. Conversely, non-ablative laser treatment does not involve injury to the skin. There are many different types of non-ablative lasers available for treatment of acne scars, including the Pulse-Dye Laser, and fractionated lasers.
Non-ablative lasers are generally more accepted as treatment for acne scarring and skin rejuvenation. While ablative laser treatment may help to resurface skin, it also carries a lot of risks. Increased inflammation is noted with the use of ablative laser therapy, and there is a risk of permanent skin whitening.
In addition, while the results from ablative laser therapy used to treat wrinkles are generally significant, the results are not as impressive when treating acne scars. Non-ablative lasers, however, are highly effective in the treatment of acne scars and have quicker recovery times than ablative laser therapy.
Non-Ablative Laser Treatment
Pulse Dyed Laser
- Removes redness of acne scars
- Helps treat keloid scars, flattening and controlling itch
- Topical anesthetic applied prior to procedure
- Treatment sessions last approximately 1 hour
- Repeat sessions every 3 months as needed
Fractioned Lasers
Affirm Laser
- Helps in skin rejuvenation
- Decreases appearance of brown spots, acne scars, and facial veins
- Treatment sessions last approximately 20 minutes
- Repeat sessions as needed
Fraxel Laser
- Improves texture and tone of skin
- Reduces brown spots
- Smoothes wrinkles
- Significantly improves acne scars
- Small injuries, the diameter of a hair shaft, are created by the laser, leaving untreated skin between the injuries, which heals the small injuries by replacing with healthy tissue
- Fraction of skin treated per session
- May be repeated up to 5 times, over a 3 – 5 week period as needed
- Anesthetic cream applied prior to session
- Moderate pain level during procedure
- Pain level similar to that of a sunburn following the procedure
- 2 – 7 day recovery time
- 20% – 70% improvement in acne scarring
Side Effects
- Discoloration of skin (less than 1% chance)
- Texture change, bump or depression in skin (less than 1% chance)
- Infection or cold sore leading to prolonged healing and scarring (rare)
- Formation of small blister
- Redness and swelling
Dermal Fillers
Dermal fillers are injected into the skin in order to push up the acne scar, resulting in decreased appearance of the scar and smoother skin. The patient’s own fat can be used as filler, or synthetic materials can be used. Dermal fillers are most effective on shallow, saucer shaped scars, and are not effective on deep acne scars. The results of dermal fillers are not permanent. Dermal fillers must be repeatedly injected into the same area every 3 – 6 months.
Surgical Options
Subcision
A surgical option, called subcision, is when a dermatologist uses a tiny scalpel or needle to cut beneath the acne scar. This breaks the fibrous bands of scar tissue that creates tension within the skin, and results in depressed acne scars. Cutting the fibrous bands reduces tension and promotes new collagen formation. This procedure is generally repeated monthly. Though relatively safe, subcision may cause pain, bruising and swelling, as well as persistent bumps at the treatment site.
Punch Excision & Elevation
Punch excision and elevation are techniques generally used for deep acne scarring. These techniques involve removing the tissue that contains the scarring and either suturing or replacing the remaining tissue. There are three punch techniques, which include:
Punch Excision
- Biopsy tool is used to remove the scar and its surrounding edges
- Skin is sutured together to heal
- Scar formed from procedure fades after treatment
Punch Excision with Skin Grafting
- Biopsy tool is used to remove the scar and its surrounding edges
- Wound is filled with graft of patient’s own skin
Punch Elevation
- Used on deeper boxcar scars
- Biopsy tool is used to remove the scar and its surrounding edges
- Scar tissue is elevated and reattached, thus diminishing depth of scar and minimizing chance of discoloration from different skin being grafted in its place
Side Effects of Surgical Problems
- Risk of infection
- Redness, swelling
Chemical Peels
Chemical peels involve applying a chemical solution to the skin. This solution is left on the skin for a certain amount of time in order to dissolve tissue cells and encourage the growth of new tissue. The dead cells are removed to show new skin cells beneath, thus improving the look and texture of skin. Some chemical appeals are appropriate for treating shallow acne scars. However, chemical peels are generally ineffective against deep acne scars.
Microdermabrasion
Microdermabrasion removes the dead layer of protective skin cells on the surface of the skin in order to improve the texture of skin, as well as reduce areas of dark pigmentation. While microdermabrasion is successful in removing minor effects of acne, such as darker pigmentation, it is not effective at treating true acne scars.
Home Remedies & Natural Treatment
In addition to medical procedures, prescription medications, and over the counter medications, there are many home remedies and natural treatments believed to treat acne and acne scars. The following are treatments requiring little more than a trip into the kitchen or to a local naturopathic grocery store:
- Paste of sandalwood powder and black gram dal applied to the affected area overnight and washed off with cold water the next day
- Paste of sandalwood and rose water applied to scars, kept on overnight and washed off with cold water the next day (may add milk to moisturize and prevent skin dryness)
- Lemon juice applied to affected area for 10 – 15 minutes reduces dark pigmentation associated with scarring
- Honey, warmed and applied to scars for 10-15 minutes, then washed off with cold water
- Aloe Vera applied to scars
Whether opting for natural remedies or seeking the advice and treatment of a medical doctor, acne and acne scars can be effectively treated. It is important to remember that, as with all issues relating to health, a healthy diet and exercise is essential to overall wellbeing. In the case of acne scars, drinking plenty of water is of the upmost importance and will help to prevent acne and aid in the beauty of skin in general.
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