Acne Scars

A Comprehensive Guide to Types & Treatments of Acne Scars

Acne can be an emotionally distressing condition, and its fall-out, namely acne scars and hyperpigmentation, can further exacerbate this. If you’re dealing with acne scars, you are not alone. Acne scarring is a common issue that affects many people worldwide, from adolescents to adults. This guide aims to offer a comprehensive overview of acne scars, their types and the best treatment options available.

What Are Acne Scars and What Causes Acne Scarring?

Acne scars are the result of inflammatory acne lesions, such as cysts, pustules, and papules. These lesions occur when the pore becomes engorged with excess sebum (oil), dead skin cells, and bacteria, leading to a rupture in the follicle wall. When this happens deep within the skin, the material spilled into the surrounding tissue creates deeper lesions. The skin attempts to repair these lesions by producing collagen — the building block of skin tissue. If the body produces too much or too little collagen, an acne scar can form.

Types of Acne Scars

There are several types of acne scars. Their appearance can vary widely depending on the type and severity of the acne that caused them. It is important to understand the differences between them as this is what determines the most effective treatment for acne scarring. Below are are the most common types of acne scars.

Boxcar Scars

Wide, U-shaped scars with sharp, defined edges are called boxcar scars. They can be either shallow or deep. The shallower ones can be treated with resurfacing treatments, while the deeper ones might require more invasive procedures, like punch excisions. They are most commonly found on the cheeks and temples.

Ice Pick Scars

Named for their narrow, V-shaped appearance that looks like small round or oval holes, as if made by an ice pick, these scars are typically deep and less than 2mm wide. Due to their depth, ice pick scars are often the hardest to treat with surface-level treatments and might require procedures like TCA CROSS (Trichloroacetic Acid Chemical Reconstruction of Skin Scars) or punch grafting.

Rolling Scars

Characterised by their wave-like or rolling appearance, these scars are broad depressions with sloping edges due to damage under the skin’s surface. Rolling scars are often the result of long-term inflammatory acne and are caused by bands of scar tissue that form under the skin, giving the surface a rolling and uneven appearance. Subcision or laser treatments are often recommended for these types of scars.

Hypertrophic Scars and Keloids

Both of these scars are raised and firm. Hypertrophic scars stay within the boundaries of the original acne lesion and are usually the result of severe acne types, like nodular or cystic acne. Keloid scars, on the other hand, extend beyond the boundaries of the original lesion and can continue to grow over time. They appear raised and are usually darker than the surrounding skin. Effective treatments for both types include corticosteroid creams, tapes or injections, silicone sheets, cryotherapy, laser therapy, or surgical removal in severe cases.

Acne Scar Treatment

Choosing the right treatment for your acne scars depends on the type of scars, their severity, and your skin type. Here’s a deeper dive into the most common treatments:

Topical Treatments

These are often the first line of treatment for mild to moderate acne scars. Active ingredients like retinoids such as Tretinoin, vitamin C, hydroquinone, arbutin, azelaic acid and exfoliating acids can help to stimulate skin cell turnover, promote collagen production and lighten hyperpigmented scars. They’re often used in conjunction with other treatments for maximum efficacy. This is particularly important for deeper or more extensive acne scarring.

Laser Resurfacing

This involves removing the top layer of skin to help reduce the appearance of shallow acne scars. There are several types of laser resurfacing treatments, including ablative (removes thin layers of skin) and non-ablative (stimulates collagen production). Fractional laser treatment is another popular option. This works by creating tiny microthermal zones to replace damaged cells with healthy new ones.

Chemical Peels

These treatments use a strong solution to remove the top layer of skin, promoting new skin growth. Chemical peels can be particularly effective for treating shallow boxcar or rolling scars.

Microneedling

This procedure involves using a device with small needles to puncture the skin and stimulate collagen production. Microneedling and RF microneedling can help reduce the depth and visibility of scars.

Microdermabrasion and Dermabrasion

These techniques involve physically exfoliating the top layer of skin. Dermabrasion is more intensive, reaching deeper layers of the skin to effectively treat more noticeable scars.

Dermal Filler Injections

Fillers, like hyaluronic acid dermal fillers, can sometimes “fill in” atrophic scars. This makes them look less noticeable. However, this is a temporary treatment and you will need to repeat it periodically.

Surgery

In severe cases, you may need to consider surgical options. One such procedure is subcision which breaks up fibrous bands that cause rolling scars. Punch excision involves removing the scarred area and closing the wound with stitches. Skin grafting is not usually done for acne scarring. It is generally used in severe traumatic scarring caused by burns or injuries. Grafting replaces the scarred skin with healthy skin from another part of the body. It may be considered in very severe cases.

There are a lot of different treatment options for acne scarring but this is a very diverse and complex skin condition. Remember, the best treatment for you will depend on your skin type, scar types, severity of scarring and skin goals. As always, consult with a doctor or skincare professional to discuss the most suitable treatment for your acne scars.

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Frequently asked questions

While not all acne scars can be prevented, reducing the incidence of acne breakouts and not picking or squeezing spots can help minimise the risk of scarring.

While some home remedies like yoghurt masks or skincare like Vitamin C tones/creams, arbutin, azelaic acid and exfoliating acids may help reduce the visibility of mild scars or post-inflammatory hyperpigmentation they are typically less effective for significant acne scars.

Some scars may fade over time, but many acne scars require treatment to improve significantly.

While it's challenging to remove acne scars entirely, various treatments can significantly reduce their appearance and improve skin texture.

Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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