Pimples and blemishes don’t always fade away to nothing, and, just as there are several kinds of acne, there are several types of acne scars that breakouts can leave behind.
Published: January 27, 2021
Last updated: February 16, 2021
Acne scarring occurs when pimples and breakouts do not heal properly. While many blemishes will disappear without a trace, acne breakouts-ranging from mild to severe-have the ability to leave behind pitted, raised, or discolored scars. Fortunately, there are a variety of both professional and at-home treatment options to smooth skin and lighten after marks for all skin types.
What are acne scars?
Anyone who has ever dealt with a pimple or breakout knows that there are often several stages to the healing process. Some blemishes turn into dark spots that slowly fade away, while others leave behind markings and indentations, not unlike the scarring caused by more traditional wounds. So, what’s the difference between the two?
For starters, one is temporary and the other is not. Acne marks-formally known as post-inflammatory hyperpigmentation (PIH) or post-inflammatory erythema (PIE)- refer to the pink, red, brown, or black spots people experience in the immediate aftermath of a breakout, but ultimately disappear.
Acne scars, on the other hand, involve actual damage to the skin. Deep acne scars affect the underlying collagen and cause the fibrous tissue to heal improperly. As collagen production ramps up in an attempt to correct the damage, the repaired epidermis may not appear as soft or smooth as the previously healthy skin.
Similar to the way a bad cut on your arm might heal and leave behind a mark that is tougher, raised, indented, or a different hue than your normal skin color, scarring from acne can have the same impact.
Acne scars form after inflamed skin erupts into pimples (due to bacteria, excess oil, or dead skin cells clogging pores), and does not heal properly. When the acne lesions penetrate deep into the skin, they damage both the surface of the skin and the tissue beneath it. As the acne clears, the body tries to repair this damage. While minor breakouts (think: whiteheads and blackheads) tend to go away without a trace, more significant damage in the pores and follicle walls can lead to more severe acne lesions and, in turn, scarring.
During the healing process, the body produces new collagen-the protein component of connective tissue that gives support and structure to the skin. If the body produces too little or too much collagen, the skin will scar. In turn, that surplus or deficit of collagen determines the appearance and type of scar a person is left with. While acne scars are indeed a type of scar, there are special treatments that should be used for this specific scarring.
What are the main concerns related to acne scar issues?
According to the National Center for Biotechnology Information, approximately 650 million people around the globe are impacted by acne and 40 percent of those individuals deal with scarring. While the causes of acne range from hereditary predispositions to lifestyle factors, scarring is always a possibility and a lack of treatment can worsen the chance of scarring.
There are two main categories of acne scars caused either by a loss of or an excess of collagen:
- Atrophic Acne Scars (a.k.a. Depressed Acne Scars): Occur when the body produces an insufficient amount of collagen during the healing process, resulting in cave-like depressed scars on the surface of the skin.
- Hypertrophic Acne Scars (a.k.a. Raised Acne Scars): Occur when the body produces too much collagen during the healing process, resulting in protruding bumps.
Within those two general categories, there are four more specific types of acne scars:
- Boxcar Scars: Like chicken pox scarring, these atrophic depressions are typically round or oval with steep vertical sides.
- Icepick Scars: This type of atrophic scarring is characterized by long, thin, needle-like marks.
- Keloid Scars: More severe than a typical hypertrophic scar, these raised bumps can, in some cases, end up being larger than the original acne lesion.
- Rolling Scars: Not as sharply defined as boxcar scars, these atrophic markings give the appearance of wave-like depressions on the surface of the skin.
Each of these types of scars result in a different formation of scar tissue on the surface of the skin. Considering their formations can differ, it is important to know the type you have when seeking the best type of treatment.
Who may wish to seek an acne scar treatment?
Over-the-counter and at-home skin care treatments are available to help lessen the appearance of acne scars. Acne scars on those with darker skin pigmentation may not show as much as those with lighter skin, lessening the need to seek treatment.
If the scar tissue is visible and presents itself as a problem, it is probably best to start with skin-care products such as creams and gels. If those do not help with lessening the appearance of the scars then it most likely is time to seek a professional procedure.
How can someone treat acne scars?
Like all scarring, the ability to correct the appearance of acne scars depends on both the type and severity. Although acne scarring of any kind is permanent, there are both invasive and non-invasive treatment options that can work to minimize the skin indentations and abnormalities it causes. Be sure to consult a board-certified dermatologist regarding any potential side effects before pursuing any of the following treatments.
- Dermabrasion for Acne Scars: This procedure will scrape away the surface of the scar. New skin will be encouraged to grow within the area that once contained the scar. Atrophic scars that are deeper within the skin will be brought closer to its surface.
- Microneedling for Acne: Stimulates collagen production to help treat atrophic scars. A hand-rolled device is used to create small holes within the scar tissue, triggering the body’s natural healing process.
For Boxcar Scar:
- Dermal Fillers and Injectables: Hyaluronic acid-based dermal fillers will be injected into the depressed area in order to help raise the skin.
- Autologous Fat Transfer for Acne Scars: Used to treat atrophic scars, this procedure liposuctions fat from areas like the butt and thighs, which is then injected into the treated area. The patient will witness an increase in skin tone that will lift up the depressed scarred area.
- Chemical Peels for Acne Scars: With several types of facial masks available to rejuvenate the skin, chemical peels are the most favored for treating acne scars. These facial peels cause a deep exfoliation in the skin that helps new, fresh skin to surface in place of the scar tissue.
For Keloid Scars
- Laser Skin Resurfacing: Laser treatments include both ablative and non-ablative lasers to treat both atrophic and hypertrophic scarring. These lasers will remove the top layer of the skin, stimulating collagen production and improving cell turnover. Hybrid Fractional Lasers like Halo™ can also be utilized.
For Ice Pick Scars
- Punch Excision: The skin is punched in a circular fashion in order to remove a scar. A skin graft is then used to replace the area of the scar with new skin.
For Rolling Scars
- Subcision: A needle is placed under the depressed scar and it is moved back and forth to cut the fibrotic strands that cause the depression. Once the tension is released, the skin will begin to rise.
- Over-the-Counter Skincare: Products which contain anti-bacterial and anti-inflammatory ingredients can be incorporated into skincare routines in order to help with fading acne scars.
- Prescription Skincare: Topical treatments which can be subscribed to you by a dermatologist can help brighten the skin and assist in fading out dark marks caused by acne scars.
- Scar Creams and Gels: Products that come in the form of creams and gels can help to reduce discomfort when healing from wounds caused by acne and fight the formation of a scar. Any existing scars can also become flatter and have their appearance reduced.
Much like active acne, the impact of acne scars is both physical and emotional. It isn't simply a matter of vanity to seek treatment for acne-related scarring. Clearer skin has been shown to correlate with higher levels of self-esteem and confidence.
Addressing the scars and marks left behind by acne vulgaris with a dermatologist or plastic surgeon not only improves a person's current skin health, but also helps to prevent post-acne scarring in the future.
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- American Academy of Dermatology Association Scars: Diagnosis and Treatment aad.org