Acne scars are a common problem that can affect anyone who has experienced acne. These scars can be unsightly and impact one’s self-esteem, but with the right knowledge and treatment, they can be minimized or even eliminated altogether.
Acne scars can affect anyone who has suffered from acne. They affect mental health as well as the skin. Fortunately, there are many treatment options available, including creams, red light therapy, minimally invasive procedures, and surgery.
The Emotional Problem of Acne Scars
Acne scars can cause profound social anxiety. They can lead to shame, embarrassment, and low self-esteem. Anything that improves the skin health can also improve the patient’s physical and mental health.
An acne scar is a permanent disfigurement that developed during an acne episode. Severe acne is more likely to cause scarring, but mild acne is dangerous, too.
An acne scar causes texture and appearance changes to the skin. Depending on the type of scar, the skin can show pitting, depressions, and raised areas.
Acne scars can develop anywhere, but are most likely found on the face, neck, chest, and back.
Acne Scars Affect Most People with Severe Acne
There’s a 95% chance of scarring with acne. The more severe the acne, and the greater the duration, the more the chances go up that it will end in scars.
According to studies, 50% of people with moderate to severe acne, and 33% of people with mild acne, go on to develop scars.
Skin type and the person’s ethnicity do not affect the scores, but skin color does have a bearing on scarring. Darker skinned people are more likely to scar from acne.
What Happens if You Don’t Treat Acne Scars
Ignoring acne only raises the chance of acquiring scars. The more you get the acne under control, the lower the chance that you end up with scarring. Treat now for better results.
Plus that, scars can get worse over time. That means the social anxiety they cause gets worse, too.
Acne scars can worsen over time because the underlying collagen and tissue damage becomes more extensive and difficult to repair.
The longer a scar exists, the more resistant they become to treatment. Lasers, chemical peels, and microneedling do not work as well on older scars as the newer ones.
None of this would matter if the scars didn’t affect your sense of self. How do you feel in crowds and groups? Do you feel accepted? Or do you feel judged. If the acne and its scars are causing you distress, then delaying treatment only prolongs that anxiety.
Acne scars can be a source of embarrassment, shame, and social isolation.
Acne scar intervention and treatment can prevent further scarring. The earlier you start, the more optimized the outcome can be.
The Causes of Acne Scars
The types of acne that cause scars:
- the inflammatory process causes scarring in inflammatory acne
- the cyst entanglement and pulling cause scarring in non-inflammatory acne
Inflammatory Acne: How Pimples form Scars
Inflammatory acne is a common cause of acne scarring.
- cytokines and chemokines attack where collagen forms, creating scar tissue
- incomplete collagen causes atrophic and hypertrophic scars
- atrophic scars are depressed and pitted
- hypertrophic scars are thick and raised
Inflammatory acne occurs when hair follicles become clogged with oil and dead skin cells. The clogging leads to pimples.
The immune system attacks the invader causing the bumps as if it were a virus; instead, though, it’s just attacking its own face. Inflammation makes matters worse, something the immune system doesn’t understand.
The immune response releases inflammatory cytokines and chemokines. These immune cells attack collagen and form scar tissue.
Collagen is usually a desired outcome, but sometimes its production can cause scars. The body attempts to heal itself of the inflammatory damage it caused. It creates new collagen fibers. The inflammatory cycle interrupts the collagen formation. Instead of collagen, you get atrophic or hypertrophic scars.
An atrophic scar is a depression with a loss of tissue. This is how pits and depressions are made. A hypertrophic scar is the overproduction of collagen; hypertrophic scars are thick and raised off the skin.
Another scarring process comes from the inflammation’s damage to the skin’s blood vessels. The damage changes the skin’s texture and color.
Non-Inflammatory Acne: How Blackheads (and Whiteheads) form Scars
Non-inflammatory acne also causes scarring when oil and cells clog hair follicles:
- clogged hair follicles form blackheads and whiteheads (comedones)
- the comedones grow into cysts
- cysts damage tissue that scars
Non-inflammatory acne causes pigmentation deposits that look like scars:
- the non-inflammatory acne creates cysts that cause trauma
- the trauma causes melanocytes to deposit pigment that appears to stain the skin
Non-inflammatory acne includes the formation of blackheads and whiteheads. The acne process produces excess oil and causes dead skin cells to slough off the face.
The oil and cells clog hair cells, causing comedone (blackhead and whitehead) formation. These enlarge to cysts that traumatize the skin, leaving scars behind.
The cysts can also stretch the skin, which also causes trauma. That triggers inflammation, which then causes tissue damage and scarring. As with inflammatory acne, the trauma damages collagen formation. That damage leads to atrophic (depressed) and hypertrophic (raised) scars.
Non-inflammatory acne cysts can also trigger pigment deposits. These are not scars, but are disfiguration that acne leaves behind. The skin’s melanocytes to deposit pigment in the skin. The pigment can remain after the acne resolves.
Types of Acne Scars
Both the inflammatory and the non-inflammatory acne cause depressed pits (atrophic scars) and raised bumps (hypertrophic scars). Just the mechanism that leads to the trauma is different. These scars form when the collagen formation process fails to finish in a normal fashion.
Atrophic scars form when acne damages the skin’s collagen fibers. Atrophic scars are pits, indentations, or depressions. They are more likely to occur near papules, pustules, and cysts, which are the result of inflammatory acne.
Atrophic scars can range in size and severity. Smaller atrophic scars are shallow depressions. Larger scars are deep and jagged indentations.
Non-inflammatory acne causes atrophic scars when blackheads and whiteheads form into cysts. These stretch and traumatize the skin, damaging collagen fibers. Interrupted collagen formation can form pits and depressions.
Boxcar (Atrophic) Scars
A common subtype of atrophic scars is the boxcar variety. These are sharply defined and angular. Inflammatory acne featuring papules, pustules and cysts are most likely to cause boxcar scars. They have a wider edge than typical atrophic scars, giving them even more depth. They are usually found in the cheeks and temples.
Ice Pick (Atrophic) Scars
Ice pick scars are a type of atrophic acne scar that is characterized by a deep, narrow indentation in the skin’s surface. These scars are typically caused by severe, nodular or cystic acne lesions that penetrate deep into the skin. The skin loses elasticity where the scar forms, which allows the ice pick scar form into a narrow and deep indentation. Ice pick scars are also usually found on the cheeks and temples.
Hypertrophic scars are a different type of collagen fiber damage. A hypertrophic scar is raised above the skin’s surface.
Hypertrophic scars are most commonly associated with severe inflammatory acne, such as nodules and cysts. These types of acne lesions can cause significant damage to the skin’s collagen fibers. The immune system responds with scarring to heal the damage. The accumulation of scars tissue causes the scar to raise and thicken.
Hypertrophic scars can also develop as a result of trauma to the skin, such as picking or squeezing acne lesions. In some cases, individuals with a genetic predisposition to hypertrophic scarring may be more likely to develop these types of scars in response to acne or other types of skin injury.
Hypertrophic scars typically present as raised, red or pink lesions that can be firm or tender to the touch. They may be more common in certain areas of the body, such as the chest or back, where acne lesions may be more severe or difficult to treat.
Treatment Options for Acne Scars
Topical scar treatments include:
- retinoids (tretinoin, adapalene)
- alpha-hydroxy acids
- vitamin C
Gel or cream treatments include retinoids, alpha-hydroxy acids, and vitamin C. They work by supporting collagen production. They also encourage dead skin to slough off so that new skin can replace it. The collagen and new skin help to reduce the appearance of the scars. Vitamin C also reduces chronic inflammation.
Dermatological Scar Procedures
- Chemical peels
- Laser therapy
- Surgery (punch excision, subcision, skin grafting)
Chemical Peels for Acne Scars
Chemical peels can be an effective treatment option for reducing the appearance of acne scars.
A chemical peel involves the application of acid to exfoliate and peel away the outer layer of skin.
The process stimulates collagen formation, and improves texture. The result is a reduction in scar surface area.
Industry publications state that patient satisfaction with chemical peels for acne scar reduction is high. Most customers enjoy a significant improvement in their scar appearance.
Not everyone is a candidate, and there are side effects. These include redness, peeling, and pigmentation.
Microdermabrasion for Acne Scars
Microdermabrasion removes the top layer of skin to reduce the appearance of acne scars. It is non-invasive and is considered a cosmetic treatment. The reduction of skin stimulates cell growth and collagen production.
Microdermabrasion can reduce shallow acne marks, and pigmentation, but is less effective on deep acne scars.
Patient satisfaction with microdermabrasion for acne appearance is generally positive. Many patients report noticeable improvement in the texture and appearance of their skin, including a reduction in the appearance of acne scars. However, individual results may vary depending on the severity of the scars and other factors.
Microneedling for Acne Scars
Microneedling is a good procedure for reducing the appearance of acne scars.
Microneedling is a minimally invasive cosmetic procedure that involves using a device with tiny needles to puncture the skin. The needles stimulate natural healing processes. These promote collagen and elastin production.
Collagen and elastin are essential building blocks of healthy skin, and by increasing their production, microneedling can help repair and rebuild scarred skin.
In addition, microneedling can help open up pores, which can improve the absorption of topical medications.
According to patient satisfaction surveys, microneedling is generally well-tolerated. Patients report a high degree of satisfaction with the procedure for acne scar reduction. Patients report an improvement in the texture and tone of their skin, as well as a reduction in the appearance of acne scars.
Laser Therapy for Acne Scars
Laser therapy can be an effective treatment for reducing the appearance of acne scars.
Laser therapy delivers targeted light to create micro-channels in the skin. These channels stimulate collagen production. Collagen improves skin firmness and reduces scar appearance.
Ablative laser removes the outer layer of skin (epidermis) and heats the underlying skin (dermis)
Fractionated resurfacing laser is recommended for thick and bumpy scars.
Non-ablative lasers heat the water in scars, removing a thin layer of skin, and stimulating the production of new collagen.
Surgery for Acne Scars
- Punch excision and grafting
Punch excision is a minor surgical procedure useful for reducing the size and depth of boxcar and ice pick scars.
The dermatologist uses a circular blade to cut out the scars. He or she then stiches the area, or repairs it with a skin graft.
Patient satisfaction with punch excision for scar reduction appears to be generally positive, although more research is needed to establish its effectiveness. There is still a paucity of literature evaluating the technique’s effectiveness for improving acne scarring.
Subcision is the use of a sharp instrument to break apart firm scar tissue. The procedure separates the upper and underlying layers of tissue. This frees up the skin to move better, reducing trauma. The doctor makes sweeping motions with the knife to reduce adhesion between the layers.
Several studies have evaluated the efficacy of subcision in improving acne scars’ appearance. One study found that subcision combined with dermal filler injection improved the appearance of rolling acne scars by 50-75%.
Another study found that subcision alone led to a 50% improvement in the appearance of atrophic acne scars.
Patient satisfaction with subcision for scar reduction appears to be generally high. One study found that 90% of patients who underwent subcision reported a significant improvement in their acne scars’ appearance.
Photobiomodulation (Red Light Therapy) for Acne Scar Reduction
Photobiomodulation (PBM), also known as low-level light therapy, is a non-invasive treatment that uses light energy to promote healing and reduce inflammation in the skin.
PBM has been studied for its potential in treating various skin conditions, including acne scars. PBM devices emit light at specific wavelengths, typically in the red or near-infrared spectrum, and can be used in-office or at home with portable devices.
PBM stimulates the production of collagen and elastin. It also opens blood vessels, allowing oxygen and nutrition to help repair damaged skin.
PBM stimulates the production of biological batteries called adenosine triphosphate (ATP). The body uses the ATP molecules as energy carriers. Skin repair requires energy that ATP provides.
Several studies have investigated the use of PBM for acne scar reduction, with promising results.
One study found that PBM improved the appearance of acne scars by reducing redness, inflammation, and scar depth
Another study found that PBM combined with microdermabrasion improved the appearance of acne scars in a small group of patients.
Patient satisfaction with PBM for acne scar reduction appears to be positive, with some studies reporting high levels of satisfaction among patients.
One study found that PBM combined with microneedling resulted in significant improvement in acne scars, with 88% of patients reporting satisfaction with the treatment].
Another study found that PBM combined with fractional CO2 laser treatment resulted in significant improvement in acne scars, with high patient satisfaction rates.
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