Acne breakouts can be frustrating, and they can also leave scars on the face and other areas of the body. Those tiny little pimples on your face, chest, back, neck, etc. which are painful at times end up leaving scars especially when they are rubbed by some hard scrub or mistakenly been burst by hands.  Some people find that acne scars are an unwanted reminder of a painful and bothersome condition.

Types of Acne Scars.

  • Ice-pick scars – these are deep, narrow, pitted scars
  • Rolling scars – broad depressions with a sloping edge
  • Boxcar scars – broad depressions with sharply defined edges
  • Atrophic scars – flat, thin scars or depressed scars (anetoderma)
  • Hypertrophic or keloid scars – thick lumpy scars.

Causes of Acne Scars

  • Not everyone who develops pimples develops scars. Scarring is thus an individual’s tendency. Even among siblings, both may develop pimples yet only one of them may develop scars. 
  • Acne scars are usually the result of inflamed blemishes caused by skin pores engorged with excess oil, dead skin cells and bacteria. The pore swells, causing a break in the follicle wall. Shallow lesions are usually minor and heal quickly. But if there is a deep break in the wall of the pore, infected material can spill out into surrounding tissue, creating deeper lesions. The skin attempts to repair these lesions by forming new collagen fibers. These repairs usually aren’t as smooth and flawless as the original skin.
  • When acne forms on your skin, your body’s natural healing processes kick in just like they would for an injury or illness. The problem is that’s not always a perfect system. Acne forms when your skin pores get clogged with too much oil and dead skin cells. Sometimes, it appears close to the surface of the skin – which means it will probably heal after a short time with minimal scarring. When acne is rooted farther down in the skin, though, it takes longer to heal. Because this runs deeper and destroys more of your skin tissue, it often leaves scars.
  • After a breakout, your body will try to heal itself by replacing the lost skin tissue that has been destroyed. Scarring occurs when the body produces either too much or too little of this tissue. When the body creates too much tissue, the acne lesion becomes a raised scar – known as a hypertrophic scar (or, in severe cases, a keloid). On the other hand, a lack of tissue results in skin depressions – known as atrophic scars.
  • Those dark marks you sometimes get after a bad outbreak are a different type of scar. Technically, they’re not scars at all, just changes in pigmentation (a technical term for skin color). When a lesion gets popped or opened up some other way, the skin has to close back together and cover up the depression. Your body is usually pretty good at healing itself, but after a particularly deep trauma – like a pit from a popped acne lesion – the body doesn’t always cover up seamlessly. Often, the skin that closes over the wound changes color, texture, or tone. In other cases, the broken blood vessels from a popped lesion leave a mark on your skin. These are what we usually call “dark marks” or hyperpigmentation.

How to identify Acne Scars

  • Depressed scars usually form on the face. A dermatologist may refer to these scars as “atrophic” (a-tro-fic) scars or use the name of the specific depressed scar:
    • Boxcar
    • Icepick
    • Rolling
  • Raised: These acne scars are more common on the back and chest. The medical term for a raised scar is “hypertrophic.”

Who are more likely to have Acne Scars?

  • Both men and women are equally prone to getting an acne scar. Sadly, even when you practice the hands-off policy, you can still sometimes get scars. Here are some factors that play a role in whether or not you’ll develop lasting marks after a bad breakout:
    • Factor 1: Genetics: For some people, scarring is simply in the genes. If your family has a history of acne scars, you may want to be extra careful about taking care of your skin.
    • Factor 2: Sun exposure: The Vitamin D in sunlight is great for your face – just don’t get too much of it. While intense sun exposure may not directly cause scarring, it definitely plays a role in making your acne marks darker and more noticeable.
    • Factor 3: Puberty: Big surprise, right? Someday we’ll discover puberty is actually good for something. In the meantime, it seems to cause more trouble than it’s worth. Case in point: teenagers tend to develop more acne because of all the hormonal changes taking place in their bodies. And more acne means a higher risk of scarring.
    • Factor 4: Acne severity: As you might expect, scarring is directly tied to severity. When acne is more inflamed, more widespread, and more deeply rooted in the skin, scarring is much more likely to occur.
    • Factor 5: Acne frequency: Similarly, patients who experience frequent breakouts run a higher risk of scarring.
    • Factor 6: Gender: Both men and women can develop acne scarring – it just seems to be more prominent among men. That’s because, in general, men tend to develop acne that’s severer and more persistent – due to androgen (the male hormone). 
    • Factor 7: Time: The sooner, the better! Turns out the longer you wait before getting treatment, the higher your risk of developing scars. So if just washing your face and keeping your hands off isn’t doing the trick, it may be time to see a dermatologist and get some help.

How can acne scars be treated:

  • Acne Scar Surgery – 
    • This sounds scarier than it is. Dermatologists often perform this minor surgery to treat very noticeable acne scars. The goal is to create a less-noticeable scar. The remaining scar should fade with time. To perform acne scar surgery, a dermatologist may lift the scar. Bringing a scar closer to the surface of the skin tends to make it less noticeable. Another type of acne scar surgery involves breaking up scar tissue. A dermatologist or dermatologic surgeon can safely perform acne scar surgery in a medical office. Patients remain awake but numb so that they do not feel pain. 
    • Best for: Treating a few depressed scars.
  • Resurfacing procedures-
    • When a patient wants to diminish the appearance of widespread acne scarring, a dermatologist may recommend a resurfacing procedure. Resurfacing removes layers of skin, which allows the body to produce new skin cells. Dermatologists use the following resurfacing procedures to treat depressed acne scars: 
      • Laser skin resurfacing
      • Chemical peeling
      • Dermabrasion 
      • Microdermabrasion (differs from kits bought for at-home use)
    • Resurfacing works well for treating acne scars that are nearly flat (not too deep). Even dermabrasion, which removes the top layers of skin and some of the middle layers, cannot effectively treat deep acne scars.
    • Best for: Depressed acne scars that are not deep. Useful for contouring scar edges to make scars less noticeable. Deep scars often require skin surgery and resurfacing. 
  • Fillers
    • Dermatologists use fillers to safely and effectively plump depressed acne scars. A dermatologist may fill acne scars with collagen, the patient’s own fat, or another substance. Many fillers give us temporary results, which last between 6 and 18 months. Some fillers are permanent.
    • Both temporary and permanent fillers have unique pros and cons. If this is a treatment option for you, be sure to ask your dermatologist about the pros and cons of the recommended filler.
    • Best for: Treating a few depressed scars, but not icepick scars.
  • Skin tightening
    • This is a newer treatment and tends to be more affordable. This treatment is safe for all skin colors.
    • Dermatologists often use a technology called radiofrequency to tighten the skin. As the skin tightens, depressed acne scars become less noticeable. 
    • Radiofrequency requires repeat appointments. Most patients return once a month for four months. After a radiofrequency treatment, many patients say they feel a burning sensation for about one hour and their skin has a pinkish color for two to three days. 
    • Radiofrequency treatments require some at-home care. For at least one week after each treatment, you will need to apply sunscreen every morning and a moisturizing cream at night. Dermatologists recommend wearing a sunscreen that offers UVA/UVB protection, an SPF of 30 or greater, and water resistance.
    • Best for: Depressed acne scars. Sometimes, skin tightening effectively treats deep icepick and boxcar scars. 
  • Collagen-induction therapy
    • Also known as “needling” or “micro-needling,” this treatment encourages your body to make more collagen. 
    • To perform this procedure, a dermatologist moves a sterile, handheld needle-studded roller across the depressed acne scars. This punctures your skin. As your skin heals, it produces collagen.  nine months. Most people, however, notice gradual changes over a few months. Many patients require between three and six treatments and return every four to six weeks for a treatment. 
    • After each treatment, you may have some swelling and possibly bruising. These side effects usually clear within four to five days.
    • You will need to follow a skin care plan while undergoing treatment. 
    • Research shows that this is a safe treatment for people of all skin colors.
    • Best for: Widespread depressed acne scars. Not a treatment for raised acne scars, which form when the body produces too much collagen. 
  • Electrodesiccation
    • This treatment uses electric probes to heat the tissue, which causes the tissue to die. This treatment may be part of a treatment plan for boxcar acne scars. Electrodesiccation by itself is not an effective treatment for acne scars.
    • Best for: Shaping or reducing the edges of boxcar scars.
  • Injections
  • PRP (Platelet Rich Plasma) of GFC (Growth Factor Concentrate) injections can be used in the treatment of acne scars. These injections abound in growth factors which can help in new collagen formation and reduce the depth of scars. PRP is done in various sessions. Typically a 4 session regimen is followed (month 1, month 2, month 3, and month 6). PRP can be combined with various other procedures like fractional CO2 laser, micro needling, subcision, etc.
  • Many patients receive injections of corticosteroids. A chemotherapy medicine known as fluorouracil (5-FU) can also be effective in treating raised acne scars. Some scars respond best when injections of both 5-FU and corticosteroids are used.
  • Interferon, which is also used to treat cancer, can be effective. Our bodies naturally produce interferon.
  • If the scar does not respond (or stops responding) after you receive the 4th injection, acne scar surgery may be recommended.
  • Best for: Painful, raised scars
  • Laser therapy
    • Lasers and other light treatments can treat raised scars safely and effectively. Treatment with a pulsed dye laser (PDL) can help reduce the itch and pain, diminish color, and flatten a raised scar. For people with lighter skin, intense pulsed light (IPL) also may be a treatment option.
    • Fractional CO2 laser is one of the most effective therapies for treatment of acen scars. Since this is a powerful therapy, a downtime for 5-7 days is expected after the procedure. Thus this procedure must be planned when there are no important social commitments in the near future.
    • eExcimer laser – This is a laser therapy for those patients who do not want a long downtime. The flip side is that it is not very effective. Typically the result obtained by 4-5 sessions of excimer laser is equivalent to 1 session of CO2 laser. The plus point is that the person can resume activities as early as 48 hours after the procedures.
    • Best for: All types of acne scars
  • Cryosurgery
    • This treatment freezes the scar tissue. Freezing the tissue causes it to die and gradually fall off. To improve the results, dermatologists recommend a series of cryotherapy sessions and corticosteroid injections. This combination often produces better results. The main drawback is that cryotherapy can cause permanent light spots to form on the treated skin.  
    • Best for: It can effectively diminish raised scars in people who have lighter skin. However, cryosurgery is not recommended for people who have the skin of color.
  • Blunt blade subcision – This is a new procedure that was pioneered at Derma Circles. The conventional subcision uses sharp needles which causes intense pain and has high chances of bruising. At Derma Circles we have developed a special instrument which is a blunt blade. This instrument avoids both of these side effects and is able to achieve a good result.
  • Scar creams, gels, and silicone dressings
    • Often available without a prescription, these products can be used at home to treat raised scars. They can help reduce the itch and discomfort as well as shrink, flatten, and fade raised scars.
    • Silicone dressings and bandages can be especially helpful. Although no one knows exactly how these work, one possibility is that silicone helps hydrate the skin. This may reduce the itch and pain as well as make the skin more flexible.
    • To be effective, these products must be used continuously. This can be difficult, especially for scars on the face. Many people are willing to do this because these treatments have little risk of side effects. Even so, with continuous use, some people develop itchy, irritated skin. This usually clears when the person stops using the product.
    • Best for: Reducing scar size and discomfort. None is likely to eliminate a raised scar.
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