Acne Scars

Acne is a common skin condition that many of us encounter at some point in our lives. Most acne lesions heal without residual scarring, but unfortunately for some, permanent skin damage and scars can occur.

Inflamed lesions, such as papules, pustules, or cysts are the most common causes of acne scarring. Acne scars form when the inflammation damages the deeper layers of the skin. Although scarring is actually part of the body’s natural healing process, acne scars can cause significant emotional stress. Individuals who have severe cases of cystic acne are more prone to developing scars after the acne has gone away. Scarring can also occur for individuals that have mild cases of acne.

Picking at, or popping a pimple can injure the skin and lead to permanent skin damage. Scars can develop from small or large pimples. When it comes to acne scarring, early treatment is the best prevention.

Acne treatments are plentiful, and early treatment reduces the risk of scarring and other acne-related complications.

Acne scarring can take different forms:

Ice pick scars:
These are the most common and classic forms of acne scarring. They typically appear as deep pits or indentations on the surface of the skin of 1-2 mm in diameter. The scars are very narrow and look like small holes or large open pores in the skin. They commonly appear on the cheeks.

Boxcar scars:
They typically appear as angular scars that are sunken, with well-defined edges. They usually occur on the temples and cheeks. Boxcar scars may be either superficial or deep and measure more than 3 mm in diameter.

Rolling scars:
These scars generally have a wide and shallow depth and occur when bands of tissue are formed between the skin’s surface and the deeper structures underneath. The bands of tissue pull at the top layer of skin, causing the surface of the skin to have a rolling and “wave-like” appearance.

Hypertrophic/keloid scars:
These are raised, smooth scars often seen along the jaw line or upper chest and back.

Scarring usually occurs in cases of inflammatory acne. As the skin tries to heal itself, it can often create too much, or too little collagen in one spot, which results in an uneven texture of the skin.

Some individuals are at an increased risk of scars regardless of the severity of acne. Some patients will develop hypertrophic scars on the chest, shoulder and back with the minimal degree of acne.

Scars can also be result of excess irritation and damage caused by physical trauma such as squeezing or popping pimples.

Keeping the skin clean and clear during breakouts is essential for controlling and diminishing the effects of acne.

Consider a regimen that includes skin care products containing salicylic acid to help promote skin cell shedding and unclog pores, or a glucosamine complex to even out and brighten your skin tone. After cleansing, use an oil-free moisturizer to keep the skin adequately hydrated. Another way to prevent acne is to use cosmetics specially designed for acne-prone skin that are either oil-free or non-comedogenic.

Make sure your skincare products don’t contain isopropyl myristate, isopropyl esters, oleic acid, stearic acid, petrolatum and lanolin (especially acetylated lanolin, alcohols and lanolin fatty acids).

For severe or persistent cases of acne, the best course of action is to consult with a dermatologist to determine the right solution for your specific skin needs.

The most effective way to prevent acne scars is to not irritate the skin during an acne outbreak. Do not rupture whiteheads, blackheads or pimples Avoid astringents (containing alcohol) that may dry out and irritate the skin Let scabs run their course – do not pick or remove them. Use a non-greasy sunscreen when outdoors for extended periods of time.

OTC
Over-the-counter products containing active ingredients such as benzoyl peroxide, salicylic acid and alpha hydroxy acids are helpful in reducing infection and inflammation. Camouflaging creams may also be used to mask the appearance of acne scars.

Prescription
To prevent scarring, a doctor may inject a corticosteroid into a cyst to decrease inflammation and speed healing. A doctor may also prescribe a topical cream, such as tretinoin, adaplene or tazarotene, which encourage collagen production, thereby potentially improving the appearance of scarring.To prevent acne from developing, medications that contain ingredients such as retinoids are effective for unblocking the pores of oil glands. They are generally considered to be the first choice of treatment for whiteheads and blackheads. Your physician can choose the topical retinoids that is best suited to your needs.If you have severe acne, consult with a dermatologist to find out which treatment option may be best for you. Oral anti-inflammatories and antibacterials, as well as birth control pills may be used to treat acne.For cases of severe cystic acne, or acne that doesn’t respond well to other treatments, isotretinoin may be prescribed.

Procedures
Chemical peels (alpha hydroxy treatments) are an effective solution for minor, superficial scarring. They can improve overall skin tone and lustre; they tend to work best if you get a series of at least six peels, having one every 1-2 weeks.Resurfacing treatments can be performed through laser therapy or microdermabrasion.
Laser resurfacing involves removing the surface layer of the skin via heat injury. The healing process stimulates the production of collagen and removes some of the damaged/scarred outer skin tissue.
Non-ablatative therapies using for example, pulsed dye lasers, can also help fill in some shallow depressed scars.In most cases, punch grafting or punch elevation is also used for improved results. Punch elevation involves lifting the tissue instead of removing the scar. The tissue initially sits slightly higher than the surrounding skin, but retracts as it heals to become level with the remaining skin.