Acne Scar Treatments

What causes acne scarring?

Scars develop because the body is trying to repair the site of the acne spot. The degree of scarring is determined by the body’s level of response.

An acne scar can develop and take on the appearance of two main forms:

• Where there is a loss of tissue – causing an indentation or ‘pockmark’ in the surface of the skin.
• Where there is excessive scar tissue – raised above the surface of the skin.

Any area of the three main skin layers containing ‘sebaceous’ (oil producing) glands are prone to acne, especially the face, back and chest.

Scars are caused by inflammation when an acne spot expands and a breakdown occurs in its surrounding wall. The skin tries to repair the scar by forming new connective fibres known as collagen, which gives skin its structure and elasticity. However, collagen can stay permanently in place and cause acne scarring.

The scars created when acne spots are small are shallow and heal quickly. In other circumstances, the contents of a spot spill into the surrounding tissue and cause deeper scars.

Any type of acne spot can lead to scarring which is more common when nodules and cysts – which are solid, pus filled and extend deeper into the skin – are present.

Types of acne scars

In many cases a patient is often likely to have more than type of acne scar. To get rid of each type a dermatologist will need to assess, identify and treat acne scars, individually.

The main types of acne scars are:

Atrophic or ‘indentation’ scarring

Atrophic scars are often the result of severe acne that heals below the normal layers of the skin. When the skin is unable to create new collagen fibres, the type of acne scars that can form, are:

Ice pick scars – small deep holes

A type of acne scar that resembles an ice pick with a hole that’s wide at the top, which narrows to a point as it goes deeper into the skin.

This type of indentation scarring or pockmarking is one of the most common acne scar types, found mostly on the forehead and upper cheeks, where the skin is thinner. It’s also one of the most challenging of acne scars to treat.

Rolling scars – uneven skin

Acne scarring, typically where skin is thicker, on the lower cheeks and jaw. The indentations or ‘pockmarks’ have sloping edges that give the skin an undulating and uneven appearance.

Boxcar scars – craters in the skin

Boxcar scars, which commonly appear on the lower checks and jaw, account for around 20 to 30 per cent of atrophic scars. The pockmarks have sharper edges reaching deeper into the skin.

Hypertrophic or keloid scars

Acne scars, usually found on the chest, back and shoulders and jaw line, where uneven scar tissue stands proud of the skin. In this instance, the acne scarring is caused by an abnormally excessive growth of collagen tissue in an area of the skin, which can be itchy, tender or painful.

Hyperpigmentation

Dark spots on the skin, usually, red, brown or purple – are not true acne scars, but post-inflammatory hyperpigmentation. This is a condition where the area of skin areas affected by acne is dark, which is usually more noticeable with darker skin tones.

Grades of acne scarring

An assessment by a dermatologist to identify a patient’s type of acne scarring may also measure the severity on a grading scale of 1 -4, as follows:

Grade One: ‘Macular’ (blotchy and uneven) – an acne scar that’s red but flat.

Grade Two: ‘Mild’ – an acne scar that can easily be covered by makeup or facial hair.

Grade Three: ‘Moderate’ – acne scarring noticeable at a social distance, which is not easily covered by makeup or facial hair.

Grade Four: ‘Severe’ – acne scarring highly visible at a social distance greater than 50 centimetres (1.64 feet), and most unlikely that facial hair or makeup will completely cover up or hide.

Treatment for acne scars

In many cases, it’s impossible for patients with acne scarring to cover up prominent scars with facial hair or makeup to make less noticeable.

An initial consultation with a dermatologist to discuss acne treatment will also include a medical assessment of skin type, and how the acne scars may respond to a specific procedure.

Young adults may also be experiencing a current problem with active breakouts of acne, resulting in extra sensitive skin.

Over the counter treatments

There are a number of powerful, highly effective over the counter creams which dermatologists often recommend, including:

Alpha Hydroxy acids (AHAs)

These are a group of plant and animal-derived acids used in a variety of skincare products such as serums, toners, and creams, including:

• Citric acid (from citrus fruits)
• Glycolic acid (from sugar cane)
• Lactic acid (from lactose or other carbohydrates)

Most AHA creams are likely to to contain glycolic and lactic acid as they tend not to cause skin irritation, and are mainly used to exfoliate – remove dead skin cells. Other uses for related skin conditions include:

• Preventing active breakouts
• Lighten pigmentation and darker skin complexion
• Improve appearance of surface lines and wrinkles

Salicylic acid

Salicylic acid is a beta hydroxy acid, which is mostly used to treat mild acne such as, blackheads and whiteheads by removing the outer layer of the skin. When applied to the skin, salicylic acid aims to:

• Help the skin get rid of dead skin cells from the top layer
• Reduce redness, inflammation and swelling

It’s also used to treat acne itself as well as psoriasis and other related skin conditions.

Retinoids

Retinoids are a class of chemical compounds derived from Vitamin A and skincare serum peptides – short chains of amino acids which build specific proteins needed by the skin. Vitamin A can stimulate collagen and elastin regeneration of the skin surface cells.

Retinol is a ‘synthetic retinoids’ derivative of vitamin A. Small molecules go deep into the dermis (middle layer of skin) to help neutralise free radicals – that cause the break down of skin collagen – and boost the production of fresh tissue skin cells.

Medical research has proven that retinol is not only highly effective in treating acne by de-clogging pores, it also a powerful treatment used to:

• Reduce the appearance of acne scars
• Minimise hyperpigmentation (dark spots)
• Get rid of dead skin
• Act as an anti-inflammatory

Clinic treatment for acne scars

Dermatologists may sometimes prescribe at least one or more treatments, or repeat procedures, to obtain a noticeable improvement in an individual’s skin appearance. These can often include a resurfacing treatment which will need to be carried out by the dermatologist or skin care practitioner at their clinic or surgery.

A typical and popular skin resurfacing treatment is:

Chemical peels

This procedure uses salicylic acid or glycolic acid to remove the top layer of skin cells and stimulate the growth of new, skin tissue that’s smoother in appearance.

There are 3 types of chemical peel:

Superficial peels – skin cells are removed from the top layer of skin (epidermis).

The treatment is applied to the skin and left on for a few minutes, which is usually safe if carried out correctly. However, the effect is not permanent and will need to be repeated.

Medium peels – skin cells are removed from the top and middle layers of skin.

A burning or stinging sensation may be felt when applied and the skin may redden or look tanned for a few days afterwards. Further treatment will be needed every 6 to 12 months to maintain the effects.

Deeper peels – aimed at affecting the deeper layers of the skin, and not really suitable for darker skin tones.

Treatment is applied to the face and can be left on for 30 minutes or more. A local anaesthetic and sedative may be needed to numb any pain. Some peeling, redness and discomfort may be experienced for a few days or longer but has long-lasting effects so treatment does not usually need to be repeated.

After treatment – the skin will be more sensitive to the sun than usual. It is advised to apply a sunscreen for at least a month during recovery.

Microneedling

A procedure used in acne scar treatments involving a roller covered with fine needles to prick the skin and make tiny holes in its surface.

The aim of a microneedling treatment is to generate new collagen and skin tissue for a smoother, firmer, more toned skin.

Microneedling pinpricks are so small they are hardly visible or noticeable after treatment. The dermatologist moves the tool evenly across the skin to ensure regenerated skin will be even.

A topical anaesthetic to reduce any pain is given at the start, and minor redness and irritation may be experienced for a few days after treatment.

However, dermatologists consider microneedling a safe procedure for most people with good health. The procedure is likely to pose a risk to those individuals taking specific types of acne medications or for women during pregnancy.

Laser resurfacing

A treatment for acne scars which delivers heat to the scarred collagen on and under the skin surface. Laser treatment doesn’t completely remove acne scars but uses the body’s ‘wound-healing’ response to break up scar tissue. At the same time, new healthy skin cells are encouraged to grow and replace the scar tissue.

Individuals with active acne or a darker skin tone may not be suitable for laser resurfacing treatment.

There are two types of laser treatment used in treating acne scarring.

Ablative – Removes the top layer of skin which means more recovery time.

Non-ablative – Penetrates beneath the skin only to encourage new cell growth.

Typical laser treatments used by dermatologists include:

C02 laser resurfacing

A handheld device is used to direct ‘micro-wounds’ caused by the laser light to penetrate into deep layers of the skin, and encourage rapid cell removal and fresh connective skin tissue.

Normally takes between 30 – 60 minutes with no discomfort experienced at any time during treatment.

Common side effects are minor redness or swelling that normally fades within days of treatment.

First noticeable results can be seen around 10 days after treatment, and results can last for several months and even up to a year or more.

Fractional lasers

Laser beam divides into thousands of microscopic treatment areas to target a tiny fraction of the skin at a time. Tissue underneath the acne scars is stimulated to remove darkly pigmented cells beneath the top layer of skin.

Dermal Fillers

An acne scar treatment, in which dermal filler is injected into a scar indentation to create volume, and the skin is raised upward. Results are seen immediately after treatment.

Dermal fillers are made of hyaluronic acid, a clear, gel-like substance found naturally in some fluids and tissues in the body.

The function of hyaluronic acid is to stimulate the skin to produce more collagen, the main structural protein used to make new, connective skin tissue.

The hyaluronic acid also has a hydrating effect, which helps to improve the overall tone and texture of the skin.

Dermal filler can make a permanent improvement to a skin’s appearance despite not entirely getting rid of acne scars and acne scarring.

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