Once your acne has cleared you may be left with unsightly marks and scars on your skin which can remain for months, years, or even permanently. For this reason acne marks and scars can be just as upsetting to the acne sufferer as the acne itself. But before you despair there are lots of treatment options available to get rid of both acne marks and scars.
The mark left on the skin from an inflamed acne lesion is a macule or a “pseudo scar” which is a flat, reddish spot on white skin, and brown, black, gray, blue, or even blue-black on skin of color. This form of hyperpigmentation it is not raised or sunken. This mark indicates that the inflamed acne lesion is in its final stage. A mark like this can remain on the skin anywhere from a few weeks to six months or longer depending on how deep the damage extends into the layers of the skin. For more information about post-inflammatory hyperpigmentation and how to treat it please see my previous post Help for Hyperpigmentation.
Though post-inflammatory hyperpigmentation is unsightly and may take many months to heal, acne scars are a more troubling reminder of past acne lesions since they simply do not fade or heal with the passing of time. Scars are reminders of injury to tissue and the body’s attempt to repair that injury. There are two main types of acne scars: hypertrophic and atrophic. Both are formed in the same way – inflamed lesions destroy a portion of the dermis and along with the collagen in that area. There is no way to predict who will scar, how deep the scars will be, and if they will improve over time. Most frequently scars result from severe inflammatory cystic, nodular acne. Though by no means a perfect solution, one way to prevent scars or to ensure that they aren’t very severe is to treat acne as early as possible and for as long as necessary. The faster you respond to the inflammation in the skin the more likely you are to prevent scars. Though this, of course, is no guarantee that scars will not develop it is a way to perhaps help ensure they will not be deep scars.
Hypertrophic scars are created when the skin responds to injury by overproducing new collagen. This type of scar is also called a keloid scar. The excess amount of collagen that forms gets piled up in fibrous masses thus resulting in protruding, firm, and smooth scars. Typically these scars are 1 to 2 millimeters in diameter, but some may be much larger – 1 centimeter or more. Keloids can be red or purplish in color and most significantly, keloids extend above the skin’s surface. This type of scar can hurt, be itchy, and even become infected. There is a genetic connection when it comes to the formation of keloids with such a condition running in families, and the cause of this type of scar is not completely understood. Unfortunately, once keloids develop they can grow both uncontrollably and unpredictably and even recur after treatment. Keloids can be treated with localized injections of corticosteroid or interferon. Laser treatments can be combined with steroid treatment in order to avoid a recurrence of scars. Cryotherapy, the freezing of keloidal scars, can also be combined with steroid injections as a removal option. There are also a few unproven therapies that might help keloids like using silicone sheets applied directly to the scar or applying creams such as Mederma and Aldara. Sadly keloids remain difficult to treat and, as already mentioned, may even return after treatment.
Atrophic scars are caused when the damaged collagen only partially, or not at all, grows back. This leaves a depressed area in the skin. The website skincarephysicians.com/acnenet lists five different types of atrophic scars that can occur because of acne:
- Ice pick scars that usually occur on the cheeks. They are usually small and can be either shallow or deep, dark or soft to the touch.
- Depressed fibrotic scars that are usually quite large and have sharp edges and steep sides.
- Soft scars which are usually small and circular in shape. They can be either superficial or deep and are soft to the touch.
- Atrophic macules are soft and often have a slightly wrinkled base. They are small when they are on the face but can be a centimeter or larger on the body.
- Follicular macular atrophy usually occurs on the chest or back. These scars are small, soft, and white.
Atrophic acne scars cannot really be completely eliminated but with both resurfacing treatment and fillers they can be improved about 80%. By seeing how a scar reacts to gentle stretching you can get a rough idea of what type of treatment would be best for you. Shallow or soft-sided scars will almost or totally disappear when the skin is pulled taut; these types of scars can be corrected with resurfacing and fillers. Scars that cannot be stretched out when you pull the skin generally require surgical excision to correct.
Numerous treatments exist for atrophic scars. They include: excision, dermabrasion, chemical peels, laser treatments, skin fillers, and implants. Very briefly I will describe each of these procedures:
- Excision is used for ice pick scars and is done with a small surgical instrument whose size matches that of the scar being treated. The entire scar area is punched out with the instrument. There are variations on this technique, and it is combined with dermabrasion and laser treatment for the best result.
- Dermabrasion is performed by doctor who uses a motorized tool with a metal head or a wire brush to remove the epidermis and the papillary layer of the skin. Though tissue damage occurs it initiates a healing process by which new collagen is formed. Though this is a very effective treatment for scars problems though pigmentation problems can develop even when the procedure is done properly.
- Light chemical peels work by removing dead skin cells and promoting the production of collagen. You need between four to eight light peels in order to see results. Doctors can perform deep chemical peels that usually remove part of the epidermis. This leads to collagen remodeling and renewal of the epidermis. Trichloroacetic acid (TCA) is usually used for the deep peels, in concentrations of 20 to 70%.
- Two types of laser treatments exist: ablative and nonablative. Ablative lasers destroy tissue while nonablative target only a specific area and not do destroy tissue. In both cases the regeneration of the epidermis occurs.
- Skin fillers plump or elevate the area of the skin that is sunken. Fillers fall into two main categories: biodegradable or permanent. Biodegradable fillers are made from either human or animal tissues. The body metabolizes these substances eventually and then most, if not all, of the benefits are lost. The rate at which this metabolism occurs depends on the substance used and the individual’s unique characteristics. There are both cow and human collagen fillers as well as hyaluronic acid fillers available. Also fat from another area in the patient’s body can be injected into the face. Permanent fillers are usually made from silicone and are supposed to stay in place pretty much permanently (as their name indicates), but silicone fillers are surrounded by controversy because of their link to autoimmune diseases and allergic reactions that can occur from their use.
- Implants are the least commonly used technique to correct acne scars. These are skin grafts that use skin from another area of the patient’s body. This graft is implanted in the dermis beneath the acne scar. Additionally, Synthetic implants made from polymers can be implanted beneath acne scars.
There are numerous treatments available that can significantly improve the look of acne marks and scars so there is no need to be unhappy with your appearance if you have post-inflammatory hyperpigmentation or acne scars (or both). In order to find out what your best treatment option is it is important to talk to a qualified medical specialist.
Sources and Further Reading
- AcneNet – Acne Scars American Academy of Dermatology
- Breaking Out: A Women’s Guide to Coping with Acne at Any Age by Lydia Preston – chapter 13
- Dr. Susan Taylor’s Rx for Brown Skin: Your Prescription for Flawless Skin, Hair, and Nails by Dr. Susan Taylor – chapter 11
- Healing Adult Acne: Your Guide to Clear Skin And Self-confidence by Dr. Richard Fried – chapter four
- Acne Scars Can Be Solved – Daily Beauty