It is not uncommon for people to struggle with acne well into their adult years. Acne damages your skin cells. The effort to repair these skin cells doesn’t always return your skin to its exact former state. Deep depressions or scar tissue can remain once your acne is healed. Learn more about how to prevent acne scars.
Even those individuals who are lucky enough to experience a dramatic decline in acne related symptoms over time may still be left with acne scarring, which can give the skin an irregular appearance.
What Are Acne Scars?
An example of acne scarring (Source: Medical News Today)
Acne scarring is the direct result of deep trauma to the skin related to acne. External factors, such as picking, can traumatize even small acne lesions and result in scarring. Acne scars manifest as areas of pitted or raised skin and can occur on the face or body. Not to be confused with post acne erythema (redness) or hyperpigmentation (brown spots) which are flat, temporary changes related to inflammation that tend to resolve over time, acne scarring changes the overall texture of the skin and does not always improve with time.
Acne scars result from the body’s natural attempt to heal itself. Skin pores that become clogged with dead skin cells slowly fill with excess oil and can allow bacteria to grow. These pores (or follicles) can become engorged resulting in acne lesions (i.e. whiteheads or blackheads). When these lesions rupture, the material spilling out into the skin is irritating and cause inflammation which presents as redness, tenderness and sometimes thick white fluid that can be expressed from the acne lesion. To repair this issue, the skin will naturally form new collagen fibers. Raised acne scars occur when the skin overproduces collagen, while pitted acne scars result when not enough collagen is produced.
What Causes Acne Scars?
When your pores become clogged with oil, dead skin cells, or other impurities, your body has an inflammatory reaction which results in acne. When acne is close to the skin’s surface it often heals with minimal damage to the skin. Acne which damages the deeper layers of the skin more often results in scarring.
Acne scars are formed by an imperfect healing process. As the body seeks to repair itself, it produces new skin cells. When the body produces too many, a raised scar is formed. When the body produces too few skin cells, an indentation is left behind.
What Type of Acne Typically Causes Scarring?
There are many different types of acne, some of which are more prone to scarring than others. Whiteheads and blackheads rarely result in scarring. Inflammatory acne, such as acne cysts or nodules, is most likely to create long-term scarring as this type of acne affects deeper layers of the skin.
Common Types of Acne Scars
Types of acne scars (Source: Odylique.com)
Keloid Scars: A keloid scar is a raised scar resulting from an over-zealous response to acne. An excessive buildup of collagen and skin tissue leaves a ridge or bump. Keloid scars are sometimes painful to the touch or itchy. Normally, keloid scars are found on the back, shoulders, or jawline.
Atrophic Scars: Atrophic scars are depressions in the skin resulting from the production of too little skin tissue during the healing response. Atrophic or depressed scars are of several varieties:
- Ice Pick Scars appear as triangular shaped chisels in the skin. These common scars are often found in areas where the skin is thin, such as the forehead or upper cheeks.
- Boxcar Scars are deep indents with clearly defined edges. Boxcar scars are commonly found on the lower cheeks and jawline.
- Rolling Scars are typically present where skin is thicker, such as the cheeks. These acne scars have sloped edges, and make skin appear wavy or unevenly textured.
If you’re prone to acne scarring, you most likely have a mix of several types of scars. It’s rare for someone to present with just one type.
Why Do I Have Acne Scars?
If you have acne scars, you’re not the only one. Of the 80% of people under the age of 30 with acne, 20% of them will scar. Whether or not you fall into this category depends on several factors, many of which are unavoidable:
Genetics: Some people are more prone to scarring than others. Not only from acne, but from all types of skin damage. If you have a family history of scarring, or acne scarring, you may want to prioritize acne prevention.
Gender: Although both men and women deal with acne, scarring is more common in men. Androgen hormones, which are more prevalent in men, tend to make acne more severe and persistent, two additional factors which lead to acne scarring.
Acne Severity: The deeper and more inflamed your acne, the more likely it will result in scarring.
Acne Persistence: The more often you have breakouts, the more your risk for scarring increases.
Puberty: Teenagers are more prone to acne thanks to hormonal fluctuations. More acne and more frequent breakouts lead to a greater chance of scarring.
Sun Exposure: While sun exposure won’t necessarily cause more scarring, it potentially makes scarring more visible. Scars darken at a faster rate than the surrounding skin, sometimes permanently.
Lack of Treatment: The longer you wait to treat your acne, the greater your risk of scarring. If frequent face washing or over-the-counter medications aren’t helping you, consider seeing a dermatologist.
Picking and Touching: Picking at acne causes trauma to the skin that is more likely to result in scarring and prolong the healing process. Some people are not aware that they are picking at their skin.
Acne Scarring vs Hyperpigmentation
Close up image of skin comparing acne scars (left) with hyperpigmentation (right)
Hyperpigmentation may also result from acne, but this discoloration is not considered a true scar. Hyperpigmentation refers to the dark spots that are left behind when broken blood vessels fail to perfectly heal.
Hyperpigmentation most often happens when pimples are popped, leaving behind a wound that changes the skin’s texture and color. Dark brown or red spots may appear even if you don’t pop your acne, although in these cases, the hyperpigmentation is more likely to fade after just a few months.
How to Prevent Acne Scars
Acne scars are primarily prevented via the prevention of acne. Once you have acne, how and when you treat it also matters.
Minimizing Excess Oil
Acne is the result of excess oil, dead skin cells, bacteria, and other environmental impurities becoming trapped in your pores. To minimize this build-up, practice the following:
- Keep your hands and face as clean as possible
- Choose a face wash specifically formulated for oily skin
- Choose moisturizers that are free of oil, or non-comedogenic
- Use a gentle exfoliant once weekly
Early Acne Treatment
Because scarring occurs more frequently in severe acne, it’s important to treat your breakouts in the early stages. Practice the following to reduce acne-related inflammation before it gets worse:
- Follow the above advice on daily washing and weekly exfoliating
- Choose products containing acne-fighting ingredients such as benzoyl peroxide or salicylic acid
- Use spot-treatments as needed at the first sign of a breakout
Never Pop Your Pimples!
Finally, if you do have a severe breakout, just be patient. While nobody wants to wait out a pimple, it’s the best way to avoid scarring. Squeezing, popping, or picking at acne increases your risk of scarring in two ways:
- Bacteria and impurities get pushed deeper into the pore
- The surrounding skin cells experience more trauma
Keep your future face in mind when tempted to pop your pimples! It’s no fun living with acne, but it’s short lived while scars are long term. For more information on how to avoid future scarring via acne prevention or treatment, contact your dermatologist.
How Can I Treat My Acne Scars?
Acne scars can affect one’s self-esteem, confidence, and overall quality of life. The best first step is to treat any active acne lesions to prevent future scarring. However if you are already left with scarring, there are many effective treatments that can improve skin texture and reduce acne scarring.
Depending on the type and severity of the scarring, effective treatments to consider include:
- Chemical Peels: An acid-based solution is applied topically to either the entire face or just in areas of pitted scarring to remove the outer layer of skin and stimulate collagen repair. Multiple sessions are necessary to optimize results. A series of chemical peels can leave the skin looking smoother and less scarred in appearance, as well as improve skin discoloration.
- Dermal Fillers: Injectable hyaluronic acid (a natural sugar molecule that absorbs water and acts similar to a moisturizer), such as Belotero, Juvederm or Restylane, can be injected into depressions in the skin from acne scarring to help smooth out the skin texture. Dermal fillers are temporary and often need multiple sessions to maximize scar repair.
- Laser Resurfacing: A fractional laser delivers pixelated columns of laser heat in a controlled and predictable manner to either heat the skin (Fraxel Re:Store) or remove the skin (Fraxel Re:Pair or Active/Deep FX) to elicit scar remodeling. The number of recommended treatment and the amount of downtime involved with these lasers varies. It is best to ask an expert about which laser would best fit your needs and lifestyle.
A consult with a board-certified cosmetic dermatologist will help determine how to customize these options for your acne scarring.