An In-depth Look Into Acne Scars: Causes And Treatment

A pimple or acne lesion occurs when the pores on your skin are inflamed by bacteria, oils, and dead skin. ¹ Acne breakouts are more or less inevitable with individuals aged 12-40, with over 85% of people from this demographic having them – making it the most common existing skin condition.²

Acne in adolescents is often caused by rapidly shifting hormones, while adults contract acne due to several factors, including; environment, periods, cosmetic products, stress, birth control pills, and hormones.¹

Causes of acne scars

An inflammatory lesion like a pustule, cyst, or papule is the most frequent cause of acne scars. Blemishes become inflamed when the follicle, or pore, fills up with too much oil, dead skin cells, and bacteria. The wall of the follicle breaks as a result of the pore swelling.

When the skin’s surface is in close proximity to the rupture, the lesion won’t typically be severe and would heal fast. More serious lesions develop when there is a significant rupture in the follicular wall. A healthy layer of skin is destroyed when the infectious substance leaks into the dermis.

When the dermis is damaged, the skin produces new collagen fibres to repair it. The fibrous protein called collagen allows the skin to retain its elasticity and strength. Unfortunately, skin restoration can never appear to be as polished and perfect as it once did before the damage.

The single best indicator of scar formation is inflammation. Scarring is more prone to happen when the skin is inflamed more severely. Long-lasting deep breakouts raise the likelihood of scarring as well.³

Types of scarring

Most people with acne on their face have a certain level of scarring, the severity of which varies depending on the acne grade. Infiltrates of inflammatory cells are present in almost 80 per cent of atrophic scars, which are the outcome of an abnormal tissue repair response to epidermal inflammation that causes acne scars. Acne severity varies depending on how differently distinct P. acnes phylotypes trigger the epidermis’ natural immunity.⁴ Here are the different types of acne scarring you may encounter:

Ice pick scarring: The shaft of an ice pick tool is wide and gets smaller toward the tip. This type of acne scarring is similar in that it starts as a large hole at the top and narrows to a point as it penetrates deeper into the skin, mimicking the tool’s shape. This indentation is typical and one of the hardest scars to heal. You’ll notice these scars in places your skin is thinner, including your forehead and top cheekbones.¹

Rolling scarring: The lower cheeks and jaw, where your skin is thicker, are where you’ll frequently see these scars. The skin appears uneven and wavy due to the sloping margins of the indentations caused by fibrosis.¹

Boxcar scarring: Indents with sharper edges are called boxcar scars. Those edges penetrate the flesh deeply and are found in the lower chest and jaw areas.1

Treatments

When treating acne scars, an algorithmic strategy should be used to treat each aspect of scarring. The most effective way to avoid or reduce acne-related scarring is to treat active acne as soon as it appears. In order to avoid initiating a loop where the active pimples continue to scar in regions that have already received treatment, it is crucial to be sure that it has been treated before beginning scar treatment.⁴

1. Home skincare

Sunscreen helps reduce the contrast between skin without scars and skin with scars. Additionally, some medicated lotions, such as those containing azelaic acids, could be beneficial.⁵

2. Laser resurfacing

This method is frequently used to treat indented scars. Do note that people with darker skin or a history of keloids are more likely to experience adverse effects from this procedure.⁵

3. Lactic acid

Studies have shown that lactic acid peels administered by dermatologists once every two weeks for three months improved the texture, look, and skin pigmentation and reduced acne scars.

Many serums, peels, and ointments contain lactic acid, but because apple cider vinegar naturally contains lactic acid, you may also use it as a spot treatment or a toner. However, apple cider and other DIY remedies may be too harsh for people with sensitive skin. Before beginning to use the product, they must be evaluated on a tiny patch of skin.

When a product is applied to sensitive skin, there is a chance that it can irritate and inflame the skin, which could result in post-inflammatory hyperpigmentation.⁶

4. Soft tissue fillers

The skin overlying indented scars can be made plumper by injecting collagen, fat, or other material under the skin. The idea is to hide the scars as much as possible by doing so. Repeated treatments are necessary to maintain the impact because the results are transient. Fortunately, skin colour changes are not likely to occur using this technique.⁶

5. Dermabrasion

One of the best and most popular treatments for acne scars is dermabrasion. Dermatologists employ instruments to more thoroughly exfoliate the outermost layer of skin than those who use at-home DIY microdermabrasion kits.⁶

6. Skin needling

This procedure aims to encourage the underlying tissue’s production of collagen by rolling a needle-studded tool over the skin. It is a simple, risk-free method that could reduce acne scarring, and the danger of skin discolouration is extremely low. However, you may require additional treatments because the results are mild.⁵

7. Surgery

Your doctor can remove targeted acne scars using a quick surgery called punch excision, then closing the wound with sutures or a skin transplant. They will use a procedure known as subcision to release the fibre under a scar by inserting needles under the skin.⁵

Conclusion

Even though acne scars are prevalent, they can still be embarrassing and annoying. Fortunately, with today’s brand-new technology and the wealth of knowledge we’ve accrued, you can access many treatments that will make them much less noticeable. While these scars are generally permanent, a good dermatologist can aid you in reducing their visibility seamlessly.

Angeline Yong Dermatology is an established dermatology clinic in Singapore dedicated to providing personalised solutions to all your dermatological needs. Contact us today to learn more.

References

Acne scars: Causes, diagnosis, types & treatment. Cleveland Clinic. (2020, June 23). Retrieved November 15, 2022, from https://my.clevelandclinic.org/health/diseases/21222-acne-scars

Masterson, K. N. (2018). Acne basics. Journal of the Dermatology Nurses’ Association, 10(1S). https://doi.org/10.1097/jdn.0000000000000361

Palmer, A. (2021, October 1). Causes of acne scars and how to prevent them. Verywell Health. Retrieved November 15, 2022, from https://www.verywellhealth.com/what-causes-acne-scars-15517

Connolly, D., Vu, H. L., Mariwalla, K., & Saedi, N. (2017). Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. The Journal of clinical and aesthetic dermatology, 10(9), 12–23.

Lawrence E. Gibson, M. D. (2022, October 25). Acne scars: What’s The best treatment? Mayo Clinic. Retrieved November 15, 2022, from https://www.mayoclinic.org/diseases-conditions/acne/expert-answers/acne-scars/faq-20058101

Ferreira, M. (2021, December 10). Acne scars: Treatment, removal, best, and more. Healthline. Retrieved November 15, 2022, from https://www.healthline.com/health/acne-scars

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An In-depth Look Into Acne Scars: Causes And Treatment