Health Tips

Scarring is one the most common consequences of acne. It’s one thing to carry the inflamed, red and prominent pimple on your face and have it disappear in a week's time; it’s another thing to leave an acne scar on your beautiful face for many years. Many individuals with acne scars usually cover them up with cosmetic products, which can clog up skin pores and further aggravate acne development , resulting in more skin issues.

How does acne scars come about?

Our skin consists of epidermis and dermis. The dermis is made up of connective tissues and has the following components.

Image credit: https://quizlet.com/122328067/class-4-connective-tissue-flash-cards/

Acne scarring is a result of an altered wound healing response to the skin’s inflammation, which leads to an imbalance in the extracellular matrix degradation and synthesis of collagen. 

In other words, scars are formed when a breakout penetrates the skin deeply and damages the connective tissues beneath it. The skin is unable to regenerate itself exactly the way it was, hence the wound is replaced with granulation tissue made up of collagen fibres. These fibres fill the wound from the inside out and help to heal the damaged area of skin.

Don’t want acne scar? Don’t squeeze them.

You sure don’t like it when someone gives you too much pressure. Well, your acne feels the same way too! To avoid acne scar, avoid squeezing your acne with your fingers or other tools. When you squeeze acne too hard, especially on those that have not yet fully formed, you can damage the fine veins, glands and tissues that surround them. This can make the symptoms of acne worse and increase the risk of scarring.

Why not all acne results in scarring?

You may already have observed that not everyone who has acne also develops long-lasting acne scars. Scientists found that inflammatory acne is more likely to develop scars than non-inflammatory acne, although not all patients develop scarring. The reasons behind this are not clear. 

Types of acne scars

Before you try to treat your acne scars, it’s important to know what type they are. Each type responds to treatment differently, and some treatments are better for particular types than others. 

You may have more than one type of scar:

Atrophic scars

This is the most common type of acne scar. It is caused by the destruction and loss of collagen fibres in the skin’s dermis layer and followed by skin contraction, which leads to an indented appearance. 

It can further be classified into:

Ice pick scars

Image credit from: https://www.olivaclinic.com/blog/ice-pick-scars-treatments/

Boxcar scars

Image credit from: https://www.healthline.com/health/boxcar-scars

Rolling scars

Image credit from https://slmdskincare.com/blogs/learn/the-5-kinds-of-acne-scars-how-to-treat-each-type

Hypertrophic scars and keloids

Hypertrophic scars and keloids are easy to recognise -- they are characterized by a firm, raised elevations in the skin or scar tissues. Hypertrophic scars do not extend beyond the margin of the original wound. In contrast, keloids extend beyond the margin of the original wound. 

Treatment of acne scars

Unfortunately, there is no single treatment that can completely remove acne scars. Nevertheless, a multimodality approach can reduce the acne scars significantly and make it less noticeable. There are various treatment options available for acne scars and the right choice depends on the type, size and nature of your acne scars. Before you start any treatment of acne scars, make sure you see a dermatologist first. 

The available treatment options for acne scars can be classified into at-home treatment, which you may carry out on your own after consulting a healthcare provider, and in-office procedures, which require an expertise from a specialist. 

Topical retinoids

Topical retinoids are commonly used for acne treatment with additional scar-smoothing benefits. In a scientific review, topical retinoids (0.3% adapalene) have been shown to reduce scarring and pigmentation problems on skin. This is likely due to the topical retinoid’s action on the human’s gene for producing collagen. A common example of topical retinoids is adapalene, which goes by the brand name of Differin® and Deriva®. These products are available in various concentrations of adapalene, always check with your pharmacist the appropriate concentration indicated for your skin condition before buying them. 

However, bear in mind that using topical retinoids may increase your skin’s sensitivity towards sunlight. Always remember to wear sunscreen daily during topical retinoids treatment. Only apply your topical retinoids at night. 

Salicylic acid

Salicylic acid is a widely common component in many acne products, including face wash and creams for acne blemishes. It is the staple medication for acne treatment. In addition, salicylic acid is also one of the best peeling agents for the treatment of acne scars. However, it may bring about side effects such as skin dryness, redness and tingling sensation. You may want to avoid using salicylic acid if you have a sensitive skin.

In-office procedures

The following procedures are suitable for more extensive and severe acne scarring, although they ought to be carried out by professional specialists.

• Chemical peeling

• Laser therapy

• Fillers or hyaluronic acid injections

• Microneedling

• Microdermabrasion

• Cryotherapy (for keloid scars)

We hope that this article helps you understand better about acne scars and its treatment. While your acne scars may not be healed completely, or you may not be able to afford sophisticated treatment, just keep in mind that true beauty comes from inner peace and confidence. We don’t pretend that acne scars would not affect one’s self esteem, but let’s expand our definition for beauty beyond face and look deeper into our inner beauty.

Just like the song  “scars to your beautiful” by Alessia Cara:
“There's a hope that's waiting for you in the dark
You should know you're beautiful just the way you are
And you don't have to change a thing, the world could change its heart
No scars to your beautiful, we're stars and we're beautiful”
 

References:

1. UpToDate - Management of acne scars

2. https://int.eucerin.com/acne/article-overview/how-to-reduce-acne-scars-150

3. https://www.healthline.com/health/acne-scars#minor-in--office-surgery

Written by

Ms Joyce Toh