Acne scars, or pimple marks, are similar to other types of wound scars. Just as deep wounds can leave scars, deep and inflamed pimples can also leave marks.
Scar formation occurs when the skin repairs itself after an injury. If the wound is superficial, the skin completely regenerates, but in deeper wounds, especially those affecting the dermis (the layer beneath the skin), there is a higher chance of scar formation.
Around 30% of individuals with moderate or severe acne during adolescence develop acne scars.
The majority of people recover from acne without any permanent effects, but some may have acne marks left on the skin’s surface. For mild acne scars, some skincare products and medical treatments can be somewhat effective, but for more significant acne scars, surgical intervention or skin resurfacing may be necessary.
The most important step to prevent acne from leaving scars is to start treatment early. Nearly all types of acne can be controlled and treated. However, if treatment is delayed, the severity may increase, thus raising the risk of scarring. It is important not to neglect consulting a dermatologist.
How Do Acne Scars Form?
Acne occurs when pores become clogged with oil and cells, which then become inflamed due to bacterial activity. These inflamed and swollen bumps stretch the skin, causing tears in the follicular walls. The size of the inflamed lesion and the elasticity of the skin determine the extent of the tear. If the tear is large and the dermis is damaged, it leads to scarring.
When the dermis is damaged, the body produces collagen to repair the area. Collagen is a fibrous protein produced by the skin, and it provides strength and elasticity, playing a crucial role in the repair process. However, after this repair, the skin rarely returns to its smooth and flawless condition, and indentations or scars may remain.
Types of Acne Scars:
The scars left on the skin can vary from person to person and case to case. Some skin types are more affected by acne scarring, while others may recover with minimal damage.
Acne scars can be categorized into two main types:
Hypertrophic / Keloid Scars: These occur when the body produces too much collagen to repair the skin damage, causing a buildup of tissue on the skin’s surface. This is a result of the body’s inability to regulate collagen production during the healing process. These scars are usually red or pink and appear as soft, raised lumps.
Atrophic Scars: These scars occur when there is tissue loss during the healing process. There are three common types:
Icepick scars: Small, but deep indentations.
Boxcar scars: Round or oval depressions with steep, defined edges.
Rolling scars: These create a wavy, undulating appearance on the skin, often resembling waves.
In addition to the above, acne can also lead to discoloration in the skin that doesn’t result in permanent scarring, but still can be bothersome. In darker-skinned individuals, acne may cause localized darkening (hyperpigmentation), while lighter-skinned individuals may experience redness (erythema). These discolorations should not be confused with permanent acne scars as they are usually temporary color changes.
How Are Acne Scars Treated?
There are several methods for treating acne scars. These treatments can be applied under the guidance of a doctor:
Use of Sunscreens: Acne scars can be of different tones compared to the surrounding skin. To even out the skin tone, sunscreen and certain skin lightening products can be used.
Soft Tissue Fillers: Acne scars that form as indentations can be reduced by collagen or fat injections, making the scars less noticeable. However, this is not a permanent solution and may need to be repeated periodically.
Laser Skin Resurfacing: This treatment can help reduce acne scars and improve the appearance of the skin.
Energy Devices: Devices like radiofrequency or IPL (Intense Pulsed Light) lasers can reduce the visibility of acne scars without damaging the upper layers of the skin.
Chemical Peels: This procedure involves removing the upper layers of skin to help reduce deep acne scars.
Microneedling: Using a device called a dermapen, which contains micro-needles, the underlying tissues are stimulated to reduce acne scars. This is a simple and safe procedure, but it may require several treatments to see results.
Surgical Procedures: Minor procedures like punch excision involve a doctor cutting out acne scars and closing the area with small stitches or a skin graft. Another technique is subcision, where fibrous bands beneath the scar are broken up using special needles, making deep acne scars less noticeable.
Botox for Acne Scars: Botox injections can be used as a treatment method for acne scars, particularly when there are wrinkles or folds in the skin surrounding the scars. The botox injections smooth out the area, improving the appearance of the skin. However, the effects are temporary, and the treatment may need to be repeated periodically.