Discover how acne scars form and effective methods for reducing or eliminating them
Acne isn’t just a momentary inconvenience - it can permanently leave blemishes on your face.
Fortunately, there are ways to reduce and even eliminate acne scars. Even if your acne scars are so deep you can’t conceal them with makeup, there are treatments that can reduce the appearance of acne scars.
What are the types of acne scars and how do they form?
Before treating acne scars, you need to figure out what kind of scars you have. Depending on the type of scars you have, different treatments are required. There are two main categories of scars - atrophic and erythematous. Simply put, atrophic scars involve structural changes to the smoothness of your skin and erythematous scars are redness.
Erythematous scars refers to a reddening of the skin from capillaries becoming inflamed and potentially broken. When the redness of skin remains even after acne inflammation, it’s called post inflammatory erythema (PIE).
Atrophic acne scars come from damage to collagen. Collagen is the main structural protein of your skin. An absence of collagen causes pitting or gaps in the skin. There can also be abnormal over creation of collagen which results in keloid or hypertrophic scars that rise above the surface of the skin.
Atrophic scars are classified into three types - icepick, boxcar, and rolling - based on how wide they are.
Icepick scars are the most common of atrophic acne scars, representing 60 to 70% of cases. They are characterized by narrow v-shaped tracts in the skin less than 2mm wide. Boxcar scars are wider than icepick scars with a width of 1.5 to 4mm and rolling are the widest with a width of up to 5mm. It’s important to make the distinction between acne scars based on width because width of scar determines which therapies will work.
How to treat acne scars
Topical interventions for acne scars
For erythematous scars, you can greatly reduce redness by using topical treatment in the comfort of your own home. The American Academy of Dermatology states that retinoids such as retinol and tretinoin “are the core of topical therapy for acne”. You can also reduce the appearance of scars by using peptides, vitamin C, and vitamin E topically.
Procedures for acne scars
Cosmetic surgeons can provide two kinds of treatment for acne: area treatments that remedy whole sections of your face and individual treatments that remedy single scars.
Area treatments for acne scars
For erythematous scars there are three kinds of therapy that use light as treatment - pulse dye laser (PDL), potassium titanyl phosphate laser (KTP), and intense pulsed light (IPL). These treatments reduce the appearance of redness by shrinking broken capillaries over wide areas of your face.
For atrophic acne scars, topical aids can help reduce the appearance of scars, but to fully treat them, you may need surgical intervention.
Regardless of type of atrophic scars you have, you can use these techniques to reduce the general appearance of your scars:
Microabrasions and chemical peels also work for the generalized treatment of rolling scars or shallow boxcar scars.
Treatment for individual acne scars
If you’re targeting a specific individual scar, the treatment changes and is more specialized to the type of acne scar you have.
For individual ice pick scars, the best therapies are punch excision and CROSS technique.
Punch excision actually involves removing the damaged tissue. If necessary skin can be grafted, but generally, the cut is narrow enough for icepick scars to heal over. The CROSS technique stands for chemical reconstruction of skin scars. It involves applying trichloroacetic acid (TCA) to the acne scars, causing necrosis in the scars, prompting them to heal with a higher floor than they previously had. CROSS can require up to 6 sessions of treatment to complete and requires you treat your skin with specialized cream before and during the treatment
For individual boxcar scars, CROSS technique and punch excision may work depending on the depth and width of your scars. Punch elevation and injectable fillers will work in most cases.
Punch elevation is like punch excision but damaged tissue isn’t removed and the floor of a scar is elevated with fixing tape or a stitch. There is just one FDA approved filler for acne scars: Bellafill. Made from bovine collagen, Bellafill provides a long-lasting smooth appearance of skin, but may cause allergic reactions. While other commonly used fillers like hyaluronic acid that may require multiple injections in a year. Bellafill injections typically last for years.
For individual rolling scars, injectable fillers and the technique of subcision are the best options.
Subcision involves a doctor using a hypodermic needle to break the connection between scar tissue and deeper skin tissue, allowing the floor of the scar to move closer to the surface. It typically takes multiple visits over the course of a few weeks to accomplish desired results.
Should I use surgery to fix my acne scars?
Because they come with significant drawbacks, surgical treatment for acne scars should not be your first choice of treatment.
Surgery pros
Surgery cons
Due to the risks and costs associated with surgery, the best approach for dealing with acne scars is an incremental approach - first try topical approaches and then move to surgical if necessary.
If you choose to use a surgical procedure to treat your acne after using retinoids topically or orally, make sure to check with your dermatologist to see if you need to discontinue use for your cosmetic procedure or surgery.
Even with the best treatments, you may not be able to restore your skin to its pre-acne state.
Often the most important action you can take to fight against acne scars it to prevent acne from damaging your skin in the first place. Best practices include washing your face and treating it with bacteria-killing salicylic acid and benzoyl peroxide. If you have cystic or nodular acne, see a dermatologist and get your cysts drained before they can damage your skin.
REFERENCES:
1. Acne Scarring—Pathogenesis, Evaluation, and Treatment Options. PubMed Central Web site. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/
2. Photoprotection according to skin phototype and dermatoses: practical recommendations from an expert panel. PubMed Central Web Site. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252523/
3. Why Topical Retinoids Are Mainstay of Therapy for Acne. Springer Link Web site. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/