Acne scars: Causes, types and treatments

 Key takeaways:

• Acne scars are permanent (or long-lasting) marks that acne leaves on the skin even after they have been healed. The different types of acne scars are ice pick scars, boxcar scars, rolling scars, atrophic scars, and hypertrophic scars.
• There are various treatments available to improve the appearance of acne scars. These treatments include microneedling, laser therapy, fillers, and chemical peels.
• Acne scars can be caused by picking or popping acne, and a family history of acne scars. Avoid picking or popping acne, protect the skin from sun exposure, and consult a board-certified dermatologist if home remedies or over-the-counter treatments do not show improvement.

Did you know that acne affects over 80% of adolescents and young adults worldwide? While some are fortunate enough to experience acne for a short period, others endure a longer, more challenging journey. 

Having to deal with acne scars can be just as tough as treating acne itself. Because acne scars can have a huge effect on one’s self-esteem and overall well-being, it is easier for you to feel alone. 

However, the good news is that acne scars are treatable. The first step is understanding what an acne scar is, its types, and finding the right treatment for you. 

 What is an acne scar?

Acne scars are permanent (or long-lasting) marks or blemishes that remain on your skin even after your acne breakouts have healed. Contrary to popular belief, acne scars are different from regular pimples; pimples are temporary inflammations caused by clogged pores, while acne scars are lasting changes in your skin's texture and appearance.

Whenever your skin undergoes unusual inflammation, like deep pimples or cysts, it initiates a healing process where your body produces collagen, a protein that repairs and rebuilds damaged skin tissues.

Sometimes, your body may produce too much or too little collagen during the healing process. This can result in raised or hypertrophic scars if there's an excess of collagen, or depressed or atrophic scars if there's a lack of collagen. The type of acne scar that forms depends on various factors, such as the severity and duration of the acne lesion, genetics, and skin type.

 Types of acne scars

There are several types of acne scars, each with its own unique characteristics and appearance. Let's look at each type in detail:

 1. Ice pick scars

Ice pick scars are deep and narrow indentations that resemble small puncture marks on the skin. They often appear as small, V-shaped, or U-shaped depressions. These scars are formed when acne lesions damage the skin's deeper layers, leading to the formation of deep, narrow pits.

 2. Boxcar scars

Broad, shallow depressions with well-defined edges, boxer scars usually have a square or rectangular shape and give the skin a pitted appearance. Boxer scars are formed when inflammatory acne destroys collagen in the skin, resulting in depressed areas with sharp edges. You can get boxer scars from both mild and severe acne. 

 3. Rolling scars

Rolling scars have a wavy or rolling appearance on the skin's surface. They are caused by bands of scar tissue that form beneath the skin, pulling it downward and creating an uneven texture. Usually, rolling scars are caused by long-term, inflammatory acne. 

 4. Atrophic scars

Atrophic acne scars appear indented below the normal layer of skin tissue. They develop when the skin is unable to regenerate new tissue, thus resulting in imbalanced scarring. Atrophic scars are commonly seen as a consequence of severe acne or chickenpox, and their healing process leads to an uneven texture on your skin, where the scars are depressed or sunken in comparison to the surrounding skin. 

 5. Hypertrophic scars

Hypertrophic acne scars are a type of scar that forms raised lumps of scar tissue in the area where acne once was. They occur when there is an overproduction of collagen during the wound-healing process, leading to the formation of raised tissue.

Hypertrophic scars tend to stay within the boundaries of the original spot without extending beyond them. These scars are more commonly found on areas such as the face, chest, back, and shoulders.

 Causes of acne scars

A lot of factors lead to the development of acne scars. Knowing these contributing factors can shed light on why some people are more prone to developing scars than others. According to the American Academy of Dermatology Association, the possible causes of acne scars include:

• Having acne that penetrates deep into the skin, such as acne cysts or nodules. Severe or cystic acne is more likely to result in scarring compared to mild or moderate acne. The deeper and more inflamed the acne lesions, the higher the risk of scarring. 
• Picking, popping, squeezing, or scratching the acne. These further irritate and damage the skin, hence leading to more severe inflammation.
• Having a family history of acne scars. Some individuals may have a genetic predisposition to developing acne scars. Factors such as skin type, healing ability, and collagen production can vary from person to person, which influences the severity of scarring. 

 Treatments for acne scars

Dermatologists use different methods to treat acne scars, each serving a specific purpose in improving their appearance. The following are some commonly used treatments:

 1. Microneedling

Microneedling is a treatment that requires the use of a device equipped with tiny needles to create controlled micro-injuries on the skin's surface. When applied to the treatment of acne scars, microneedling offers several benefits, like collagen stimulation, minimal downtime, and increased absorption of topical products.

This treatment procedure is typically performed as a series of treatments spaced 3 to 8 weeks apart to achieve optimal results. The number of sessions required depends on the severity of the acne scars.

 2. Laser therapy

Laser treatments use high-energy light beams to penetrate the skin, heat the underlying tissues, and trigger a wound-healing response. This process stimulates the production of new collagen fibers, which can help fill in and smooth out acne scars. Over time, the increased collagen production leads to improved skin texture and a reduction in the appearance of scars. 

It is essential to avoid sun exposure and maintain sun protection practices before and after laser treatment – If you show up for laser treatment with a tan, your dermatologist may need to postpone the procedure. This is because using a laser on tanned skin can lead to serious burns or skin discoloration. Similarly, exposing your treated skin to the sun's harmful rays can result in further scarring and other complications. 

 3. Fillers

Soft tissue fillers, such as hyaluronic acid or collagen-based injections, are particularly injected into atrophic scars to raise them to the level of the surrounding skin. One of the benefits of fillers is the immediate improvement they provide. As soon as the filler is injected, you can notice a visible reduction in the depth and visibility of the scars. 

Most results of filler treatments are temporary. After a while, the body naturally breaks down and absorbs the filler material. The duration of the results varies depending on the type of filler used, but it generally ranges from several months to a year or more. You may need regular maintenance treatments to sustain the desired results in the long term.

 4. Chemical peels

Chemical peels work by exfoliating the outermost layers of the skin. The chemical solution applied during the procedure causes the skin to peel and shed, removing the damaged and scarred surface layers. 

The treatment is customized based on the severity of the acne scars and individual factors. Different types of chemical peels are available, ranging from superficial to deep peels. After diagnosis,  your dermatologist would choose the appropriate chemical solution and adjust the peel's depth and concentration accordingly.

 Home remedies for treating acne scars

Home remedies can be a complementary approach to help reduce the appearance of acne scars. However, their effectiveness may vary and are not a substitute for professional treatment. Here are some at-home remedies and why you should try them for your acne scars:

1. Aloe vera has soothing properties and may help reduce inflammation and improve the appearance of scars. When blended with manuka honey, aloe vera may help promote the healing of acne scars.

2. Lemon juice contains natural acids that can exfoliate the skin and lighten the appearance of scars. But you have to be cautious, as lemon juice can cause skin irritation, especially for people with sensitive skin. So, do a patch test first and avoid sun exposure after application.

3. Honey has moisturizing and healing properties that may help improve the texture and tone of the skin. 

4. Coconut oil contains fatty acids that can nourish the skin. Nonetheless, be mindful if you have oily or acne-prone skin, as coconut oil may not be suitable for everyone.

5. Rosehip seed oil is rich in essential fatty acids and vitamins that may promote skin regeneration.

6. Baking soda has exfoliating properties that can help remove dead skin cells and reduce the visibility of scars.

Before applying any remedy to your face, do a patch test on a small area of skin to check for any allergies. Also, be patient and stick to a skincare routine. If your acne scars are severe or deeply indented, it's recommended to talk to a board-certified dermatologist.

 When to see a dermatologist for your acne scars

For the effective treatment of acne scars, consulting a dermatologist is important. Below are some instances where it is recommended to see a dermatologist for your acne scars.

• If you have deep scars across large areas of the face or body or scars that affect your self-esteem
• If you have tried different home remedies or over-the-counter treatments for acne scars without seeing obvious improvement, it may be time to consult a dermatologist.
• If your acne scars are complex, such as a combination of different scar types (e.g., ice pick scars, boxcar scars, rolling scars)
• If you have post-inflammatory hyperpigmentation (PIH) or other pigmentation issues resulting from acne scars

During a scar consultation, your dermatologist will examine your skin, focusing on the areas affected by acne scars. They will also ask about your medical history, including any previous acne treatments, skin conditions, allergies, or medications you have taken. 

Based on the examination and the information gathered, your dermatologist will recommend a personalized treatment plan for you. This may include topical treatments, chemical peels, microdermabrasion, laser therapy, dermal fillers, or surgical procedures, depending on the type of scars you have.

 Wrap-up

Acne scars can affect your self-esteem. This is why it is essential to learn about their causes, types, and treatments. There are different types of scars, and factors like family history can contribute to their development. 

While some home remedies, like aloe vera and honey, may help with acne scar treatment, seeking the expertise of a dermatologist is crucial.