Acne Scars - The Physical Effects of Acne
Acne scars are one of the most common physical effects of acne. However the emotional effects from scarring can last long
after the pimples themselves have disappeared. While it's difficult
to avoid scarring completely, understanding what causes scarring can
help you reduce long-term damage.
What causes acne scarring?
When body tissue is injured or damaged, the body rushes its “repair
team” to the injury site. This specialised team includes white blood
cells and a range of inflammatory molecules that work to fight infection
and heal the damaged tissue. Once the infection is gone, however, the
tissue can’t always be restored to its former state. The result can be a
Who is most susceptible to acne scars?
How and why people get acne scars is not completely understood.
Because acne scarring differs from person to person, it’s likely that
some people are simply more prone to scarring than others. People who
are susceptible to scarring often find a genetic link as well - both the
severity of scarring and the type of scarring can "run in the family."
The ‘lifetime’ of individual scars can also vary quite a lot too;
some people’s acne scars last a lifetime with little change, while
others diminish over time. We do know that scarring occurs most
frequently in people who have the most severe forms of inflammatory
acne, involving deep nodular lesions.
How can I avoid acne scarring?
Because we know so little about what causes one person to scar more
easily than another, the best way to avoid scarring is to help prevent
acne through a good skin care routine. It's important to nip zits in the
bud by maintaining your skin early on, and for as long as necessary. If
you do get breakouts however, it’s important to manage them properly
rather than squeezing or picking at them. Handling the skin — squeezing
with your fingernails, poking pimples with a pin, etc— significantly
increases the likelihood of damage occurring to the surrounding tissue,
and the lesion leaving a permanent scar.
Remember: A pimple that's bothering you today will soon disappear if
you leave it alone; but if you pick at it or pop the pimple, it could stick around
forever. If you have a particularly troublesome pimple, see your
dermatologist for safe, professional scar treatment or extraction.
A healthy body heals faster and better, so a healthy lifestyle can go
a long way to help your body’s ability to heal. Eat a balanced diet,
get plenty of rest and drink lots of water. If your work or play takes
you out in the sun, protect yourself against harmful UVA and UVB rays
with oil-free sunscreen as excess sun exposure can make scars stick
around longer. Smoking is another ‘no-no’ when it comes to protecting
your skin. Smoking depletes your skin's valuable oxygen collagen
reserves, causing free radical damage and toxin deposits making it more
vulnerable to aging and acne scarring.
Types of acne scars
First some good news! As a blemish heals, the inflamed area flattens,
leaving behind a reddish spot. Though it may look like an acne scar,
it’s actually a macule — the final stage of an acne lesion. Macules can
last for up to six months, but don’t leave behind a permanent scar.
This is also the case for post-inflammatory hyperpigmentation, a
darkening of the skin at the site of a healing acne lesion. Most
prevalent in Asian, African-American and Latino populations, these spots
can last up to 18 months — but can disappear more quickly with reduced
sun exposure. Both macules and post-inflammatory hyperpigmentation are
considered "pseudo-scarring" because they eventually disappear
There are two kinds of scars that can be left behind by acne: acne
scars caused by increased tissue formation, and acne scars caused by
tissue loss. Scars caused by increased tissue formation, (keloid or
hypertropic scars), are less common and appear to be hereditary. These
scars are more common among Asian, African-American and Latino acne
sufferers. Keloid scarring occurs when the skin cells respond by
producing an excess of collagen, which forms into lumpy fibrous masses
usually along the jaw line and on the back or chest. These acne scars
appear firm and shiny, and can last for years.
Acne scars caused by tissue loss are much more common, and can take many different forms:
- Soft Acne Scars have gentle, sloping rolled edges that merge
with the surrounding skin. They are usually small, circular or linear in
shape, and soft to the touch.
- Ice-Pick Acne Scars. Usually found on the cheek, ice-pick
scars are small but deep, with a jagged edge and steep sides. If they
are soft to the touch, they can be improved by stretching the skin; hard
ice-pick scars, however, are difficult to treat.
- Depressed Fibrotic Acne Scars. Over time, ice-pick scars can
evolve into depressed fibrotic scars which also have sharp edges and
steep sides, but are larger and firm at the base.
- Atrophic Macules, a form of acne scarring most common in
Caucasians, Atrophic Macules are soft with a slightly wrinkled base.
Blood vessels just below the surface of the scar can make them appear
purplish at first, but this discoloration often fades over time to a
pale ivory. Atrophic macules are usually small when they occur on the
face, but can be a centimetre or larger in other places on the body.
- Follicular Macular Atrophy is more likely to occur on the
chest or back. These small, soft white lesions resemble whiteheads that
haven’t fully developed; they can last for months or even years.
Can my acne scars be managed?
The short answer is yes - acne scar solutions are available.
Post-inflammatory hyperpigmentation and macules can be improved with
bleaching agents while some superficial acne scarring can be treated
with topical resurfacing treatments, like Retinol, which is available in
many over-the-counter forms, as well as in prescription medications.
Other forms of scarring can be improved with microdermabrasion (a
minimum of 6–8 treatments are usually required) or dermatologic surgery.
It might not be possible to restore your skin to its pre-acne
appearance — but if your scars have a significant effect on your
emotional well-being, it’s definitely worth considering treatment. There
are a number of different scar treatments available; consult your
dermatologist to find out if your particular acne scarring can be
improved and what the most effective treatments are.