Acne Scars: Types, Prevention, and Treatment

A girl with acne scars is looking into the mirror

Acne comes and goes, but what's truly bothersome are the lingering acne scars. They serve as a constant visible reminder of past acne breakouts affecting your self-esteem and eroding your confidence.

It’s good when they leave quietly, but even if they persist, there is no need to worry about how to get rid of acne scars, as various treatment procedures are available. However, the improvement is slow-paced, and you have to be patient. 

There is no one-size-fits-all solution for acne scars, and the first step to treating them is knowing their types and causes. In this blog, we will discuss everything you need to know about acne scars before starting your treatment. 

How Do Acne Scars Appear

Sometimes, inflamed lesions break at the dermis level and cause acne scarring. Acne breakouts don’t only damage the appearance of the skin but penetrate the deep layer to damage the tissue and the skin there. After the acne disappears, the body tries to combat this damage and produces collagen.

A scar appears when the body generates too little or too much collagen. Different kinds of scars also depend upon the amount of collagen being produced. 

When Do You Get Scars 

It cannot be determined who gets scars and who will not. But some conditions increase the probability of having those terrific little digs on the skin.

1. If you pick or pop your acne: People have this habit of picking their acne, especially when there is an event coming on and they have this pressure of being the most good-looking. 
2. If your acne is inflammatory: Among all forms of acne, cysts and nodules tend to go deeper into the skin, and if you’re experiencing these kinds, you may develop scars.  
3. If it’s in your genes: If your parents or any blood relatives have this tendency to get those acne scars, you might have to face them too. 
4. If you’re dealing with acne for longer durations: If you’re struggling with acne for longer periods and you are delaying the treatment, you may get scars. 
   

Types of Acne Scars

If you have developed scarring, don't panic. Seek treatment, but before starting, be sure to identify your scar type.

Let’s discuss the different types of acne scars;

Keloid or Hypertrophic Acne Scars

When the scar tissue takes the form of an elevated bulge at the position where there was acne before, it forms keloid or hypertrophic acne scars. You can catch them majorly on your jawline, shoulders, back and chest. Sometimes, they may irritate you and cause itching, while they can appear in tender forms as well. 

Atrophic (Depressed) Acne Scars

How do you characterise the atrophic or depressed acne scars? They heal beneath the surface of the outer layer of the skin and appear flat and shallow. Most often, these types of acne scars occur due to severe cystic acne, but they can also result from other forms of acne. 

Atrophic acne scars have three other distinctions;

1. Boxcar Scars:

In these scars, you will see box-shaped concavities identified with clear-cut edges. If you have faced chicken pox, rashes with blisters or widespread acne, you might face boxcar acne scars as well on the regions of the thick skin, including the jawline and lower cheek areas. 

2. Rolling scars:

Source: Freepik

Rolling scars are usually identified by their gradual contours and fluctuating depths. Your skin may appear uneven and sometimes wavy too. Compared to the other acne scars, these ones are wider and shallow. Often a result of inflammatory acne, proper care and acne management can help reduce the risk factors of this acne. 

3. Ice Pick Scars:

You may see them commonly on the cheeks and identify them as narrow indentations that point down into the skin’s surface. Treating this kind of acne scars is more challenging than other ones. You may have to put in the dedicated and continuous effort in order to get rid of these aggressive interventions. Dermatological procedures can help. 

Post-Inflammtory Hyperpigmentation

After your acne has healed up, you may have to face a discoloured patch on that area. It is called post-acne hyperpigmentation and majorly happens due to inflammatory acne. Severe acne may result in this hyperpigmentation, especially when you pick it up, squeeze it, or leave it untreated. They may disappear on their own. But if they don’t, you can follow a skincare regimen to reduce them. 

How to Treat Acne Scars

Acne scars are challenging as they might be stubborn, and there is no “ideal treatment” for everyone. Every skin is different; hence, the core of the concern is to be understood before diving into the treatment. 

We have listed a number of treatments that may help you to eliminate those deep acne scars. Healing depends on various factors, including the type and severity of your acne scarring. 

If your scars were marked years before, and you woke up to the treatment now, it may take time in this case.

Treating Keloid and Hypertrophic Acne Scars

There are several ways to treat keloid and hypertrophic scars, including;

• Laser Therapy: Laser therapies can involve both ablative and nonablative types and are generally paired with steroid injections.
• Steroid/Corticosteroid Injections: Scar tissues are directly targeted with these injections to soften and flatten it. One injection will never help you out but you will require several injections from time to time, as per your doctor. 
• Silicone Sheets: These sheets are based on gel and typically increase the scar hydration and soften the scar tissue. 
• Cryotherapy: A frigid substance is used to eliminate the scar.
• Surgical Removal: Surgical removal is there to assist you if nothing of the above helps you. In some cases, keloids can grow back and worsen after this removal process. 
• Bio-Oil: Bio-oil is easily available at the pharmacy near you. It helps reduce raised acne scars and makes the texture of your skin better. 
• Massage: Massages have always been the right way, and they help with reducing scar tissue as well.
  

Treating Boxcar Acne Scars

• Laser Therapy: Various types of laser therapies work differently. Your doctor will guide you through the procedure. Fresh skin tissue can be stimulated to produce collagen, which further helps to improve your skin’s texture. 
• Dermal Fillers: There are depressions on the skin within the acne scars, and you can get filler injected into them, known as dermal fillers. It makes those depressions even with the surrounding skin.
  
  
  
  
• Punch Excision: As the name suggests, the scar is excised and then stitched 
  back. 
• Dermabrasion: The topmost layer of your skin is exfoliated. This process stimulates the body to produce even more collagen. 
  

Treating Rolling Scars

Subcision is used to treat rolling scars. A fine needle is maneuvered in a back-and-forth motion beneath the scar. It disrupts the fibrous strands to pull them downwards. After these strands are cut, the skin is allowed to lift up, which makes the skin appear smooth. 

Treating Ice Pick Scars

Punch Grafting: A small tool is used to cut out the scar. The void is filled with a skin graft.

Punch Excision: The acne scar is excised with a cookie-cutter-like tool. Afterwards, it is stitched back into its place and appears less conspicuous.

Chemical Peeling: Harmed or impaired layers of the skin are removed with chemicals, which activates the new growth. 

Treating Acne Hyperpigmentation (Post-Inflammatory)

If you are dealing with post-acne hyperpigmentation, alpha hydroxy acids can play their role well. Try over-the-counter and prescription products containing alpha hydroxy acids to cope with mild to moderate acne scarring. If the condition is severe, prescription-strength topical retinoids can help. 

OTC retinoids may help in treating this kind of hyperpigmentation. A minimum SPF of 30 with a broad spectrum would work for combating the harmful UV rays and preventing acne-causing hyperpigmentation from spreading further. 

How to Prevent Acne Scars

If you have identified the type of acne scars you are suffering from and have started the treatment, it’s advisable to make some adequate changes in your lifestyle to keep your acne scars away.  

1. Always Wear SPF
   Sun rays can induce more damage to your scars. Always wear your sunscreen with at least SPF 30 to protect your skin.
   
2. Get Treatment for Your Acne
   Acne treatment can help heal scars without leaving acne marks behind. Seeing a doctor can help. Right from the beginning, take your acne seriously, and follow the skincare routine religiously. Leaving acne as it is can worsen the condition, resulting in stubborn acne marks. 
   
3. Keep Your Skin Hydrated
   You must keep your skin moisturised as much as possible to help your acne scars heal. Moisturisers promote the texture of the skin and reduce the visibility of the acne scars. Prevention of dryness begins with the inclusion of moisturiser after a hot shower every day.
   
4. Stress Management
   Add some stress-reducing practices that can positively affect your skin and overall well-being. Try meditation to keep your mind calm and let your skin glow. 
   
5. Get Enough Sleep
   Sleeping encourages the natural repair and rejuvenation processes of your body. Prioritise your sleep over every other unnecessary activity at night. 
   

DRSQ’s Acne Clear Serum

Acne Clear Acne correcting serum contains 0.5% retinaldehyde and plumps scar tissue and fine lines. It normalises the oil production on your skin and makes it clear and calm, reduces acne and breakouts, acts on hyperpigmentation, and works as an antibacterial and anti-inflammatory to soothe the skin’s surface. 

Conclusion

Each acne scar kind requires specific interventions, from icepick to boxcar, hyperpigmentation to hypertrophic and keloid. Knowing the kind of acne scar is the primary step to combat your scar, helping you to get the right treatment. 

Injections, laser therapies, surgical procedures, injections, and dermal fillers can help you get rid of those scars. Prevention of acne scars requires some basic lifestyle changes, including wearing SPF, using proactive acne treatment, skin hydration, stress management, and sufficient sleep. 

References:

• Pathogenesis and Treatment of Acne Scars: (Fabbrocini, G., Annunziata, M. C., D'Arco, V., et al.., 2010)
  
• Atrophic acne scars: A review of treatment options: Jacob CI, Dover JS, Kaminer MS (2001)
  
• Postinflammatory Hyperpigmentation: Etiologic and Therapeutic Considerations: Grimes, P. E. (1995)
  
• Management of acne scarring: Clinical guidelines and evidence-based treatment strategies: Gold, M. H. (2016)