The infection and inflammation associated with acne can seriously damage the skin and underlying tissue, and sometimes leave behind significant scarring.
While the best course of action is to take immediate action to control your acne and prevent further damage, there is hope for those who suffer from acne scarring. The best choice of treatment depends on the type of scarring and can range from simple topical treatments to cosmetic surgery.
In this section we overview how acne scars form, the differences between different types of scarring and the treatments available to correct the condition.
Acne scars result from damage to the skin and subcutaneous structure that occurs as a result of the infection and inflammation associated with moderate to severe acne.
In the course of inflammatory acne outbreaks, the underlying collagen matrix that supports the skin becomes damaged and replaced by scar tissue. During the inflammatory process, white blood cells release inflammatory cytokines and toxic enzymes that can kill the surrounding tissue. Large areas of damage may not be properly repaired and damaged tissue is instead replaced by fibrous scar tissue.
Recurrent damage to the skin caused by persistent acne can also lead to dysplasiac dermal and epidermal cells, resulting in uneven skin tone, hyper-pigmented spots and other skin irregularities. In this section we discuss the causes and mechanisms underlying the formation of acne scars.
Inflammatory acne can cause significant and permanent scarring. Depending on the severity, location and duration of an acne lesion, several types of scars can result.
Ice pick scars are deep narrow scars that look like little holes in the skin. Boxcar scars are larger depressions in the skin. Rolling scars result from scar-induced collagen remodeling that gives the skin a rolling, uneven appearance. Hypertrophic and Keloid scars are raised, often discolored, areas that are usually composed of scar tissue.
Rough or mottled patches with uneven pigmentation or constantly dry/rough/papery skin are a common result of persistent acne infection. Hyper pigmentation, which manifests as darkened, freckle-like spots are also common. Permanently red spots are called erythema and result from damaged capilaries near the skin surface.
In this section we overview the common types of acne scarring and identify the most effective treatments for each type.
Treatments for Acne Scars
For mild to moderate acne scarring and abnormal pigmentation, there are several OTC and Prescription treatments available.
Topical retinoids have been shown to stimulate cell turnover at the skin surface and the growth of new tissue and collagen in the dermis. Topical hydroquinone can inhibit the production of melanin, helping to gradually lighten dark spots.
OTC and spa based exfoliating treatments can help relieve minor uneven and rough skin tone. Glycolic acid, azelaic acid, alpha hydroxy acid and others are available as part of OTC and prescription chemical peels. Red light based therapy can be helpful in accelerating healing and collagen production.
In this section we overview the OTC and prescription treatments available for treating acne-induced scarring.
Clinical microdermabrasion is a technique that superficially abrades the skin with a high-pressure flow of crystals. Microdermabrasion removes a thin layer of the skin surface.
Microdermabrasion is often effective for the treatment of fine lines, rough skin and other minor defects, but less useful for the treatment of deeper scars.
The crystals are most often made from aluminum oxide or zinc oxide and can range in size. Microdermabrasion can also be done with a diamond encrusted treatment head that functions like very fine sandpaper.
The advantages of microdermabrasion are the low risk of complications, minimal patient discomfort, quick and simple treatment, and rapid recovery. The primary limitation of microdermabrasion is that this treatment is relatively ineffective for the treatment of moderate to severe acne scars.
Chemical peels use various chemical solutions to remove the outer layer of the skin, removing superficial irregularities in the appearance and texture of the skin.
Chemical peels can be helpful for people with minor wrinkles, uneven skin or abnormal pigmentation. As laser based therapies continue to improve, the popularity of chemical peels, particularly the invasive techniques, is in decline. Chemical peels range from very mild to extremely harsh.
The most popular peels are mild techniques that utilize glycolic acid, alpha hydroxy acid (AHA) and other mild acids. More invasive techniques utilize trichloroacetic acid (TCA) and phenol. Mild chemical peels can be obtained as OTC preparations or can be done at the clinic. Improper use or overexposure to chemical peeling agents can lead to tissue damage and scarring.
Most chemical peels are minimally effective for resolving significant or deep acne scars.
Laser based therapies are quickly becoming the dominant technology in cosmetic dermatology. Laser systems can be used for both ablative and non-ablative skin resurfacing. In addition, they can be used to specifically treat all of the common conditions associated with acne scarring.
Laser treatments are available for the treatment of irregular pigmentation, erythema (permanent redness), as well as the treatment of a wide range of scar tissue. Because the wavelength (color) and intensity of a laser determines the depth that it penetrates the skin and what kinds of molecules it excites, laser therapy is a highly flexible and functional tool.
A common limitation of laser treatment is the cost, which can be significantly higher than other types of treatment. In this section we overview many of the available laser technologies and their applications.
For cases of severe acne scarring, surgery is often the most direct and effective approach to repair the damage.
Common surgical techniques include excision of all or part of the damaged area to allow regrowth of healthy tissue. In addition, there are a range of cosmetic fillers that can be used to improve the appearance of deep ice pick and boxcar acne scars.
In this section we overview the techniques and products available for the surgical correction of acne scars.