Acne scars and what you can do about them
We've all dealt with it, those unsightly pimples and pox marks that are characteristic of our teenage years. Some of us escaped relatively unscathed and others still struggle with acne and the scars it leaves behind. We'll talk about what to do if you're dealing with pimples and acne, but right now I wanted to talk about the scaring that occurs and what you can do about it.
“Even without picking, acne lesions, particularly cysts, can lead to scarring because of the intense, collagen-damaging skin inflammation with which they are associated,” says Tina Alster, MD, a clinical professor of dermatology at Georgetown University Medical Center. Luckily, you don’t have to grin and bear the telltale signs of a breakout forever. Read on for dermatologists’ top strategies for healing acne scars and keeping new ones at bay.
What Does an Acne Scar Look Like?
Acne scars develop in areas where former cystic blemish lesions have been present. Acne scars come in three varieties, says Hayes Gladstone, MD, a professor of dermatology at Stanford University.
- Atrophic, which are mostly shallow
- Ice pick-shaped, which are narrow and deeper.
People with deeper skin tones may also notice darkening (or hyperpigmentation) within the scars, while people with lighter skin tones may show redness (or erythema) within the scars, says Alster.
What Makes Acne Worse?
Exposing scars to the sun can cause them to darken and slow the healing process, says Alster. How? Ultraviolet rays stimulate melanocytes (pigment-producing cells), leading to further discoloration. Your safest bet: Before heading outdoors, slather on a broad-spectrum sunscreen with an SPF of 30 or higher that contains the ingredient zinc oxide. Reapply after swimming, sweating, or after more than 2 hours in the sun. Also, limit your time in the sun, especially between the hours of 10 a.m. and 2 p.m., and wearing protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, are also recommended.
Picking and Squeezing
Scars, which are made mainly of collagen (a protein fiber normally found in the skin's second layer), are the body's way of repairing itself. Acne scars are typically indented because of collagen loss from intense inflammation, says Alster. Picking leads to further inflammation and injury of the skin, which adds to the skin’s discoloration and scarring. Squeezing or trying to pop a pimple causes pus and bacteria to filter deeper into the skin, resulting in more collagen damage, notes Ron Moy, MD, professor of dermatology at UCLA.
You may have heard that applying topical vitamin E to a scar will help it heal faster. But according to a study from researchers at the University of Miami, applying the nutrient directly onto a scar can actually hinder its healing. In the study, vitamin E had no effect (or made matters worse) for 90% of the patients, and 33% who used topical vitamin E developed a contact dermatitis.
Acne Scar Treatment
Acne scars can occur as the skin heals from pimples, nodules (larger and harder pimples), or comedones (whiteheads and blackheads). These scars appear as depressions or raised, red areas in the skin that last long after the acne is gone, and give the skin a typical bumpy or wavy appearance.
Specifically, acne scars can appear in the following forms:
Ice pick acne scars:
This is the most common type of acne scarring characterized by tiny pits usually less than 2 mm across that extend deep into the skin, giving the surface an appearance as if it were punctured by ice picks.
Boxcar acne scars:
This is another common type that is mostly found on the cheeks and temples. Boxcar scars are angular in shape and bigger in size (across) than the ice pick scars; they may be shallow or deep, but always have sharp, vertical edges.
Rolling acne scars:
These wave-like scars that are wider and shallower are caused by damages to the subcutaneous layer of the skin or the dermis.
Hypertrophic acne scars:
These raised and lumpy scars, that tend to appear more usually on the back, chest, but less commonly on the neck and face, appear often as a result of more severe acne types lesions, such as cysts or nodules. Most hypertrophic scars will shrink with time except the Keloid scars which tend to expand beyond the original wound site.
Acne Scar Treatment:
While the above typology may be of some help in identifying the nature of scarring and finding the most appropriate treatment method or approach, since most people have multiple types of scarring, it makes the best choice difficult in any case. This is compounded by the noise created by overambitious marketers who are easily identified by their empty, one-size-fit-all claims to sell their over-the-counter ‘, quick-fixes’ to the uninformed but anxious patients.
Without the professional guidance of a board certified practitioner, it is not only challenging but dangerous to use any treatment or approach in a given case. Yes, self help works, but not beyond its limits.
Laser technology is here to stay as it significantly removes or totally reduces acne scars. Lasers resurfacing is best and most effective, according to many practioners, but there are other more traditional treatments such as chemical peeling or dermabrasion.
Depending on the type, stage and severity of scarring, your skin type, general health, lifestyle, and, of course, your preferences, you can choose any of the wide range of methods or approaches, singly or in combination, to work out a comprehensive treatment plan.