Finding a solution for your acne scars is no easy task. This condition is stubborn since the fibrous tissue that constitutes the scars does not contain the same characteristics as the surrounding tissues. They are a formation of a fibrous tissue that replaces the normal skin destroyed as a result of an injury or disease1. Injured skin that is unable to repair itself generally forms scars as a healing approach. Developing acne marks or blemishes is a challenging and frustrating experience. However, thanks to extensive skin research, there are options available for you to try out.
What causes them and types?
The causes of acne scars can be broadly categorized as an acceleration in tissue formation, or due to an inflammatory reaction. The inflammatory reaction is the most common cause. The acne, or its variants that include the nodule, cyst, or a pustule swell up due to bacteria, sebaceous oil, or an accumulation of dead skin cells. In the end, the rupture of the acne damages the healthy tissues thereby triggering a wound healing process.
The acne that has undergone an inflammatory reaction may lead to acne scars with the varied appearances. Medical practitioners classify the scarring into three types. First, there are the atrophic scars which include three main sub-types: The icepick, box, and rolling scars. Ice pick constitutes 60-70% of the reported cases2. On the other hand, box type constitutes 20-30% whereas rolling ones constitute 15%-25%. There are cases where all three forms of scarring appear in a person.
- Icepick scars: Small in size (less than 2mm in diameter) that are highly marginated, form a depression or pits and extend deep into the dermal layer.
- Boxcar scars: For round or oval depressions with sharply defined vertical corners. Wider compared to ice pick ones.
- Rolling Scars: Highly stubborn type to treat. They are wider than ice pick (4-5mm) and occur in relatively appearing normal skin. They make the skin look like there’s an invasion of small pink-like waves on the skin.
Aside from atrophy type we have seen, there are other types that result from acne. For instance, there are the hypertrophy scars which are raised scars that appear where the injury to the skin had taken place.
Also, there are keloid scars that are common in darker skin. The keloids go beyond the site of the injury and exhibit signs of continuous growth. Both keloid and hypertrophic type are the outcomes of abnormal tissue growth.
In addition to this, you have another type called the sinus tract scars. According to Jim Leyden, M.D., a Professor of Dermatology at the Pennsylvania University, sinus tracts/keratinous cysts appear at the point of the inflammatory reaction. They appear to be grouped together as the cysts near the affected area group together to form pathways containing blood, serum, and other purulent material.
There are kinds that lead to pigmentation, whereas there are others that affect the blood capillaries (erythema) or some that lead to scarring, for instance, the keloid and hypertrophy ones.
Best acne scar treatments – how to get rid of them
Treatment options you should go for depends on:
- The severity of the condition
- The causal factor
- Period of delay in acquiring treatment for the these pimple or acne marks
- Your Budget
There are a variety of treatment options available in the market including acne scar creams, microdermabrasion, and laser treatment options. Alternatively, the best treatments include:
Laser treatment is an expensive procedure that requires several sessions and more downtime. The use of a fractional laser is more common as it has fewer risks compared to ablative lasers. Fractional lasers/Fraxel laser/fractional resurfacing targets the affected areas of the skin. The laser stimulates collagen production thereby facilitating textural improvement.
The type of laser used on your skin will depend on the type of acne scar. For instance, non-invasive lasers such as a pulsed dye or IPL can address the hyperpigmentation resulting from the scarring. If you opt for this procedure, you will need to understand that laser treatments are not 100% effective but they can improve your appearance.
There are a variety of dermal fillers that can be used to remove acne marks. The selected filler will depend on your expectations, facial anatomy, and degree of scarring. Dermal fillers can be highly effective against superficial atrophy acne scar. They help by lifting up the depressed skin or pits, stimulating collagen production, and diminishing their appearance. Whereas the after –effects of dermal fillers can be short-term on some types of marks, the treatment can work wonders when combined with laser treatment. Fillers are a great way to get rid of box scars.
3. Dermabrasion and microdermabrasion for acne scars
The difference between dermabrasion and microdermabrasion is that the former uses a special instrument to “sand” the skin. On the other hand, microdermabrasion is a softer approach. The two cosmetic procedures can be used to help diminish the acne scars depending on the degree of severity. However, their removal will require combination therapy, in which the microdermabrasion is used alongside other procedures such as laser therapy.
4. Chemical peels
This is a preferred option in the treatment of superficial acne marks. The chemical trichloroacetic acid (TCA), or glycolic acid peels away the top layer of your skin leaving you with a smooth, more youthful skin. Chemical peels combined with laser therapy can improve the outcomes of the skin.
5. Surgical options
Acne scar subscision is a surgical option for deep acne scars, particularly, rolling ones we have already talked about. The procedure uses a specialized needle that removes the scarred tissue underneath the skin. This invasive procedure is a simple technique that can lead to long-term improvements especially when it is paired with a subscision suction technique. The other surgical option available other than subscision is the punch excision. This procedure is preferred for ice pick as well as box scars.
Treatment delay is a significant issue when it comes to acne scarring. As a result, it is advisable to consult a dermatologist to determine the best treatment approach suitable for your skin. Although the listed procedures are relatively expensive, they have a higher chance of producing great results compared to creams and spot treatments.
1,2 Antonella Tosti, Maria Pia De Padova, Kenneth Beer (2009) Acne Scars: Classification and Treatment, CRC Press,