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Acne affects just about everyone at some point in their lives, sometimes at the most inconvenient times, like before dates, parties, or work presentations.
Acne often appears when hair follicles, or pores, on your skin get clogged by oil and dead skin cells, forming comedones. Then bacteria can start to grow, causing inflammation and red bumps.
Acne can be mild, moderate, or severe. In severe cases, acne can cause painful, pus-filled bumps, called nodules or cysts, beneath the skin’s surface.
Most of the time, the light red or brown marks left behind by healed acne clear up over time on their own. But severe acne, especially cystic acne, is likely to leave permanent scarring as it heals.
Permanent scarring is more likely to develop if you pick at or squeeze your acne instead of treating it or allowing it to heal.
Some people don’t experience acne scars. But most people deal with at least a few acne scars at some point in their lives. The type of acne scarring you can expect depends on the type of acne you develop and how you treat it.
Acne scars range in appearance from shallow, mottled depressions, sometimes called rolling scars, to deep and narrow depressions.
These depressions are skin colored but can be darker or pink as well. Here’s a look at the different types of scars acne can create:
Atrophic scars are flat, shallow depressions that heal below the top layer of skin. These scars are commonly caused by severe cystic acne. However, other types of acne can cause them as well.
The appearance of atrophic acne scars can vary depending on a person’s history with acne. There are three types of atrophic scars:
Boxcar scars most often form on areas like the lower cheeks and jaw, where skin is relatively thick.
Ice pick scars
Ice pick scars are smaller, more narrow indentations that point down into the skin’s surface. These scars are common on the cheeks.
Ice pick scars tend to be very tough to treat, and often require persistent, aggressive treatment.
Rolling scars have a varying depth, with sloping edges that make skin appear wavy and uneven.
Hypertrophic and keloid scars
Unlike atrophic scars, hypertrophic and keloid scars form as raised lumps of scar tissue where the acne once was. This happens when scar tissue builds up, sometimes from previous acne spots.
Hypertrophic scars are the same size as the acne that caused them. Keloid scars create a scar larger than the acne that caused them and grow beyond the sides of the original spot.
Hypertrophic and keloid scars are more common on areas such as the jawline, chest, back, and shoulders. People with a darker skin color are more likely to develop this type of scarring.
Once your acne heals, it often leaves behind a darker or discolored patch of skin. This is not a scar, and will resolve on its own with a good sun protection regimen.
Hyperpigmentation can occur when skin is damaged by severe acne, or if you’ve picked at your acne. But again, in all cases, your skin will return to its natural color over time with proper sun protection.
People most likely to experience post-inflammatory hyperpigmention include those who have darker skin and those who pick or squeeze their acne.
Treatment for atrophic scars, including boxcar, ice pick, and rolling scars, involves two stages. The first stage focuses on reducing the depth of the scar to even out the skin’s surface.
Stage 1 treatments for atrophic scars can be done at your dermatologist’s office using one or more of the following treatments:
- Chemical peels: Glycolic or salicylic acid is used to remove the outer layers of skin. This treatment should not be used for very deep scarring.
- Dermabrasion: A tool to “sand down” the top layers of skin is used, which can make a boxcar scar more shallow. This treatment usually requires multiple visits to your dermatologist.
- Dermal fillers: This involves injecting a substance, such as hyaluronic acid or calcium hydroxylapatite, to improve the appearance.
- Laser therapy: High-energy light removes the outer layers of skin and stimulates collagen production in inner layers of skin. This is called ablative laser therapy. Nonablative therapy uses heat to spark production of collagen in the inner layers of skin.
- Microneedling: Creating tiny injuries with needles across the scar helps to form pockets of healing with collagen production. This collagen can reduce a scar’s depth.
- Punch excision: This involves cutting a scar out of your skin, then pulling the skin together and stitching it up.
- Punch grafting: This involves removing the scar from your skin, then replacing it with skin taken from another part of the body.
- Subcision: Breaking up scar tissue raises up the scar instead of it being pulled down.
- TCA Cross (chemical reconstruction of skin scars): Applying trichloroacetic acid (TCA) onto a scar helps form extra collagen that may raise up the scar.
The next step in treating atrophic scars is to reduce any discoloration. Your dermatologist is likely to follow up with more:
- chemical peels
- laser therapy
- lifestyle recommendations like sun protection
You can also treat atrophic acne scars at home with topical over-the-counter (OTC) retinoids, such as Differin. OTC Retinoids may promote collagen formation and even out pigment.
While you may be tempted to use an at-home chemical peel, dermatologists do not recommend this because it has the potential to cause more damage than help. It’s best to talk with your dermatologist about safe ways to treat acne scars at home.
Treatment for hypertrophic and keloid scars focuses on reducing the height of the scar so the skin appears smoother.
Your dermatologist can perform one or more treatments to start reducing the appearance of your hypertrophic and keloid scars. This can include:
- Steroid injections: Steroids are injected directly into a scar to soften the scar tissue, which can reduce its height. Usually you’ll need several steroid injections spaced several weeks apart.
- Surgical removal
- Laser therapy: This may include both ablative and nonablative laser therapy.
To treat hypertrophic and keloid scars at home, you can try several options:
- Bio-Oil: This is a topical oil that may help reduce the appearance of raised scars, according to limited
research. It’s available for purchase at your local pharmacy or online.
- Massage: This can weaken scar tissue and reduce the height of your scar.
- Silicone sheeting: These are gel silicone sheets that you can place on top of your raised scars to help soften them, reducing their height. One option is ScarAway.
You can reduce the appearance of post-inflammatory hyperpigmentation at your dermatologist’s office or at home. The goal is to prevent further darkening and allow your skin to naturally recover over time.
- chemical peels
- laser therapy
- prescription topical retinols and retinoids, which can increase your skin’s production of collagen and even out complex as well as lighten dark spots. A prescription-strength formula retinoid will work more quickly and efficiently than one you can get over the counter.
- Use a broad spectrum sunscreen with an SPF of at least 30 daily at regular intervals. Physical sunscreen blockers, such as zinc oxide and titanium dioxide with iron oxide, provide better protection.
- You can try an OTC retinoid like Differin, but it may work more slowly than a stronger prescription.
For most people with acne, discoloration will fade with proper acne treatment and sun protection. However, if you have scarring or discoloration that lasts more than a year and you’re interested in treatment, speak with your dermatologist.
Your dermatologist can help develop a treatment plan best suited to your skin. Home treatments can also help reduce the appearance of acne scars, but are usually not as effective as treatments offered by your dermatologist.
Everyone experiences acne from time to time, and sometimes acne causes scarring as it heals. Acne scars vary in appearance depending on the type and severity of the acne.
There are many treatments available for acne scars of all types. If you’re concerned about acne scars, see your dermatologist to develop a treatment plan that’s right for you.