Battling acne is tough and draining because a breakout is usually just the beginning. When you thought you’ve won the fight against acne as you see those pesky zits drying up and dwindling in numbers before your eyes, you’ll soon notice some dark acne marks and scars are still visible long after the break out disappears. And sometimes, these blemishes are the worse! We know, it is one of the proofs life is unfair.
Board-certified dermatologist Dr. Julia Tzu explains that the culprit for acne scarring is basically the recurrent inflammation from deeper cystic lesions that damages the collagen in your skin. “Normal healthy tissue is then replaced by thinned-out scar tissue, which can manifest itself as depressions along the contour of the skin,” she noted.
There isn’t really a magic bullet for fading acne marks that gets rid of them overnight, but Dr. Sejal Shah and Dr. Whitney Bowe, both renowned dermatologists in New York City, advised that marks and bumps can be prevented and treated.
Before heading straight to ways on how you can prevent or treat acne scars, first, let’s end the confusion between acne marks and acne scars, is there a notable difference you should know about?
Acne Marks Versus Acne Scars
According to Dr. Bowe, patients often mistake dark spots for acne scars, although both are actually very different. Let’s dig in deeper.
Acne Marks (Dark Spots)
- Red or brown patches caused by post-inflammatory hyperpigmentation that typically goes away when you stretch out your skin gently.
- Can take three to six months to fade on their own
- Diminishing dark spots or acne marks can be faster with a diligent treatment of over-the-counter skin brighteners, Vitamin C serums, sunscreen and topical retinoids.
Types of Dark Spots
Darks spots are not true scars. In fact, although dark spots or discolorations are some of the nasty downsides of acne scars, most of them will fade over time. Discolorations on the skin, ranging from pink, red, purple, brown to black develop when a rash, pimple or acne cause skin inflammation, which then triggers overproduction of melanin.
- Hyper-Pigmentation – When the pigment melanin is produced at elevated levels and accumulates in the skin, it results in blotches or freckle-like appearance. A trauma to the skin caused by an inflamed acne lesion signals melanocytes (cells that generate the melanin pigment that gives skin its color) or in some cases, melanin to multiply at the site of acne.
- Hypo-Pigmentation – The counterpart of hyper-pigmentation that may also cause by acne scars is hypo-pigmentation. It occurs when melanocytes loses their ability to produce melanin or gets diminished from the affected skin area. Hypo-pigmentation is often more noticeable in dark-skinned people as the scar tissue that replaces the afflicted skin tends to be lighter and pinkish. Unfortunately, there are no many effective treatments available yet for hypo-pigmentation. Laser resurfacing and chemical peels may be helpful for some people.
Acne scars (the real deal!)
- True acne scars are permanent indentations from collagen damage.
- These scars come in many shapes, forms, sizes, and even colors.
- Acne scar treatment may vary depending on the scar’s category. However, generally speaking, the most common ways to treat them are through temporary dermal fillers and laser treatments.
Types of Acne Scars
Although all acne scars may look horrible, not all acne scars are created equal. Some types of scars are more frustrating than others. Frustrating because treatment may not be always 100 per cent successful.Generally, acne scars fall into two main categories: hypertrophic and atrophic scars.
1. Hypertrophic Scars – This type of acne scar can be thick and sticks out above the skin (raised hypertrophic scars) or scars with over-produced skin tissue that are thicker than the surrounding skin (also known as keloid). Unfortunately, hypertrophic scars can grow bigger than the original wound, which make them a lot more noticeable.
How hypertrophic scars develop: Overproduction of collagen is the primary culprit for developing hypertrophic scars.
Common treatments: Steroid creams (cortisone), tapes or injections can help flatten and shrink the scar. Interferon injections may also be used to soften scar tissue.
2. Atrophic Scars – This type is the most difficult to treat. Atrophic scars form a sunken area or depressions in the skin (pitted scars) due to collagen damage or damage to fat or other tissues below the skin. To make things a bit more complicated, atrophic scars have three main categories:
3. Ice Pick Scars – small, deep and very narrow scars with jagged edges. The deep holes in the skin surface look like the skin has been punctured by an ice pick or a sharp object. Ice pick scars may look like a large, open pore.
How ice pick scars develop: When an infection from a deep, inflamed blemish such as a cyst works its way to the surface of the skin, it leaves long column-like scar. Ice pick scars are the aftermath of damaged skin tissue.
Common treatments: Punch grafting or punch excision.
4. Rolling Scars – Rolling scars look like a rolling or “wave-like” furrows across otherwise normal-looking skin. They are common for people who have had patches of skin that have been distressed by inflammatory acne for a long period of time. They tend to become more obvious as the skin ages and loses its plumpness and elasticity.
How rolling scars develop: Rolling scars occur as a result of bands of scar tissue that form below the skin, which gives the skin surface a rolling appearance or rounded, sloping edges.
Common treatments: Subcision
5. Boxcar Scars – broad, round or rectangular depressions with steep, defined edges or craters in the skin. They usually cover smaller areas than rolling scars.
How boxcar scars develop: An inflammatory breakout destroys collagen, which can result in a substantial loss of skin tissue. Since the skin over this area is left without support, it creates a sunken or depressed area in the surface of the skin.
Common treatments: Dermal fillers, laser resurfacing, punch excision or elevation.
Factors Why Acne Scars Occur
You may be wondering why some people breakout like you but how come your acne scars are worse than them or fade a lot slower and longer than other people. Apart from the severity of scars as listed above, other factors may come into play, which include:
- Skin Type – People with darker skin tones, such as African American, Indian and Asian, the skin produces more pigment as its natural response when their skin gets inflamed.
- Age – As you age, collagen and subcutaneous fat levels of your body diminish, which can limit the help it provides to give your skin the structural support it needs. As a result, acne scars can become more pronounced.
Ways to Prevent Acne Scars
Preventing acne scars is not rocket-science – getting on a good skincare regimen, not picking or popping your zits, not traumatizing the skin, and protecting it with SPF are quite a few simple ways to avoid acne starring. But did you know that so-called acne solutions can be used to prevent nasty acne scars from happening? They all follow the same rule: Take action as soon as you get a zit.
How Do You Do It
One of the best tips to help prevent acne scars that top dermatologist recommend is to consider medication to prevent zits from sprouting on the first place. “Early, effective medications can treat pimples and prevent inflammation that can cause permanent scarring,” advised Josh Zeichner, assistant professor in the dermatology department at Mount Sinai Medical Center in New York City. Decreasing inflammation is the key.
The mainstays: Benzoyl peroxide and salicylic acid
1. Benzoyl Peroxide
It is an antibacterial ingredient that penetrates deep into the pores and kills acne-causing bacteria. Benzoyl Peroxide is commonly used in treating white heads, with percentages that range from 2.5 to 10 per cent. To avoid skin irritation and dryness, start with the lowest concentration, and then work your way up if there are no visible results after a few weeks of use.
What many people notice during their first week of using benzoyl peroxide to treat acne is it will leave the skin uncomfortably dry. Applying an oil-free moisturizer every day can help give your skin the moisture it needs, which manages dryness and flaking. You may also feel that after applying benzoyl peroxide on your skin, you may get red and a little itchy. You may also notice that new pimples erupt. These side effects are normal, particularly during the initial stages.
Keep in mind that benzoyl peroxide is a slow worker so don’t expect instant results. You’ll get the worst of side effects by week 3, but as you soldier through them, you’ll soon see improvement in your skin by the tenth week, and a relatively clearer skin by week 12 and beyond.
2. Salicylic Acid
- Considered a BHA (beta hydroxyl acid), salicylic acid is one of the most common ingredients to treat acne by exfoliating the skin to remove dead skin cells in the pores, without the risk of rupturing pores or breaking tiny blood vessels. Here are some reasons why treating acne with salicylic acid is recommended:
- It speeds up skin cell turnover by making skin grow faster
- It increases collagen production, which helps fills in indentions in the skin, making it smooth and plump
- It is anti-inflammatory so it reduces redness
- It works the same as alpha-hydroxy acids, such as glycolic acid and lactic acid, but it is used in a much lower concentration.
However, the problem with most acne products that contain salicylic acid is that they do not have the right concentration of salicylic acid at the right pH.
Typically, the percentage of salicyclic acid ranges from 0.05 to 2 per cent in over-the-counter acne treatment products, depending on the severity of acne, and look for an optimal pH of around three to four. Salicylic acid works best in products that stays on the skin for longer periods, such as a lotion, gel or toner.
Both benzoyl peroxide and salicylic acid must be applied continually on the skin even after your acne has cleared, as pores can clog again that can cause your acne to go back.
3. Try AHAs
Alpha hydroxy acids or AHAs, which are widely used in chemical peels, may help prevent new lesions from forming. AHAs are typically used when you need more than the two main stay approaches, benzoyl peroxide and salicylic acid. Unlike what many people think how AHAs work, they peel off the top layer of the skin, sloughing off dead skin cells and unclogging pores in the process. They do not prevent the sebaceous glands from producing sebum or oil. AHAs also help regenerate new skin cells and speed up healing of lesions.
Glycolic acids are the most common AHAs used in treating acne. In many cases, over-the-counter AHA products are used in combination with benzoyl peroxide as they work best that way. When you first notice a pimple, applying an acne product with AHA immediately can regenerate the skin in that particular spot, which prevents the pimple from maturing.
However, the downside of using AHAs is that it can make your skin a lot more sensitive to the sun, which is why applying sunscreen on treated areas is necessary. Dryness or redness may also occur. If that happens, suspend the use of your AHA product while the skin heals.
4. Get a Cortisone Shot
A quick trip to dermatologist for cortisone injection can significantly slim down your chances of a big, deep, inflamed acne from scarring. New York –based dermatologist Dr. Jeremy Fenton says, a cortisone shot will not only get rid of large acne lesions (also referred to as nodules and cysts or cystic acne), but it also reduces the risk of scarring. When cortisone is injected directly into an area of inflammation, it can quickly reduce swelling and heal the lesion.
These lesions have a diameter of 5mm or higher and are deep within the skin, making them resistant to topical treatment. The tricky part is that if you left them untreated, cystic acne can last for several weeks or months, and can scar pretty badly.
However, the downside of a cortisone shot is it can be a bit painful, although your dermatologist can use a topical anesthetic to numb the area before giving the injection.
5. Take Your Chances On Lasers
Laser technology became popular for a reason: they work. In most cases, once you have scars, they are permanent. Don’t wait for too long before taking any action to prevent acne scars. Fractionated resurfacing lasers make controlled wound to the skin possible, wherein only the irregular collagen in the scar gets damaged that still allows new, healthy collagen to take its place.
- The Hype: Acne Patch – Acne patches aren’t new, though they are more popular in Asian countries like Korea and Japan. They are typically packaged as a sheet of sticky dots in different sizes. All you need to do is pop one dot over a zit and then wait for the patch to work its magic. Seriously, how do they work? It depends on the type of patch (yes, there are two types of acne patch, so don’t get confused).
- Unmedicated patch – It works by taking care of the wound, because when you think about it, a pimple, zit, acne or whatever you want to call it, is basically a wound that’s a bit oozy and disgusting. The Unmedicated acne patches are usually infused with salicylic acid and tea tree oil, and are made out of a thick and flexible hydrocolloid dressing, which can help:
- Keep the blemish from trauma – your fingers! We all know that touching and picking those pesky zits are the ultimate culprits for scars.
- Absorb excess fluid by drawing gunk out of the blemish and getting it sucked into the patch and away from your skin, which may speed up healing time. That is why when you remove the patch, you can see a white pod in the middle of the patch.
- Reduce redness and irritation from the get-go.
- Medicated patch – These are sold in sheets, but they are more rigid and thinner than unmedicated patches and have vinyl-like texture. The advantage of it is when you stick a patch on your face, it wouldn’t be too obvious.
- The Unfamiliar: Acne-Clearing Blue Light – It sounds complicated, but it works simply by letting the blue light penetrate into the sin’s surface to stop future breakouts. The blue light helps eliminate bacteria, hitting acne right at the source without stripping it dry. It is also more gentle than abrasive scrubbing.
- Discontinued Drug: Accutane – Also known as isotretinoin, accutane is a form of Vitamin A that can influence how an acne develops in four ways:
- It significantly shrinks the size of the skin’s sebaceous glands and dramatically reduces the amount of oil these glands produce.
- Because accutane reduces oil production, it also reduces the amount of bacteria in the skin, particularly P.acnes, the acne bacteria that live in skin oil.
- It slows down the rate skin cells inside the pore is produced, which prevents pores from becoming clogged.
- It has anti-inflammatory properties
Note that in about 30% of patients that used accutane, acne breakouts may get worse within the first month of use, but dramatic results were seen after completing a cycle. However, accutane is a dangerous drug. It caused debilitating conditions, including Crohn’s disease, ulcerative colitis and inflammatory bowel disease in people who used it as acne medication, and can cause life-threatening birth defects in pregnant women. Accutane was removed from the market in the United Staes in June 2009.
What You May Have Overlooked In Your Skin Care Regimen
Many people focus on over-the-counter acne treatments or more advanced treatment for relief, and tend to ignore the basics: Your skin care.
Poor skin care regimen may cause more acne to erupt, causing future irritation and scarring. In other words, no matter what treatment you apply on your skin to treat acne, if you are ignoring your basic skin care must-do’s, you can make your acne worse and get those awful scars. If you want to finally take the reigns back on your skin, follow this “NOT-DO” list.
1. Using Harsh Bar Soaps To Cleanse Your Face
Avoid using irritating facial washes, harsh scrubs and exfoliants that can aggravate your already inflamed and tender skin. Switch to a ph-neutral non-soap cleanser and/or look for noncomedogenic products. Noncomedogenic means the product is specially formulated so it won’t clog pores or aggravate acne.
2. Washing Too Frequently
You are not doing your skin any favor by overwashing your skin. It strips your skin of its necessary oils and rid skin of essential nutrients it needs to combat future breakouts. Moreover, when you strip your skin of its natural oils, it produces excess oil in an effort to recover and repair itself.
3. Picking Or Squeezing Your Pimple
It’s a big no-no – avoid popping your zits it at all cost no matter how tempting it can be sometimes. Picking results in more inflammation or secondary infection, both of which can lead to severe scarring. Always remember to keepyour hands off your face (your fingers can easily transfer bacteria to your face which can force acne further ino the skin) and get proper acne-fighting treatment instead.
4. Skipping Spf
When your skin is inflamed or when you feel your are using too many skin care products on your face to get rid of acne, you may thought it’s okay not to wear sunscreen. Listen, do not rely on the sunscreen in your moisturizer or stop using sunscreen because it is a skin care routine you shouldn’t miss – ever! Sun exposure can make scarring worse, and you should use a dedicated sunscreen on your face to really protect your skin from the sun’s harmful UV rays.
5. Using The Wrong Products
Layering too many products on your skin can clog pores that dehydrates your skin, leading to more breakouts is one thing. And using the wrong products is another story. For instance, using oils like tea tree oil that you thought were good for acne prone skin, can easily clog your pores, making your acne worse.
6. Using The Wrong Makeup
If you have a zit or a bad acne breakout, concealing the blemishes with makeup can be helpful. However, piling on heavy concealers or foundations can make your acne worse. Many full coverage products contain pore-clogging ingredients, such as heavy oils, that can trap oil and dirt underneath your skin. As a result, it aggravates your acne and slows the healing process, leading to scarring.
Opt for makeup products with acne-fighting ingredients, such as willow bark or salicylic acid. You will know your make up has skin-loving benefits if:
- They have a lighter formulation, such as a serum or cream, which can allow your skin to heal
- They are water-based, which is less likely to clog your pores
- They are mineral or noncomedogenic
Ways to Diminish Acne Scars
Okay, so let’s say prevention is not an option anymore. Are there options to fade acne scars? Fortunately, you have multiple options to choose from.
1. Over-the-counter Creams: Cortisone and Fade Creams – Using a cortisone cream on red or swollen scar can calm your skin, says Dr. Tina Alster, a Georgetown University professor of dermatology. The cortisone is absorbed by the skin cells and minimizes inflammation.
2. Skin Lighteners – Diminishing acne marks and lightening your dark spots is probably on the top of your list after battling an acne breakout.
- Kojic acid, a natural skin lightener derived from mushroom extract, is widely used as it is relatively safe and effective.
- Retin A or Retinoids is often prescribed to treat acne scars, however in many cases, people stopped treatment long before it even has a chance to work usually because of the side effects. Scary changes, including dry skin, redness, peeling and flaking usually occurs by week 3 of using Retin A, but these are normal. Once you get over this hump, your skin can typically adjust to the medication by week 6 to 8, and see visible results.
- Retin A works as comedolytic – sounds complicated, but it simply means it keeps pore blockags from forming. Pores that are not clogged means pimples can’t develop. The added benefit of using Retin A is its ability to reduce post-inflammatory hyperpigmentation. It may help fade dark spots on your skin left from an acne breakout.
- Other recommended ingredients to look for in lightening creams are arbutin (also called bearberry extract) and Vitamin C (also known as ascorbic acid).
3. Laser and Filler Treatments – You may want to consider booking an appointment with your dermatologist if your acne scars seem to linger longer than what you expected.
- Laser skin resurfacing – It uses fractionated laser technology that can even out the skin surface and boost production of collagen in one to three sessions. As the skin’s building block, collagen can help fill in acne scars.
- Ablative laser – It is the gold standard for resurfacing and managing acne scars. Ablative laser vaporizes the scar by literally removing the outer layers of the skin, burning away scar tissue and allowing smoother skin to take its place. It also stimulates collagen to tighten, reducing the visibility of scars. Typically, three to five sessions are needed.
- Non-ablative laser – It stimulates collagen production without damaging the surface of the skin. Non-ablative may be less efficient that ablative lasers, but it has no significant downtime.
- Filler injection – Fillers are gel-like substances that are injected into scars to smoothen them, filling in the indentations left behind from deep acne scars. Filler injections give great results immediately but the procedure must be repeated every four to six months. Most patients are able to resume their normal routine right after treatment, provided that the treated area is not large. Consider hyaluronic based dermal filler because it is compatible with the human body.
4. Micro-needling – If laser and filler treatments are not up to your alley, you might want to consider micro-needling, a technique that builds collagen below the scar. However, multiple sessions are normally necessary to diminish acne scars.
5. Subcision – It is a minor surgical procedure that involves the use of a special hypodermic needle to sweep under the scar and break the “tethers” of the scar to the underlying tissue.
6. Punch grafting – It is popular for delivering excellent results in treating deep ice pick-type scars without the downtime of other procedures. Punch grafting, also called punch excision or punch elevation, involves removal of the damaged skin by cutting out tiny areas of scarred skin. Local anesthetics are often used to numb the area. You should be able to see the results between six and 24 weeks.
Yes, acne – the confidence-sucking mammoth of skin troubles can plague the best of us. Worse, the dreaded acne scars can linger around for months before fading. Acne scars can happen to anyone, however, don’t lose hope because treatments are available to finally remove acne and acne scars from your life – for good. It may not be an easy road ahead, but it’s possible.You just need to figure out which method is right for you.