Understanding your acne scars and how to treat them

Acne itself is hard to treat, and many who manage to beat this battle often find their skin riddled with hyperpigmentation and scarring.

Acne scarring can also be incredibly difficult to get rid ofand often requires a combination of topical treatments as well as dermabrasion, resurfacing lasers and peels. Which of these treatments work best depends on which kind of acne scarring you have.

In all cases, the first step to getting rid of your acne scars starts with defeating your acne. Acne is a sign of inflammation on the face and will decrease the effectiveness of scar treatments. Acne causing bacteria, such as p.acnes, also releases chemicals and compounds that can make scarring worse. Not to mention, treating scars while still experiencing acne will just add more scarring to the mix

It may take some trial and error to determine what kind of acne treatment will work best for you. If your acne is moderate to severe, it is best to consult a GP or dermatologist for prescription treatments.

The different types of acne scarring

Hypertrophic or raised scars

Raised scars often occur when there is an overproduction of collagen during the skin’s healing process, resulting in a raised bump on the skin.

There are two types of raised scars: hypertrophic and keloid. Hypertrophic scars are most common, while keloid scars are larger and more severe. Keloid scars are often the result of an injury like a cut; however, they are sometimes caused by acne.

Atrophic or pitted scars

Pitted scars are the opposite of raised scars and look as though they are hollow or tunnelling deeper into the skin. This type of scarring often occurs when the skin didn’t fully rebuild because there was insufficient collagen in the skin. Pitted scars could even indicate that p.acnes bacteria interfered with skin reparation or that there was too much inflammation present. This type of scarring is also most common in those who experience cystic acne.

There are three types of pitted scars:

Boxcar scars: These scars are often square and have well-defined edges, much like a chickenpox scar.

Icepick scars: Icepick scars are small and narrow and often tunnel deep into the skin.

Rolling scars: Rolling scars are similar to boxcar scars but have shallower and smoother edges like a rolling hillside. Both rolling and boxcar scars are common in people whose cystic acne ruptured the cell wall causing the acne to tunnel.

Post-inflammatory pigmentation or flat scars

Flat acne scars, also known as post-inflammatory pigmentation, are not actually scars. Instead, they are a result of discolouration occurring during the skin’s healing process. These types of marks can be challenging to get rid of but are not permanent.

There are three types of post-inflammatory pigmentation:

Post-inflammatory hyperpigmentation: This is when the skin becomes darker after acne and often takes on a brown/purple shade.

Post-inflammatory hypopigmentation: This is when the skin loses pigment, often presenting as white marks.

Post-inflammatory erythema: This is when the skin becomes pink or red. PIE is also one of the more recently defined types of post-inflammatory pigmentation.

How to treat atrophic and hypertrophic scars

Unfortunately, both hypertrophic and atrophic acne scarring can’t be treated with topical creams and require attention from a dermatologist or esthetician. These types of treatments are often expensive and require patients to take time off work and school.

Common treatments for atrophic scars include:

• Dermabrasion
• Laser resurfacing
• Subsicion
• Punch excision
• Fillers
• Chemical peels
• Mirconeedling
• Chemical reconstruction (TCA Cross)

Common treatments for hypertrophic acne include:

• Topical steroids or steroid injections
• Surgical removal
• Laser treatment
• Silicone sheeting

How to treat post-inflammatory pigmentation

Luckily for those with post-inflammatory pigmentation, this condition is often not permanent and can be treated with topical serums, creams and sun protection. If your pigmentation proves to be stubborn and persists for over a year, dermatologist treatments can offer more effective help.

Common home treatments for post-inflammatory pigmentation include:

• Retinol (prescription or OTC)
• Vitamin C serums
• Niacinamide serums
• Azelaic acid
• Broad-spectrum SPF
• Chemical exfoliation (lactic acid, glycolic acid, salicylic acid)

Common dermatologist treatments for post-inflammatory pigmentation include:

• Hydroquinone
• Laser treatments
• Chemical peels
• Prescription retinoids

Remember, when it comes to all acne scar treatments, it’s crucial to protect the skin from UV damage by using a broad-spectrum SPF. This will stop the skin from incurring further damage and lessen any irritation that treatment may cause when exposed to the sun.