Acne Scar Removal and Treatment

Having acne breakouts is not fun, but having acne scars can greatly reduce our confidence and make us feel self-conscious.

Acne scarring can be permanent, however acne scar removal treatment may help in reducing its appearance and make it barely visible.

What exactly is an acne scar?

Scarring is a common consequence of acne. It represents an altered wound-healing process after acne inflammation. Acne scars may be atrophic, hypertrophic, or keloidal. Atrophic acne scars are the most common types of scars, and may come in the forms of ice pick, rolling, and boxcar scars based upon morphology.

Types of acne scars

Types of acne scars (source).

1. Ice Pick Acne Scars

These are narrow (<2mm) deep scars that can extend into the deep dermis or even the subcutaneous layer. They are usually wider on the skin surface and become narrower as they go deeper. This type of scarring is difficult to treat with traditional resurfacing modalities.

Ice pick scars (source).

2. Boxcar Acne Scars

Boxcar scars are more shallow than ice pick scars, they are wide scars with a flat base and sharp margins. They can be either shallow (<0.5mm) or deep (>0.5mm). These type of scars are typically distributed over the cheeks and temples.  

Boxcar scars (source).

3. Rolling Acne Scars

These are wide scars (>4-5 mm) with sloped edges that produce undulating appearance on the skin surface. These types of scars usually have an abnormal fibrous attachment of the dermis to the subcutis.

4. Hypertrophic and Keloid Scars

Hypertrophic scars appear as bumps on the skin depending on the size of the healed wound, and are raised within the margin of the original acne wound. Keloids are raised scars that extend beyond the margin of the original wound. Keloid scarring tends to have a genetic component, where dark skinned individuals are more likely to develop keloids.

Hypertrophic vs keloid scars (source).

Preventing acne scarring

Although it is a common consequence of acne, not all patients who have inflammatory acne develop scarring. The reasons for the difference in propensity to scar remain unclear, but the type of inflammatory response and genetic predisposition may make you more susceptible to acne scarring. However, we can modify our risk of developing permanent scars in the following ways:

1. Quick and swift acne treatment

If you are having breakouts that cannot be managed with over-the-counter products, it is important to seek professional help early to reduce the risk of scars. Your doctor may suggest a mixture of topical and oral medications, prescription skincare as well as adjunctive treatment like comedone extraction, light therapy, chemical peels, and laser treatments. If you do have nodules or cysts, it may also be worthwhile to consult your doctor to see whether you are suitable for intralesional steroid injections to rapidly reduce the inflammation.

The longer you delay effective treatments and have inflammation in the skin, the higher the risk of permanent scarring.

2. No picking at zits and scabs

Never pick at scars and squeeze pimples. This causes further inflammation in the area, increasing the risk of secondary infections, thus delaying wound healing time and leading to scar formation. Give the pimple ample time to heal, and it will resolve over time.

3. Incorporating skincare actives into your routine

When your skin starts breaking out, it can be tempting to use astringent washes and harsh scrubs to remove the pesky bumps your skin. However, overuse of over-drying skincare can result in dryness, irritation, and even worsen breakouts. Over-washing the face can also lead to further unwanted skin irritation. Instead, it is important to treat the skin gently while incorporating light moisturisers and sunscreens into your routine. In addition, you can consider adding skincare actives gradually to improve:

1. Clogged pores
   – Chemical exfoliants (e.g. glycolic acid, mandelic acid, lactic acid, salicylic acid)
   – Vitamin A derivatives (e.g. retinols, retinol esters, retinoic acids)
2. Reduce inflammation and bacteria
   – Benzoyl peroxide
   – Azelaic acid is both anti-bacterial and anti-inflammatory
3. Reduce pigmentation
   – Sunscreens to reduce pigment formation
   – Pigment reduction (e.g Azelaic acid , Kojic acid , Arbutin)
   – Chemical exfoliants ( e.g. glycolic acid) to slough off existing pigmentation
   – Cystamine
4. Skin hydration
   – Hyaluronic acid
   – Free fatty acids/cholesterols/ ceramides

4. Be mindful of makeup  

Try to avoid applying heavy oil-based makeup that may lead to further clogging of the pores and result in worsening acne. Do not go to bed with makeup on, and have a gentle cleansing routine to effectively remove all residue. Also, make-up wipes should be avoided as they can be irritating to very sensitive skin.

By incorporating essential changes in your skincare routine and lifestyle, you can better manage your chances of experiencing permanent acne scarring and reduce any pre-existing acne scars as well. Speak to our doctor to learn about removing acne scars for your skin type.