Acne Scars

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Introduction

Acne scars are marks left on your skin after pimples have gone away. Most people will have pimples in their lifetime, but not all pimples will leave scars.

Teenager with box scar and saucer acne scars on cheek

Who gets it?

Whether you develop acne scarring or not depends on the subtype of acne you suffer from. Usually, people with cystic acne tend to develop scarring. Your genetics also play role. Some people are more prone to scarring in general, in these people acne scarring is more likely. In people that are prone to keloid scars (thick, ropey scars), similar scars can develop after a spot of even mild acne.

What causes it?

The main cause of acne scarring is cystic acne. These are a particular type of pimples that cause lumps under the skin. The size of cyst also matters, larger and deeper the cyst the wider and deeper the scar. Picking and squeezing of acne can cause scarring too. When pimples get infected, they can also end up with scarring.

What does it look and feel like?

Looks like...

There are many different looking acne scars. You can have more than one kind of scar type on your skin where pimples used to be.

Ice pick scars look like deep, small circular pits ( almost like large pores)
Boxcar scars look like sunken areas of skin with sharp edges
Rolling scars make your skin look wavy
Hypertrophic or keloid scars are bumps raised above your normal skin
Hyperpigmentation areas are the dark red, brown or purple marks that can remain on your skin once the pimple is gone. They are not real scars and tend to fade with time.

Feels like...

Acne scars do not normally cause any pain or itch

Occasionally, keloid type acne scars maybe painful or itchy

What tests might be needed?

No tests are needed to diagnose acne scars. Dermatologists are able to assess the different scars by looking at your skin and discuss what treatment will be needed.

What treatments are available?

There are many treatments that can help your acne scars. But the most important thing when it comes to managing acne scarring is that prevention is better than cure. The best way to prevent scarring, is to treat pimples early! See your general practitioner for a dermatologist referral for specialised treatment for severe acne.

What can I do?

Get an early referral to see a dermatologist so that you can be put on the right treatment for scarring acne. This may include isotretinoin (also known as Roaacutane or Accutane) which is only availble through a dermatologist.
Try not to pick or squeeze your pimples! This leads to more scar formation.
Maintain good sun protection (scars are known to heal poorly with sun exposure).

Medical therapies

It is important to understand that most scarring treatment plans will involve several of the below options to achieve the best outcome for each patient.

Retinoid creams can help to make your scars less noticeable and will help your acne.
Acid creams can help make your scars less noticeable and will help your acne.
Chemical peels - these need to be performed by a doctor rather than a beautician as medical grade treatment will be required to treat most scars.
Fillers can be injected under the scar to lift the skin and level out the skin surface.
Steroids can be injected into raised scars to reduce the amount theylift off the skin surface.
Radiofrequency is heat energy (like a microwave) which helps even skin surface and is safe on people with darker skin who have acne scarring.
Laser therapy - there are many different forms and it usually requires an experienced specialist to address the different scars with different technologies.
Surgical removal of scars - some scars can be cut out but this is only for special types.
Vascular lasers can help to fix the red and brown colour of a scar.
Skin needling can be done to increase collagen production around the sca.r
Microdermabrasion and dermabrasion help to improve the skin surface (smooth the bumpiness from scarring).

What happens after treatment?

With treatment, your skin will have less noticeable scarring . It is important to understand that even with the best treatment plan most people can realistically only expect 50-70% improvement of their scarring.