Treating Acne Scars
The advice most doctors would like to give people who suffer acne is to seek treatment as soon as possible; it is much easier trying to prevent acne from scarring than to find a suitable and successful treatment for acne scars.
Ideally, if your acne is treated early enough, there should be little or no physical scarring. Unfortunately, though, scarring is a fact of life for many people with acne, particularly if treatment started late or wasn’t entirely successful.
Why one person suffers from acne scars and another doesn’t is, unfortunately, still not understood, and although certain skin colouring and hereditary factors may make some people more predisposed to acne scars than others. There are several treatments which may be offered to help lessen the physical effects of the scar, depending upon the type of scars you have. In order for you to know how to get rid of acne scars fast, you must first understand the basics of acne scarring.
What is A Scar?
An acne scar is usually a result of severe acne but in some people can occur even with mild acne. Scars occur when there is inflammation from an acne lesion that doesn’t heal properly, and tissue damage occurs. White blood cells and anti-inflammatory molecules rush to the inflamed area to fight infection and help heal the damaged tissue.
As the skin heals, scar tissue forms and fills the gap created in the skin’s surface. Although the inflammation will clear, the affected tissue remains in a damaged state, unable to return to normal. The difference between the skin and scar tissue is what makes the scar so visible, and the more inflammation, the more damage to the tissue.
The skin can reform itself if the injury is less than 0.5 mm deep or less than a fraction of a millimeter wide; injuries deeper or wider cause scars. Picking or squeezing a spot is not recommended, however tempting it may be, as it can damage the skin tissue so easily.
Typically, acne scars can be raised, level with or lower than the surface skin, and luckily there is much that can be done to help acne-scarred skin. A dermatologist will need to evaluate the type of treatment needed, as different scars require different remedies, so you may be offered more than one. Other factors to consider may include:
- The depth of the scar – a deeper scar is much more likely to require aggressive treatment than a faint scar;
- The type of indentation the scar has left;
- The amount of tissue damage overlying the scar;
- The length of time the scar has been present;
- The degree of improvement expected from the treatment;
- The change in your appearance after treatment.
Types of Scars
Some acne lesions will produce red blemishes known as macules. These macules are also known as pseudo-scarsand may change the skin’s colour or leave a hyper pigmented mark on the skin, which in time may fade completely.
They are considered a post-inflammatory change to the skin rather than an actual scar, where the redness or hyper pigmentation remains as the skin goes through its healing process.
This can take anything from 6 to 12 months, providing no more acne occurs in the area. Any remaining change in the skin which leaves a blemish after a year is considered a scar.
Generally there are two types of scars caused by acne: those that cause an increase in tissue formation, and those caused by tissue loss. The scars that increase tissue formations are known as hypertrophic or keloid scars. A hypertrophic scar occurs when the wound heals to become red, raised and itchy, but over time becomes flat and pale.
A keloid is very similar, but the scar continues to grow and can become several times larger than the original spot. Both of these scars tend to be found on the chest and back of young people with acne buy may occur on the jaw line or cheeks. Scars that cause tissue loss are much more common and take many forms, including the so-called icepick, rolling and boxcar scars.
Icepick or ‘pock’ scars are narrow sharp holes in the skin, generally found on the cheeks and usually narrower than 2 mm. They extend deeply into the dermis, or subcutaneous layer of the skin, and are hard and fibrotic.
These types of scars are generally too deep for skin-resurfacing treatments, such as laser treatment, so are usually treated by surgery. Each icepick scar is dealt with individually, usually with a technique known as a punch treatment.
Rolling scars have an undulating appearance and feel about them, looking almost like fingerprints in the skin. They may be soft and can be flattened out easily by lightly stretching the skin or may be held down as they are attached to subcutaneous tissue. Boxcar scars can be very small (looking more like open pores) or large craters but regardless of size they have sharp vertical sides.
Two rare forms of acne, keloid acne and Acne conglobata, cause particularly aggressive scarring. Keloid acne stimulates the scar forming process, sending it into overdrive. Excessive amounts of collagen are produced, and firm raised irregular scar tissue forms. This is commonly found along the jawline, the chest and the back.
Very rarely are keloid scars treated by surgery itself. If surgery is performed, radiotherapy may be given afterwards to prevent the scar from reforming and growing. The main treatment for keloid scars is the injection of steroids into the scar. This has to be repeated every two months or so until the scar is soft and flat.
Even when it is flat, the scar will still leave a visible mark on the skin. Acne conglobata can leave large pink translucent scars, often referred to as ‘tissue paper’ scars. They are extremely difficult to treat.
Types of Treatment
In order to get rid of or minimize acne scarring, a combination of treatments may be offered.
Topical Creams (tretinoin)
A non-surgical form of treatment for very fine acne scarring, topical creams can be applied directly to the scars. They help to stimulate collagen production in the skin and may also be applied to depressed scars before another treatment is used.
Chemical peels involve a procedure where acid is applied to the skin In order to accelerate the removal of old dead cells from the skin surface. This then promotes new cell growth. There are three types of peels, superficial, medium and deep. All three require pre-treatment products to be used at home before the peel is applied.
The peels can be used on specific areas, such as around the eyes or mouth, as well as over the face and neck. Peels can take anything from a few minutes to over 30 minutes.
Superficial peels remove the top layer of skin cells, or epidermis, and have to be performed by either a qualified beauty therapist or a dermatologist. A combination of alpha-hydroxy acids (AHAs) and beta-hydroxy acids (BHAs), glycolic acid, lactic acid, salicylic acid and maleic acid are used.
Treatment takes only a few minutes, and afterwards the skin may look pink and feel tight for a couple of hours. Treatment for at least six weeks may be required before any results are visible.
Medium peels penetrate the skin deeper, removing the skin cells from the epidermis and the upper dermis (the middle layer of skin), and have to be performed by a dermatologist. Trichloroacetic acid (TCA) is normally used in these peels, and is sometimes combined with glycolic acid.
The peel remains on the skin for a few minutes and is then neutralized. A burning or stinging sensation may be felt during and after treatment, and skin can be very red or even go brown afterwards. Although, this will settle down it can take up to six weeks for the skin to go back to normal after this peel. Treatment may have to be repeated every 6-12 months to sustain results.
Deep peels penetrate the dermis, and are only performed by a dermatologist or surgeon. Phenol is the main ingredient, and a local anaesthetic may be given before the procedure takes place. The results can be dramatic. The peel is applied to the face and left for approximately 30 minutes.
During this time the person feels as if his or her face is ‘freezing’. After treatment painkillers may be required, and there may also be peeling and redness. The skin needs to be protected from the sun and UVA rays after treatment, and the dermatologist will offer support and post treatment information. This type of peel is one-off treatment, unlike the other two chemical peels.
These are treatments most suited to icepick scars. There are three types of punch techniques, but they all use an instrument called a punch biopsy tool, which looks similar to a pastry cutter. The methods used are known as:
- Punch excision, where the scar is removed under local anaesthetic by the punch tool and the wound is left to close and heal;
- Punch elevation, where the walls of the scar are left intact and just the base of the scar is cut, then lifted to the surrounding level of the skin;
- Punch replacement, where the scar is removed by the punch biopsy tool and the area is filled by skin grafting, usually with skin from behind the back of the person’s ear.
These are another treatment for acne scars. They can be used on their own or in combination with other scar treatments. Fillers literally plump up, or fill out, the skin where the scar has caused it to sink. They are also used when the sunken scar has been forced upwards, through nearby skin being overstretched.
Fillers are composed of collagen, the person’s own fat, and polymer implants, which are injected directly into the scar. Although they may only work as a short-term method (6-12 months) they can be repeated, and this treatment may improve some scars by up to 50 percent.
In some cases, cosmetic surgeons may use hyaluronic acid, a natural material for acne scars. This acid helps to glue the skin cells together, and is considered an alternative skin filler.
Dermabrasion removes the surface of the skin, so shallow and nodular scars become less obvious. There are two types of dermabrasion, one that requires a motorized took known as a dermatome, and another which uses a fine wire brush.
The dermatome has a spinning metal head, similar to an electric razor. This treatment promotes healing of the skin, encouraging and stimulating collagen, which plumps up the sunken areas of scarring, and the results are usually long-lasting.
The procedure can take up to an hour and is performed under local anaethetic by a surgeon or dermatologist. Bear in mind it may take several weeks before the scabs heal and the redness of the skin has subsided.
The treatment can only be used on acne skin that is no longer active, otherwise infection, inflammation and possible scarring may occur. Dermabrasion should not be confused with microdermabrasion.
Microdermabrasion involves a find jet of minute crystals being sprayed across the person’s face, using a hand-held instrument which vacuums up the loose dead skin. The flow of the crystals and the vacuums are pressurized according to skin type and the desired result.
This treatment is suitable for shallow acne scars, and is often used before laser or pulsed light treatment is given, to improve the penetration of the light through the skin.
Microbermabrasion stimulates collagen growth and realigns the skin’s cells in the epidermis, which causes the skin to thicken. After treatment, the skin may be red for a few days. There are several different microbermabrasion treatments available; they vary in intensity, and treatment may be performed by a qualified beauty therapist or a surgeon, depending upon the strength of the treatment involved.
Laser treatments are most suited to shallow scars, and are either ablative or non-ablative. Ablative treatment or laser resurfacing removes the top layer of the skin; it literally burns off or vaporizes the skin, and is generally more precise than mechanical abrasion.
It has been a popular treatment but is falling out of favour due to the long down time after treatment and the fact that it can cause the skin to become red or darker depending on your skin type.
Non-ablative laser or subsurfacing treatment works on the skin underneath the top layer, stimulating new collagen production without injury to the skin. It is much slower than ablative laser but there is no downtime and no obvious visible effects on the skin following treatment.
After ablative laser skin resurfacing treatment, the skin may remain red for a considerable time, in some cases up to six months, and it is necessary to protect the skin from the sun for at least a year after treatment. The most common used lasers for acne include
- Carbon dioxide (CO2) laser
- Erbium YAG (ErYAG) laser
- Long-pulsed erbium (YAG) laser – pulsed, yellow light
Sometimes a procedure known as a subcision may be used to treat tethered rolling acne scars. It involves inserting a specialized sterile needle with a cutting blade at the tip into the base of the scar. The fibrous strands of scar tissue are cut, encouraging collagen fibres to fill the depressed area of the scar and raising the sunken skin to the surface.
Following subcision, the skin is often swollen for three to four days and there can be a lot of deep bruising which may last two weeks or so.
The dermaroller was developed in Germany and is not widely used, but it is a very effective method of treating acne scars. It is based on the principle of needling – if you insert a hypodermic needle into the skin, it will not leave a permanent mark as it is too small but will generate considerable new collagen production.
The dermaroller is a small metal wheel which is studded with over 100 1.5mm needles. This is rolled up and down the scarred area leaving thousands of punctures which generate lots of new collagen production. The skin is very red for up to four days after treatment but soon settles with no long-term problems.
The fraxel laser is a CO2 laser where the laser beam is split into thousands of tiny beamlets. It works on the same principle as the Dermaroller, producing thousands of tiny injuries to the skin, which in turn leads to new collagen production. Downtime can be several days.
Trichloracetic acid (TCA) CROSS Technique
CROSS stand for cross-sectional reconstruction of skin scars. It is a technique developed in Korea and involves the careful application of 100 percent TCA, using a sharpened orange stick, to the base of boxcar scars. This causes an injury to the skin and considerable, very local, production of collagen. It is one of the few methods that can effectively treat boxcar scars.
There are certain things you can do to help to prevent scarring from occurring.
- Seek treatment soon. Early treatment is the best preventative against permanent scars, or those that are difficult to treat. The longer acne is tolerated before treatment, the higher the likelihood of scarring.
- Wash your face daily in antibacterial soap or solutions.
- Try not to pick your spots, tempting though it may be. You are more likely to damage the skin around the spot, creating scar tissue and inflammation. If you do need to squeeze a spot, then apply heat to the area first to open the pore, clean with an alcohol-based cleanser and apply pressure on either side of the spot. Once the pus or blackhead has been expressed, stop squeezing – if you see blood you have damaged the lower part of the skin and could be left with a scar!
- Protect your skin from the sun – use factor 15+ sunscreen for daily use, especially on the face, and avoid getting sunburnt.
- Use non-comedogenic cosmetics, face and hair products.
- Consider taking essential fatty acid supplements (EFAs). These have anti-inflammatory effects on the skin, as they are converted into prostaglandin, a hormone-like substance. The body cannot make EFAs; they have to be found in your diet. Gamma linoleic acid is particularly useful and is present in evening primrose oil and star fruit oil. Omega 3 fatty acids also seem to be beneficial; they decrease systemic inflammation, often found in those with acne. Omega 3 can be found in flaxseed oil, salmon, mackerel and other oily fish.
- Exfoliate your skin regularly using alpha-hydroxy acids. These increase the rate of cell production, decrease the stickiness of the cells and exfoliate the skin. The dead layer of skin is made thinner and smoother, and the opening of the pore is less likely to be blocked. Glycolic acid is the most popular type of peel.
Sometimes, its very important to get yourself educated about acne and the root causes and types of acne. Having some knowledge about adult acne is probably your biggest step you have undertaken to prevent and cure your acne. Without sufficient knowledge, you’ll probably start messing up your valuable face and cause irreparable damage due to acne scarring.
Thankfully, modern day research has found solutions to cure severe acne. But you must know that it will take time to heal depending on the severity of your acne scarring. If you are trying to promote a product, you must be very sure that the product delivers as it claims and give a one time solution for good! I don’t wish to create any hope or mislead anyone, especially those who are suffering from acne.
If you are here for a permanent solution, then I strongly recommend Help: Clear Skin (official site). Why? Because it’s a safe and natural way of curing any form of adult acne. Most importantly, it delivers! Please read my review on this product and find out yourself why I’m strongly recommending this acne curing system.