Everyone wants to avoid long term scarring. In order to do this, we must understand what causes scarring, how to prevent scarring, and identify different types of scars and treatment types.
Click here to read about Causes of Acne Scars, Prevention of Acne Scars, Types of Acne Scars, or Treatments for Acne Scars
Causes of Acne Scars
Scars are formed when there is injury to the skin tissue. In the case of acne, the injury is caused by the body's inflammatory response to sebum, bacteria and dead cells in the plugged follicle.
When tissue suffers an injury, the body reacts in order to minimize and repair the damage. White blood cells and a multitude of inflammatory molecules have the task of repairing tissue and fighting against infection. However, when their job is done they often may leave an unsightly path while trying to minimize the damage, which is the scar.
The occurrence and materialization of scarring is still not well understood. White blood cells and inflammatory molecules can remain at the site of an active acne lesion for days or even weeks. In people who are susceptible to scarring, the result may be an acne scar. There is considerable variation in scarring between one person and another, indicating that some people are more prone to scarring than others. Scarring frequently results from severe inflammatory nodulocystic acne that occurs deep in the skin, but scarring also may arise from more superficial inflamed lesions.
The life history of scars also is not well understood. Some people bear their acne scars for a lifetime with little change in the scars, but in other people the skin may gradually change and acne scars will actually diminish in size. People also have differing feelings about acne scars. A scar that causes embarrassment or distress for one person, even though the same size, may be accepted by another person as "not too bad." The person who is distressed by scars is more likely to seek treatment to moderate or remove the scars.
Prevention of Acne Scars
Scarring is different in different people, and it is difficult to predict who will scar, how deep scars will be, and how long scars will linger. It is also difficult to predict how successfully scars can be prevented by effective acne treatment.
Nevertheless, the only sure method of preventing or limiting the extent of scars is to treat acne early in its course, and as long as necessary. The more that inflammation can be prevented or moderated, the more likely it is that scars can be avoided. Any person with acne who has a known tendency to scar should be under the care of a dermatologist.
Types of Acne Scars
There are two general types of acne scars, depending on tissue response to inflammation: scars caused by increased tissue formation and scars caused by loss of tissue.
Scars Caused by Increased Tissue Formation
The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means "enlargement" or "overgrowth." Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury and the excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar.
Keloid or hypertrophic scars are normally 1 to 2 millimeters in diameter, but some may be 1 centimeter or larger. Keloid scars tend to "run in families"--that is, abnormal growth of scar tissue is more likely to occur in susceptible people, who often are people with relatives who have similar types of scars. Hypertrophic and keloid scars persist for years but may diminish in size over time.
Scars Caused by Loss of Tissue
Acne scars associated with loss of tissue are more common than increased tissue keloids and hypertrophic scars (lumpy, bumpy scars).
Treatments for Acne Scars
A number of treatments are available for acne scars through dermatologic surgery. The type of treatment selected should be the one that is best for you in terms of your type of skin, the cost, what you want the treatment to accomplish, and the possibility that some types of treatment may result in more scarring if you are very susceptible to scar formation.
A decision to seek dermatologic surgical treatment for acne scars also depends on:
Before committing to a treatment for your acne scars, you should have a frank discussion with your dermatologist regarding those questions, and any others you feel are important. You need to tell the dermatologist how you feel about your scars. The dermatologist needs to conduct a full examination and determine whether treatment can or should be undertaken.
The objective of scar treatment is to give the skin a more acceptable physical appearance. Total restoration of the skin, to the way it looked before you had acne, is often not possible, but scar treatment does usually improve the appearance of your skin.
Scar treatments currently available include:
Collagen injection: Collagen, a normal substance of the body, is injected under the skin to stretch and fill out certain types of superficial and deep soft scars. Collagen treatment usually does not work as well for ice-pick scars and keloids. Collagen derived from cows or other non-human sources cannot be used in people with autoimmune diseases. Human collagen or fascia is helpful for those allergic to cow-derived collagen. Cosmetic benefit from collagen injection normally lasts approximately 3 to 6 months.
Autologous fat transfer: Fat is taken from another site on your own body and prepared for injection into your skin. The fat is injected beneath the surface of the skin to elevate depressed scars. This method of autologous (from your own body) fat transfer is usually used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat is reabsorbed into the skin over a period of 6 to 18 months, the procedure usually must be repeated. Longer lasting results may be achieved with multiple fat-transfer procedures.
Dermabrasion: This is thought to be the most effective treatment for acne scars. Under local anesthetic, a high-speed brush or fraise is used to remove surface skin and alter the contour of scars. Superficial scars may be removed altogether, and deeper scars may be reduced in depth. Dermabrasion does not work for all kinds of scars; for example, it may make ice-pick scars more noticeable if the scars are wider under the skin than at the surface. In darker-skinned people, dermabrasion may cause changes in pigmentation that require additional treatment.
Microdermabrasion: This new technique is a surface form of dermabrasion. Rather than a high-speed brush, microdermabrasion uses aluminum oxide crystals passing through a vacuum tube to remove surface skin. Only the very surface cells of the skin are removed, so no additional wound is created. Multiple procedures are often required and there is no downtime away from normal everyday activities.
Chemical Peels: This procedure involves the use of a chemical to remove the top layer of the skin in order to smooth depressed scars and give the skin a more even appearance. It is most helpful for shallow superficial scars. Different chemicals can be used for different depth peels. Light peels require no healing time while deeper peels can require up to two weeks to heal. The amount of scarring and desired results determine the type of peel selected.
Laser Treatment: Lasers of various wavelength and intensity may be used to recontour scar tissue and reduce the redness of skin around healed acne lesions. The type of laser used is determined by the results that the laser treatment aims to accomplish. Tissue may actually be removed with more powerful instruments such as the carbon dioxide laser. Because the skin absorbs powerful bursts of energy from the laser, there may be post-treatment redness for several months. However, newer acne lasers, such as smooth beam, have minimal side effects and no downtime away from normal everyday activities.
Skin Surgery: Some ice-pick scars may be removed by "punch" excision of each individual scar. In this procedure each scar is cut down to the layer of subcutaneous fat; the resulting hole in the skin may be repaired with sutures or with a small skin graft.
Treatment of keloids: Surgical removal is seldom if ever used to treat keloids. A person whose skin has a tendency to form keloids from acne damage may also form keloids in response to skin surgery. Sometimes keloids are treated by injecting steroid drugs into the skin around the keloid. Topical retinoic acid may be applied directly on the keloid. In all cases the best treatment for keloids in a highly susceptible person is prevention by aggressively treating the acne early.
Again, acne scars are caused by the body's inflammatory response to acne lesions. The best way to prevent scars is to treat acne early, and as long as necessary. If scars form, a number of effective treatments are available. These treatments should be discussed with a dermatologist. Often times spots may look like scars but in fact no permanent scarring will result if effective acne treatment is aggressively pursued. Even though they are not true scars and disappear in time, they are visible and can cause embarrassment for weeks to months. Certain treatments can hasten the clearing.