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  5. How To Get Rid Of Acne Scars?

Do your acne scars constantly trouble you? Acne in itself is quite emotionally draining! But the prominent scars they leave behind can cause you more stress.

The good news is, these scars can be treated with time, dedication, and the right treatment. But before that you need to understand what they are.

In this article, we have put together information that will make it easier for you to understand more about acne scars and how you can treat them.

What Expert Says

“Side effects due to procedures for acne scars depend on the type of the procedure. Persistent erythema due to microdermabrasion, hematoma due to sub-session, PIH due to lasers can be a possibility.”

Dr. Harish Koutam, Chief Dermatologist, SkinKraft

What is Acne Scarring?

Acne scars are the result of breakouts caused by skin pores blocked with dead cells, excess oil, and bacteria. Blocking leads to swelling of the pores, which may cause breakage in the follicle wall. This can create deep or shallow lesions that prominently appear on the skin.

Shallow lesions are usually minor and heals faster than the deep ones. Deep breakage in the wall of the pore increases the risk of spilling out the infected material into the surrounding tissues thus creating deeper lesions. Your skin tries to repair these lesions by forming new collagen fibers. However, these repairs aren’t smooth compared to your original skin.

Did You Know?

Acne scars on the face, back, chest are common. About 80% of people aged between 11-30 years get acne and at least 1 out of those 5 people develop scars.

Why Do We Get Acne Scars?

Scars appear because your body tries to repair your acne. How your body responds to a wound determines the amount of scarring you will get.

Acne scars are the result of inflamed acne lesions. These lesions penetrate through your skin, damaging the tissues beneath it. This may leave a mark or pit behind.

Acne scars take on two primary forms. One in which a scar develops where there is a loss of tissue resulting in an indentation on the skin surface, or the other form in which a scar, a raised one, develops on the skin surface. This type of scar indicates that your skin is doing its normal function well. In the process of helping the acne heal, your skin creates collagen. When there's too much collagen, then there are chances that raised scars develop.

Did You Know?

While smaller blemishes can still scar your skin, it's the big ones that mostly do the damage as they tend to extend deeper into your skin. Deep nodular or cystic breakouts are more likely to destroy your skin tissues and leave scars.

Are Acne Scars Genetic?

They are not genetic. While acne scars themselves aren't a genetic condition, certain genes can certainly influence how likely you are to develop acne. It's such that if your parents struggled with acne, you might too. This can ultimately lead to development of acne scars.

Types of Acne Scars

Types of Acne scars

Acne scars can be atrophic (caused by a loss of tissue) or hypertrophic (caused by excess tissue). 

A. Atrophic Scars

Such scars are shallow, flat depressions that usually heal below the top layer of the skin. Severe cystic acne is the most common cause behind atrophic scars, but there might be other types of acne as well.

These are further segregated into ice pick scars, boxcar scars and rolling scars.

B. Ice Pick Scars

Ice pick scars are the result of a severe acne lesion. They usually develop after an infection from cysts that work their way deep into the skin. Ice pick scars are commonly noticed on the cheeks.

These scars are narrower than boxcar and rolling scars. However, they are deeper and more noticeable to the naked eye. Ice pick scars tend to be tough to treat. Home remedies may not work for these scars and it requires aggressive treatment.

C. Boxcar scars

Boxcar scars are wider than ice pick scars. They look like round craters or box-like depressions with sharp edges, giving the skin a pitted, uneven appearance. They can be narrow or deep.

Boxcar scars are caused by widespread acne, chickenpox, or varicella. They occur due to inflammatory breakouts that destroy the collagen. This leads to loss of tissue, which creates depressions in the skin. Boxcar scars are common on the lower cheeks, or jaws, where the skin is relatively thick.

D. Rolling Scars

As the name suggests, rolling scars are wide with rounded, sloping edges. They make the skin look uneven and irregular.

They are caused by fibrous bands of tissues that develop between the skin and subcutaneous tissue below. The bands pull the epidermis, giving the skin a rolling appearance.

E. Hypertrophic Scars

These scars appear as raised lumps of scar tissue. They are the result of excess tissue in the area where the lesion had developed. This happens when scar tissues build up from previous acne spots.

Hypertrophic scars are equal to the size of acne that caused them. They are commonly noticed on the jawline, back, chest, and shoulders. Those with darker skin color are more likely to develop these acne scars.

F. Post-Inflammatory Hyperpigmentation

You may notice a dark or discolored patch of skin after your acne heals. This is not a scar but post-inflammatory hyperpigmentation, that happens when your skin is damaged by severe acne or if you’ve picked or squeezed your acne. However, your skin will regain its natural color over time with a good sun protection routine.

How to Remove Acne Scars?

There are several home treatments and in-office methods that people use to get rid of acne scars. (1)

1. Home Treatments

Before starting any treatment for scars, it is recommended to consult a dermatologist. It’s important for you to know your skin before going ahead with a treatment to reduce your acne scars.

A. Salicylic Acid

Salicylic acid, a naturally occurring compound, is a popular ingredient in most anti-acne skincare products. It helps clear dirt, skin cells, debris from your pores and reduces scarring. (2) which otherwise leads to acne.

This magic ingredient can be used to reduce swelling and redness in the area, which may minimize the appearance of scars. Salicylic acid is great for all scar types, however for people with sensitive skin, it is recommended to conduct a patch test before applying it on the entire face, as it may cause irritation or dryness.

B. Alpha Hydroxy Acids

Not only are they used to treat acne, alpha hydroxy acids (AHAs) also helps in reducing the appearance of scars (3). It helps to get rid of dead skin cells and prevent clogged pores.

AHAs help exfoliate the rough outer surface of the skin to improve texture and reveal fresh skin underneath. This may help with discoloration due to scarring.

C. Lactic Acid

Lactic acid is found in the form of various creams and lotions, available at your nearest drugstore. Many products for acne contain lactic acid.

Lactic acid works as a gentle peel to lift dead skin cells. It improves the overall texture of the skin and reduces the appearance of scars. (4) Lactic acid may help lighten dark scar tissue, however, it may cause hyperpigmentation in certain cases. Due to this possible side effect, it is advised to conduct a patch test before using.

Note:

Diluted apple cider vinegar can be used in place of a drugstore product due to its natural lactic acid components.

D. Retinoids

Topical retinoids come in the form of creams and lotions. Dermatologists recommend these to reduce discoloration and improve skin texture. (5) Topical retinoids are a good option to treat fresh acne scars.

Using retinoids during the early stages of acne can help prevent and reduce scarring. They can help lighten hyperpigmented acne scars, including those in people with darker skin tones. (6)

Topical retinoids may cause sun-sensitivity. Wearing sunscreen before you step out is a must.

E. Azelaic Acid

Azelaic acid, a mild acid found in grains such as barley, wheat, and rye, has anti-inflammatory (calms skin down) and antimicrobial properties, which prevent the bacteria living on the surface of the skin from growing and thus preventing acne breakouts. It helps in skin renewal, thereby facing dark spots, minimizing the appearance of acne scars and acne-related blemishes.

Azelaic acid reduces the amount of acne-causing bacteria and allows your pores to breathe. It is used to treat mild or moderate acne. Azelaic acid is available in the form of creams, gels and foams.

F. Niacinamide

Niacinamide is a form of Vitamin B3 that plays a vital role in keeping your skin healthy. It's considered to be a potent agent in minimizing hyperpigmentation and dark spots. It has anti-inflammatory properties that help treat acne and reduce scarring.

G. Sunscreen

Sunscreen plays an important role in skin health maintenance. Regardless of whether you have a skin condition, a good sunscreen is a must. It helps protect the skin from the sun’s UV rays and also reduces the appearance of scars. Direct exposure to the sun may darken acne scars.

Always buy a sunscreen that suits your unique skin type.

2. Home Remedies

A. Coconut Oil

Studies indicate that coconut oil keeps your skin moist. It prevents the skin from producing excess serum that reduces the risk of acne scars. (7) .Remember to use it only on the affected area to prevent further breakouts. 

Note : People with extremely oily skin should avoid applying coconut oil directly. It may clog pores and worsen the situation.

B. Shea Butter

Shea butter contains anti-inflammatory properties that help fight bacteria-causing acne. It also helps reduce discoloration and acne marks.

C. Turmeric Powder

The anti-inflammatory properties of turmeric help fight acne and prevent scarring. 

D. Lemon and Honey

Lemon and honey together can work wonders for your skin. Lemon is acidic in nature and contains antibacterial qualities. This may relieve your skin of excess oil and fight bacteria.

Lemon may not suit everybody’s skin due to its acidic qualities. Conduct a patch test before you apply it on your face. 

Honey is a good antiseptic for your skin and body. It contributes to your body’s healing process and helps reduce scars faster. It is also a great way to naturally moisturize your skin and prevent it from producing too much sebum.

E. Baking Soda

Baking soda, with its anti-inflammatory properties, can help fight acne and scars. However, skincare professionals do not recommend baking soda. It is said to soak up essential oils that may cause the skin to overproduce sebum.

You can mix one part baking soda and two parts water to form a gentle scrub.

F. Aloe Vera

Aloe vera helps regulate the production of melanin. This helps reduce pigmentation and discoloration.

G. Essential Oils

Essential oils have wound-healing properties. They help prevent the development of scar tissues. They also reduce inflammation, redness and smoothen the texture of your skin.

H. Onion Extracts

Extracts of onion can help in reducing acne scars along with inflammation, redness, and soreness. You can mix 1 tablespoon of onion extract and olive oil and apply it to your face. Leave it for 20 minutes and later rinse it.

I. Apple Cider Vinegar

The acidic properties of apple cider vinegar helps remove the top layer of the skin. This reduces the appearance of scars.

Tip to use: Dab cotton ball in the solution, apply it to your skin, and leave it for 10 minutes. You can add honey for better results.

3. Common Scar Removal Treatments (In-office)

Based on your skin type and the depth of your scars, a number of lab treatments are available to reduce scarring caused by acne.

A. Chemical Peeling

If you have shallow scars, this may be a good option for you.

Chemical peels reduce discoloration and scarring. They prevent breakouts and smoothen the skin. These peels work by removing the top layer of the skin and are a great way to rejuvenate the skin.

Chemical peels usually don’t work well for those with deep scars. You may have to try out a couple of peels before determining which one works better for you.

B. Microneedling or Rolling

Microneedling is highly beneficial to reduce scars, wrinkles, stretch marks and discoloration. It also contributes to skin rejuvenation and improvement in texture. (8)

The medical process involves inserting tiny micro-needles around scars. This stimulates the body to produce more collagen. Microneedling is said to work best for depressed acne scars instead of the raised ones. Some studies have also shown that the effects of micro-needling on acne scars work better when the treatments are combined with vitamin C. This treatment may take up to 9 months to see changes.

Rolling is also an affordable option to address acne scars.

However, microneedling or rolling can cause temporary side effects like redness, pain and inflammation.

C. Injections

Hypertrophic scars or keloids can be treated with corticosteroid injections. A few medications can be injected into raised scars to soften and flatten them. The process is conducted once every few weeks. Your dermatologist may combine these with other treatments.

D. Dermal Fillers

Dermal fillers are often confused with Botox. However, the former type smoothes out the skin by filling scars or wrinkles, as opposed to “freezing” muscles. Dermatologists may recommend using soft tissue fillers to reduce the appearance of scars. These fillers may either be ones that consist of a collagen-based product or other commercial fillers like polymethylmethacrylate (PMMA), hyaluronic acid (HA) and poly-L-lactic acid (PLLA).(9)

E. Laser Treatment

This is a popular and one of the most preferred methods used to remove acne scars by dermatologists. Laser treatment helps reduce the appearance of scars by removing the uppermost layer of the skin thereby revealing younger skin cells. This process uses focused light therapy and doesn’t involve any chemicals. It may not be suitable for those with sensitive skin.

What to keep in mind before getting a laser treatment done

  • Requires a board-certified dermatologist to conduct the treatment.
  • Side effects include redness, itching, swelling and temporary oozing.
  • At times sedation is required, depending on the depth of your scars.

F. Surgery

Dermatologists may advise a patient to undergo surgery in case of deep scars. Get this done by a board-certified dermatologist only.

G. Platelet-Rich Plasma Technique (PRP)

This technique draws inspiration from the belief that the body can heal on its own. Platelet-rich plasma technique (PRP) involves a large amount of platelets. These are concentrated into a small volume of plasma to stimulate growth factors in the body. This fixes broken tissues. PRP has recently been introduced to the world of dermatology.

According to a study, rolling scars responded better to PRP as compared to ice pick and boxcar scars.(10)

H. Punch Techniques

Punch techniques are used to treat ice pick and boxcar scars. They come in three forms:

Punch Excision (for mild acne scars)

In this technique, the scar is surgically removed and the skin is sealed to achieve a smooth texture.

Punch Elevation (to treat boxcar scars)

The procedure involves surgical removal of the scar, leaving the sides. The base is then reattached to the sides to give a smooth appearance.

Punch Grafting (for deep ice pick scars)

In this process, the wound is plugged with a sample of skin taken from another part of the body, usually the back or the ear.

Are There Any Side-Effects Of Treatments Of Acne Scars?

Dr. Harish Koutam, Chief Dermatologist at SkinKraft says, “Side effects due to procedures for acne scars depend on the type of the procedure. Persistent erythema due to microdermabrasion, hematoma due to sub-session, PIH due to lasers can be a possibility.”

How Can You Prevent Acne Scars?

Prevention is better than cure. So understanding your skin and taking the right precautions is crucial. Here are some skincare tips for you to avoid acne and scarring.

A. Avoid The Sun

Being adventurous is fun, but not at the cost of your health. Too much sun exposure can dehydrate your body.

This may cause it to over-produce oil, sometimes leading to blocked pores. If you have to stay out in the sun often, make it a point to stay hydrated.

B. Wear Sunscreen

Sun damage can lead to dark spots and scars from acne. Thus, apply sunscreen with at least SPF 30 everyday, all year round. Wearing sunscreen ensures that any acne scar you develop becomes less visible.

C. Don’t Pop Your Pimples

Popping pimples may increase inflammation. This may not only leave a scar behind but can cause an acne breakout.

Avoid touching your face as your hands carry bacteria and dirt that may lead to clogged pores.

D. Follow a Skin Care Routine

Maintain a proper skin-care regimen. Remember to wash your face and remove your make up before hitting the pillow. Cleanse, tone and moisturize on a regularly. Stay hydrated.

E. Don’t Scrub Too Hard

Don’t exfoliate your face on a daily basis. This may cause skin inflammation, redness and itching, which may lead to breakouts. However, keep your skin moisturized.

F. Treat your breakouts

To avoid scarring in the first place, it's important to get your acne issues under control thus preventing it from developing into a more severe form. Products like salicylic acid and benzoyl peroxide can target your current acne issues while preventing future breakouts. Moreover, you can make certain lifestyle changes like staying hydrated, eating right, etc. to prevent the development of acne.

G. Stay Hydrated

Water plays a major role in preventing acne and scarring. In order to refrain your body from over-producing oil (that may sometimes lead to clogged pores), stay hydrated. As it is rightly said, “Water is the cure for everything.”

Are Acne Marks Permanent?

People are often confused between acne scars and marks. Brown or red patches (discoloration) left behind by acne on a person’s face are marks that fade away with time. However, pits and craters are scars that stay.

Post Inflammatory Hyperpigmentation is acne marks that look like a flat, discolored surface. As the skin heals, it produces excess melanin. This causes the darkening of the patch. PIH however, does not damage the follicle and fades away over time, usually in about 24 months.

Scars may slightly fade over time but are permanent. However, there are several home and medical remedies with which you can get rid of them.

How Long Do Acne Scars Take to Go Away?

Acne marks (discoloration) usually fade away within 3-6 months. There are many ways to speed up the process. However, scars remain and can be removed medically or by using home remedies.

What is The Difference between Acne Scars and Acne Marks?

Acne Marks

People with a darker complexion may experience PIH (marks that appear brown). People with a lighter complexion usually develop post-inflammatory erythema (purple/red marks).(11)

These fade away with time. However, there are faster ways of getting rid of acne marks.

Acne Scars

Acne scars are deep indentations. They are usually caused by picking at a blemish and take much longer to heal. Although they may slightly fade over time, acne scars are usually permanent.

It usually takes medical treatment to reduce scarring completely. Atrophic scars appear as indentations in the skin.

Wrapping Up

In today’s technologically advanced world, treating acne scars has become an easy task. Fortunately, there are treatments to help minimize the appearance of scars. However, the first step remains to treat the acne that causes them. Your dermatologist can suggest the best treatment based on your skin type and severity of scarring.

Always follow a skincare regimen and maintain skin hygiene to avoid future outbreaks.

Begin By Knowing Your Skin

1. https://www.science.gov/topicpages/f/facial+acne+scars

2. https://www.ncbi.nlm.nih.gov/pubmed/1534332

3. https://www.fda.gov/cosmetics/cosmetic-ingredients/alpha-hydroxy-acids

4. https://www.ncbi.nlm.nih.gov/pubmed/20883299

5. https://www.ncbi.nlm.nih.gov/pubmed/30909329

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335493/

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364723/

9.
https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers

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