Acne scarring is a common problem resulting from the healing of acne lesions. It can vary from mild to severe and significantly impact a person’s self-esteem and quality of life. Acne scarring manifests in various forms, from superficial marks to deep pits on the skin’s surface, and occurs when acne lesions heal with fibrous tissue replacing normal skin.
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What is acne scarring?
Acne scarring refers to the marks or changes in skin texture left behind after acne lesions heal. These scars are the body’s natural response to inflammation and can be permanent.
Who gets acne scarring?
Acne scarring commonly affects individuals who have experienced severe or prolonged acne, particularly those with a genetic predisposition or delayed treatment of active acne lesions.
Acne scars can present as atrophic (depressed) or hypertrophic (raised) lesions. The most common types include boxcar, ice pick, and rolling scars, each with distinct characteristics.
Impact and complications
Acne scarring can impact mental health, often leading to reduced self-esteem and body image issues. This can result in social anxiety and withdrawal, affecting both personal and professional interactions. The emotional distress can escalate to mental health concerns like depression. Additionally, societal pressures and stigma regarding skin appearance can intensify these psychological challenges.
Subtypes and variants
- Boxcar Scars – Wide, U-shaped scars with sharp edges.
- Ice Pick Scars – Narrow, V-shaped scars that go deep into the skin.
- Rolling Scars – Wavy indentations in the skin due to fibrous bands.
Treatment Options for Acne Scarring
The treatment of acne scarring is tailored to the type of scar, with each scar type responding best to specific treatments. While considering treatment options, individual skin type and the potential risk of post-inflammatory hyperpigmentation (PIH), especially in darker skin types is also considered.
Treatment for Different Types of Acne Scars
- TCA Cross For deep, narrow ice pick scars and some types of boxcar scars. Care should be taken in darker skin types due to PIH risk.
- Laser Resurfacing Useful for more superficial boxcar scars. Options include fractional CO2 or Erbium lasers, which help in skin regeneration. May not be appropriate for darker skin types due to PIH.
- Subcision & Fillers Ideal for lifting the depressed areas of rolling scars, providing immediate improvement.
- Microneedling Effective in improving skin texture by stimulating collagen production. Suitable for all skin types.
- RF Microneedling Enhances the benefits of traditional microneedling, particularly effective in treating rolling scars. Care should be taken in darker skin types due to PIH risk.
- CO2 Laser Resurfacing Fractional CO2 laser treatment is beneficial but should be approached cautiously in darker skin types due to the risk of PIH.
- Cortisone injections – can flatten scars
- Vascular lasers – can reduce redness of scars
These include retinoids and alpha hydroxy acids, which can help in mild cases and as adjunct treatments.
Isotretinoin and other oral medications may be considered for preventing new scars in some cases.
Options like medical grade chemical peels may also be effective, depending on the scar type.
The effectiveness of treatments varies, and some scars may be minimised rather than completely removed. Multiple sessions may be required for optimal results.