Why one person suffers from pockmarks and another does not is still not fully understood. What we know is that certain hereditary and pigmentation factors may render some to be more susceptible to acne marks than others. Depending on the type of scab you have, there are remedies on the market to help improve the physical appearance of these cicatrices. To determine which solution would be the most efficient in reducing the appearance of your acne lesions, you must first understand how they came to be. Keep reading to find out more.
What is a Scar?
An acne scar is customarily a result of severe acne. However, it can occur as a result of mild acne for some. These disfigurements transpire when there is inflammation from an acne lesion that does not fully heal and damages the skin tissue. When that happens, anti-inflammatory molecules and white blood cells rush to the inflamed area to combat infection and help with the damaged tissue. As the skin gradually heals, scar tissue develops.
Although the inflammation will eventually clear in due course, the affected tissue remains in a damaged state and is unable to return to its former healthy state. The difference between the skin and damaged tissue is what makes the marks visible — how serious the inflammation is would determine how much damage the tissue would incur.
The skin can reform itself if the wound is less than 0.5mm deep or less than a fraction of a millimetre wide; injuries deeper or wider usually lead to the formation of scabs. Additionally, squeezing or picking a spot is never encouraged. However tempting it may be, that can impair the underlying tissue easily.
It is also important to understand that acne blemishes can be raised, level with or lower than the surface skin. Fortunately, there is much that can be done to improve areas that are affected by acne marks. A dermatologist will first need to evaluate the type of therapy needed as different scars require different remedies and it is not uncommon to be offered a concoction of treatments. Other factors to consider may include:
- the depth of the pock mark (a deeper pock mark is much more likely to demand aggressive treatment as opposed to a faint one)
- the duration of time the pock mark has been present
- the type of serration the pock mark has left
- the extent of tissue damage overlying the pock mark
- the degree of improvement anticipated from the treatment
- the change in your appearance after treatment
Types of Scars
Some acne lesions will result in red blemishes known as macules. Also known as pseudo-scars, these macules may alter the skin’s colour or leave a hyperpigmented mark, which may diminish entirely over time. They are regarded as a post-inflammatory change to the skin rather than an actual scar, where hyperpigmentation or redness persists as the body goes about its healing process. This can take anything from six to 12 months, provided no more acne develops in the area. Any other change to the skin which leaves a blemish after a year is only then considered to be a scar.
Generally, there are two types that are caused by acne: those that cause an increase in tissue formation and those caused by tissue loss. The cicatrices that increase tissue formation are known as hypertrophic or keloid scars, while those that cause tissue loss are much more common and can take many forms like the icepick, rolling and box scars.
A hypertrophic scar occurs when the wound heals to become red, raised and itchy at times, but matures over time to become flat and pale.
Unlike its hypertrophic counterpart, a keloid continues to grow till it becomes several times larger than the original spot. They tend to be found on the chest and back of the younger population suffering from acne. However, they may also come about in the areas of the cheeks and jawline.
Icepick or ‘pock’ scars are narrow and sharp apertures in the skin. They are typically found on the cheeks and are generally narrower than two millimetres. They extend deeply into the dermis or subcutaneous layer of the skin and are mostly hard and fibrotic. These types of cicatrices are generally too deeply rooted for resurfacing treatments such as laser therapy and instead, is usually remedied through surgery. Each icepick wound is handled and worked on individually, usually with a technique known as a punch treatment.
Rolling scars have an uneven feel and appearance about them that resemble fingerprints. They usually happen when fibrous bands of tissue are attached to the skin and subcutaneous tissue, pulling the epidermis to create the indentation that is observed. For the rolling variant, it is best to have it treated with subcision by snipping the bands that is pulling on the surface.
Boxcar scars are very easily observable because of how they appear as depressions with steep vertical sides, creating a very uneven appearance. They usually happen after an inflammatory breakout has wreaked havoc on collagen and the tissue is no longer there. When the skin doesn’t have tissue to rely on, it creates a depression that we now see.
9 Treatment Options to Combat Acne Scarring
Depending on the severity of condition, a combination of treatments may be offered to you by your dermatologist in order to combat or reduce the appearance of your acne blemishes.
1. Topical Creams
Topical creams are great for improving the skin’s texture by fading dark scars and stimulating collagen production for repair. If you are suffering from very fine acne lesions, most dermatologists would recommend topical creams as a non-invasive form of treatment that can be directly applied to the cicatrices. Most of them work by stimulating collagen production to improve the skin’s texture from the inside out. They can also be applied to depressed cicatrices before another treatment is carried out.
2. Chemical Peels
Chemical peels remove superficial acne scars by doing away with the topmost layer of skin. A typical session of chemical peel involves the application of a safe chemical to the affected area to remove the old dead cells on the surface to reveal the new layer below. This would encourage cell growth while maintaining your gorgeous appearance. The peels vary in intensity — namely superficial, medium and deep. All three types can be applied on specific areas like the face and neck, or around the eyes and mouth. A single peeling session can range from a few minutes to half an hour.
3. Punch Technique
Punch technique is known to be effective in treating icepick pockmarks in particular. There are three variations to this technique, namely the punch excision, punch elevation, and punch replacement. The punch excision is done by removing the scar under local anaesthetic and leaving the wound to close and heal. The punch replacement requires the dermatologist to remove the scar and fill the cavity with the skin grafting technique. Lastly, the punch elevation targets the base of the scar and lifts it to the surrounding level of skin to create a smooth appearance. All three techniques utilise the same instrument called the punch biopsy tool.
Fillers can be used on their own or in combination with other procedures to improve the appearance of your acne scars. They have shown great results in improving indented scars on a six-month basis. Fillers, as the name suggests, pump up or fill out the space where the pock mark has caused it to sink. They are also used when the sunken pock mark has been forced upwards. These fillers are made up of collagen, the individual’s own fat and polymer implants, which are injected directly into the scabs. This method has been reported to have a high success rate, improving the appearance of some cicatrices by up to 50 percent.
Dermabrasion eradicates the surface of the skin so that nodular and superficial cicatrices appear less visible. This technique promotes collagen stimulation which helps elevate the recessed areas of scarring. A typical procedure of dermabrasion may take up to a full hour and is executed under local anaesthetic by a qualified surgeon or dermatologist. While results have been reported to be long-lasting, bear in mind that it may take several weeks before the scabs gradually heal and the redness to subside. This procedure can only be performed on acne that is no longer active, otherwise inflammation, infection and further blemishing may occur. Also note that dermabrasion is generally safe for the fair skinned. People with darker skin may find themselves with scarring or skin discolouration after going through with this procedure.
Not to be confused with dermabrasion, microdermabrasion involves a fine jet of minute crystals being spurted across the face via a hand-held device that sucks up the loose dead skin. It is relatively effective for shallow acne lesions and is often applied before pulsed light or laser treatment is administered to enhance the incursion of light through the skin. Microdermabrasion incites collagen development and restores the cells in the epidermis, helping the surface layer to thicken. After the session, the targeted area may appear red for a few days. There are several different microdermabrasion treatments available and they vary in intensity.
7. Laser Treatments
Laser treatments are most suited to shallow cicatrices and are either ablative or non-ablative. Ablative treatment or laser resurfacing removes the top layer of the skin; it literally burns off the surface and is generally more precise than mechanical abrasion. Non-ablative laser or sub-surfacing treatment, on the other hand, works on the skin just beneath the top layer, inciting new collagen production without injuring or damaging the surface. Unlike its ablative counterpart, non-ablative treatment has no downtime and does not display any obvious visible effect on your appearance.
Sometimes, a procedure known as a subcision may be used for the remedy of tethered rolling acne wounds. The base of the scar is penetrated using a unique sterilised needle equipped with a cutting blade at its tip. The fibrous strands of damaged tissue are then carefully expurgated to promote the formation of new collagen fibres to fill the depressed area and elevate the sunken skin to the surface. Subcision is known to be effective in treating acne scars that are depressed and attached to the skin.
Dermaroller is a very effective method of dealing with acne cicatrices, although it is not widely used. It works on the very fundamentals 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 instead produce considerable amounts of new collagen production. A typical dermaroller is made up of a small metal wheel which is studded with over a hundred 0.5mm needles. This is then rolled up and down the affected area, creating thousands of punctures which in turn, stimulates the formation of new collagen production. It is excellent in treating both shallow and deep, depressed acne scars for patients across all skin types and tones.
Ways to Prevent Acne Scars
Despite the many safe and effective treatments available to help combat those pesky marks, the adage of prevention is better than cure stands true here. Take a look at these precautionary measures that you can take to prevent scarring from forming on your complexion:
- Get professional help as soon as you can. Dealing with it early is the best preventive measure to take against permanent and problematic cicatrices. If you are prone to breakouts and choose to ignore and skip treatment, the likelihood of permanent blemishes is much higher.
- Wash your face with antibacterial cleansers regularly.
- Use non-comedogenic cosmetics, face and hair products.
- As tempting it may be, you should never pick or squeeze your spots. You are more likely to damage the area around your spots. Injuring the tissue and causing inflammation.
- If you do need to squeeze a zit, apply heat to the area first to open the pore, sanitise the region with an alcohol-based cleanser and gradually apply pressure on either side of the spot. Once the insides have been expressed, stop squeezing immediately — if you observe blood, you may have damaged the lower part of your skin and could potentially be left with a battle mark.
- Incorporate essential fatty acids (EFAs) supplements in your diet. These are anti-inflammatory supplements that are converted into a hormone-like substance known as prostaglandin. The body cannot produce EFAs like Omega 3; they can only be obtained from your diet.
- Exfoliate your face regularly using alpha-hydroxy acids. These increase the rate of cell production, reduce the stickiness of the cells and clear the pores, leaving them unblocked.
Ideally, if acne is tended to in the early stages, there should be little to no physical facial blemishes. That is why it is so important to try and prevent acne from leaving a mark than it is to find a suitable treatment for the horrible scabs it leaves behind. Unfortunately, permanent blemishes would be common for those dealing with acne. This would be worse for those who start their treatment late or find their treatment not bearing results.
With the different solutions listing above, it could get rather challenging to settle on one. It is then advisable to get professional assessment and opinions to ensure that you are on the right regimen. When you visit an aesthetic centre like Geo Aesthetics, the experienced specialists are able to suggest a plan that is tailored to improve your skin condition effectively and efficiently. Feel free to speak to a specialist at Geo Aesthetics to find out more today.