The Different Types of Acne Scars Explained

When it comes to their complexion, most people want a smooth surface that is free of unsightly pigmentation spots or marks. With the constant exposure to damaging UV rays here, it is no wonder that aesthetic companies have been upping their game when it comes to acne scar treatment in Singapore. You can even find over-the-counter products that claim to lighten them in the comfort of your own home.

But what happens if these topical products do not work in your favour? After all, the issue that you may be facing could be far too severe for any of them to resolve. To figure out why they rarely ever seem to work, you need to begin by understanding what they are, how they are formed and which types of it are you battling with to determine the best method to rid them effectively. There is more than one type of them — in fact, there are at least five common ones that you might also have. Read on to find out all you need to know in the journey of ridding unwanted acne scars.


Factors Behind Acne Scar Formation

Acne scars often occur as a result of deep tissue damage from breakouts that could have been triggered by several different influencing factors.

1. Overproduction of Oil

The most common involves an overproduction of facial oil known as sebum. This oily secretion plays an important role in maintaining moisture in your skin. However, too much of it can build up within your pores where it may combine with dead skin cells. This can create the right environment for the proliferation of bacteria, known as Cutibacterium acnes (formerly known as Propionibacterium acnes), which can cause inflammation.

2. Hormonal Imbalance, Diet & Stress

Another common trigger of acne (and acne scars as a result) is hormonal imbalance. This is most often caused by a group of hormones known as androgens. Excessive amounts of these hormones may enlarge sebaceous glands and increase the production of sebum. Poor diet and all causes of stress that you get are also believed to be major contributing factors. Foods that are lower on the glycaemic index, including quickly digested, refined carbohydrates are often cited as the most common culprits.

3. Causes of Acne Scars

Attempting to squeeze zits can frequently lead to scarring during the healing process. However, the severity of the zit itself plays the largest role in the formation of visible marks. Some people may suffer from a severe form of it known as acne cysts that are essentially large pockets of accumulated pus. In such cases, the inflammation runs so deep, it can cause severe tissue damage that your body might not unable to recover using the right amount of collagen. Instead, the cyst merely dries up, leaving behind a visible mark on your face. Smoking can also greatly increase the odds of scarring since it reduces the efficacy of your body’s ability to heal itself.


Different Types of Acne Scars

There are at least five different types of marks that you may experience following a breakout, of which the atrophic ones are most common. More commonly referred to as pockmarks, the latter appear as indentations that sink into the skin surface. Three types fall under this category: ice pick, boxcar, and rolling scars. These are usually formed when insufficient collagen is produced when your skin attempts to heal itself and their overall size largely depends on the severity of the breakout. The remaining two types are raised bumps known as hypertrophic (or keloid) marks as well as post-inflammatory hyperpigmentation.

1. Ice Pick Scars

These are deep-set, narrow, and small atrophic pockmarks that appear as if an ice pick has been pricked into your skin. These indentations usually occur after an infection of a cyst and too little collagen was involved in the healing process. The indentation extends into the dermis layer and is most often the toughest to eliminate.

2. Boxcar Scars

Boxcar indentations also sink into your skin but they tend to be much larger in width. They can appear as either deep or shallow as well as round, oval or squarish in shape. The sides of the indentations are typically steep and vertical. Similar to ice pick indentations, these atrophic marks are typically formed when there is not enough collagen to form new skin tissue as the inflammation heals. Generally, these marks are more difficult to treat if they are deeper.

3. Rolling Scars

These atrophic blemishes appear quite similar to boxcars but can be differentiated by their edges, which are much smoother than boxcar indentations. You may see them on thicker skin, such as the areas around your cheeks and jaw, appearing in wave-like patterns. These marks occur as a result of fibrous tissue from the epidermis layer being pulled deeper within the skin.

4. Hypertrophic & Keloid Scars

Unlike the first three, hypertrophic and keloid marks appear as firm, raised bumps on your face or back. These marks tend to form on your body, rather than your face, due to an overproduction of collagen. The difference between these two blemishes lies in their severity. Keloids are much more severe as they can cover a larger surface area. They may also be hereditary.

5. Post-Inflammatory Hyperpigmentation

Although they are often mistaken for permanent marks, post-inflammatory hyperpigmentation is not a true scar. They are actually discolourations that occur after a pimple heals as a result of an overproduction of melanin, following an inflammation, and usually fade away over time. Post-inflammatory hyperpigmentation does not create an indentation to your skin, rather, a dark spot on the surface of your skin. Do note that these spots can take extremely long to disappear for some people.


Acne Scar Treatments

In this modern day and age, treatments for this issue are aplenty. Depending on its severity, some individuals may require a concoction of treatments to alleviate and diminish the appearance of facial marks or wounds. Apart from the cost of the procedure, the skincare treatment for pockmarks will depend on their type (rolling, boxcar, ice pick etc.), the skin composition of the individual in accordance to the pigment quantity as well as the recovery downtime after the procedure.

Therapies for the lesser grades of scarring has always been somewhat a challenge for dermatologists as the pockmarks are often not as problematic to the patient as opposed to the consequences of overtreatment. Fortuitously for us, there are now several other options to choose from where the risk profile aligns with its severity:

1. Chemical Peel

Chemical peels are generally a positive prospect for addressing the scarring left from acne lesions. These can be from superficial to deep effect and are generally considered for milder cases. Chemical peeling process typically involves obliterating the superficial layers of the skin to the required depth followed by subsequent replacement and remodelling by normal tissue. In many cases, multiple treatments are necessary for efficacy. If you are opting for this, be sure to have patience and pace out the interval of sessions. Experiencing a case of chemical burn or the thinning of your skin may just be the last on the list of things that you will want to deal with. After all, this process is rather like an exfoliation process, but instead of abrasive bits, chemicals are used instead.

2. Microdermabrasion

Microdermabrasion is a superficial and painless remedy that offers individuals more texture benefit than permanent surface change. Results for microdermabrasion typically varies between individuals and multiple therapy sessions are necessary for visible results. Fine wrinkles and post-inflammatory hyperpigmentation have been observed to reap the best improvement with this treatment, while superficial scars may benefit from more profound and aggressive settings.

3. Skin Rolling / Microneedling

Also known as “collagen induction therapy”, skin rolling or microneedling usually enters the fray when expensive machinery is not available or desirable. It is the technique of rolling a barrel-studded device consisting of a cluster of fine needles at the targeted area. The needles will then perforate into the skin repeatedly to a controlled depth of 2 to 3 mm. For bigger surface areas, a needle-studded rolling pin or a tattoo gun without pigment may be used. There is an expected downtime of approximately 5 days for the procedure. Take note that prior to your session, your face or back is clear of acne. This is to prevent the needles from piercing into an inflamed zit, carry the bacteria on the needles and then infect the other areas of the skin during the process. It is advisable to have this treatment done professionally and for the aftercare to be carried out to a T. Avoid going to the pool, sauna or tanning after the session and if you have decided to use a store-bought do-it-yourself kit at home, ensure that you have read the instructions thoroughly before you start.

4. Non-Ablative Therapies

There are multiple forms of non-ablative therapies that include pulsed light, wavelength lasers, radiofrequency as well as other forms of energy delivery. These therapies are more effective for rolling or possibly hypertrophic marks as compared to keloid, boxcar or ice pick ones as they are less aggressive in general. Additionally, these modalities are more frequently used in conjunction with darker skin types as ablative management usually carries a higher risk of pigmentary alterations.

5. Punch Excision / Grafting

Punch excision is most ideal for ice pick blemishes that are deep and have a narrow opening. The procedure involves cutting the mark out by means of a small hole-punch device before stitching up the wound. On the other hand, punch grafting involves extracting a small piece of skin from another area of the body and thereafter, carefully placed into the void where the pockmark once resided. Both sites are then stitched up or held firmly in place with the help of surgical tape and left to heal on its own.

6. Subcision

For some individuals, their acne lesions are sometimes depressed. This can be attributed to the fibrous scar tissue that tethers down their skin surface. As a result, all the chemical peels and laser treatments in the world will limited effect. The next best alternative comes in the form of a subcision where a small needle is used to emancipate the fibrous scar tissue beneath the surface of the skin. As the affected area heals over time, new collagen will help thrust the base of the acne scar up. Patients can typically observe minor improvements in their skin condition after each session.


The Takeaway

1. The Type of Blemishes Matters

The right remedy largely depends on the severity of your blemishes. If you suffer from mild scarring such as post-inflammatory hyperpigmentation, it should be easily resolved. For more severe cases, however, using the right acne scar removal treatment is the way to go. Of course, it is always best to prevent this altogether by resolving the root of the problem — acne. Acne scars can be a huge pain in the butt to deal with. But these skin-deep manifestations do not appear overnight and arrive as a result of deep trauma to the skin following a bout of acne. In most cases, prevention is better than cure — take these acne prevention tips to tackle the problem at its root and keep your skin radiant and blemish-free.

2. Speak to a Professional to Find the Best Way to Deal with Your Condition

It is best to seek professional help and consult your dermatologist for a fair assessment of your facial condition, and thereafter, consider his or her advice on a suitable and most viable treatment route. However, it is highly imperative for one to comprehend that the fundamental objective is an improvement of their appearance rather than absolute cure or complete elimination. It is most certainly unrealistic for one to expect his or her complexion to return to a flawless state upon the early completion of treatment. Furthermore, the degree of improvement varies in relation to the skin colour and scar type of the individual.

If you wish to speak to a dermatologist or a professional or to understand more about which treatment is the best to help you in your journey to achieve a flawless complexion, feel free to speak to one over at Geo Aesthetics today.