Acne & Acne Scarring
What is Acne?
Acne is a common skin condition that occurs when hair follicles become clogged with oil, dead skin cells, and bacteria. It can cause a range of blemishes, including pimples, blackheads, whiteheads, and deeper cysts. Acne is most common on the face, chest, back, and shoulders.
Who Gets Acne? (Epidemiology)
- Acne affects up to 85% of teenagers and young adults, making it one of the most widespread skin conditions.
- Many adults in their 20s, 30s, and beyond also experience persistent acne or late-onset acne.
- It affects all skin types and ethnicities, though pigmentation changes (such as dark spots) may be more common in darker skin tones.
- Hormonal fluctuations, genetics, stress, and certain skincare products or medications can contribute to breakouts.
Types of Acne
Acne varies in severity and appearance, with different types requiring different treatment approaches:
Non-Inflammatory Acne (Clogged pores without redness)
- Blackheads (Open Comedones): Pores clogged with oil and debris, appearing as dark spots.
- Whiteheads (Closed Comedones): Small, flesh-colored bumps caused by clogged pores.
Inflammatory Acne (Red, swollen, and painful blemishes)
- Papules: Small, red, inflamed bumps.
- Pustules: Pimples filled with pus, often with a white or yellow center.
- Nodules: Hard, painful lumps beneath the skin.
- Cysts: Large, pus-filled, deep-seated acne lesions that can lead to scarring.
The Emotional Impact of Acne
Acne is more than just a skin condition—it can have a profound effect on self-esteem, confidence, and mental well-being. Many people with acne experience:
- Social anxiety and embarrassment
- Lower self-confidence in professional and personal life
- Increased risk of depression and emotional distress
- Negative impacts on quality of life
Seeking early treatment not only improves the skin but also helps reduce the emotional toll acne can take.
If acne is affecting your confidence or leaving scars, seeking early treatment from a dermatologist can help you achieve clearer skin and feel more comfortable in your own skin.
Why Does Acne Cause Scarring?
Acne scarring occurs when deep inflammation from pimples and cysts damages the skin’s structure, leading to fibrosis and permanent changes in texture as it heals. Severe acne, particularly nodular or cystic acne, causes significant inflammation that destroys collagen and disrupts the normal healing process. When the skin attempts to repair itself, it may either produce too much or too little collagen, resulting in different types of scars. In some susceptible people even mild acne can lead to scarring.
Risk Factors for Acne Scarring
Not everyone with acne develops scars. The likelihood of scarring depends on:
- Severity of Acne – Deep, inflamed cysts and nodules are more likely to scar.
- Delayed or Inadequate Treatment – The longer acne goes untreated, the higher the risk of scarring.
- Skin Type & Genetics – Some individuals are more prone to scarring due to genetic factors. A family history of acne scarring can increase the risk.
- Picking or Squeezing Acne – This increases inflammation and damage to the skin, worsening scars.
- Skin Tone – People with darker skin tones may develop post-inflammatory hyperpigmentation, while lighter skin tones may be prone to red marks (erythema).
Types of Acne Scars
Acne scars appear in different forms, each requiring a specific treatment approach.
Atrophic (Depressed) Scars
These scars occur when there is a loss of collagen, causing indentations in the skin. They are further classified into:
- Ice Pick Scars – Deep, narrow, and V-shaped scars that extend into the dermis, giving the skin a pitted look.
- Boxcar Scars – Broad, sharply defined depressions with steep edges, often seen on the cheeks and temples.
- Rolling Scars – Wavy, shallow indentations that give the skin an uneven, undulating appearance.
Hypertrophic & Keloid Scars
These raised scars result from excess collagen production during healing.
- Hypertrophic Scars – Thick, raised scars that remain within the boundaries of the original acne lesion.
- Keloid Scars – Large, raised scars that grow beyond the original lesion, often occurring on the chest, back, shoulders, and jawline.
Post-Inflammatory Pigmentation (PIH) & Erythema (PIE)
Though not true scars, these marks are often mistaken for scarring:
- PIH (Brown Marks) – Dark spots that occur after acne heals, common in darker skin tones.
- PIE (Red Marks) – Persistent redness that remains after acne, common in lighter skin tones. These may develop into scars over time.
Learn more here
Acne
Acne treatment options vary based on the severity of the patient’s acne, there are a number of available treatment options including:
- Correct skin care and lifestyle/diet
- Topical or oral antibiotics
- Topical retinoids
- Oral isotretinoin
- Extraction therapy
- LED light therapy
- Skin peels and other targeted treatments.
- Laser and light treatments
Acne Scarring
Acne scarring is best treated once all active breakout are under control. However we now understand the sooner we start treatment for scars the better!!
For persistent acne scars, there are multiple treatment options. The best option for you will depend on numerous factors including age, skin type, type of scarring, budget, downtime, and also personal preference.
Most people require a series of treatments and will see gradual improvement over time until we reach the desired endpoint.
Acne Scar Treatments
Acne scarring can be improved with various treatment options, depending on the type and severity of the scars.
1. Laser Resurfacing
- Fractional CO2 & Erbium Lasers
- These lasers remove the top layers of skin and stimulate collagen production
- Pulsed Dye Laser (PDL) & Nd:YAG Laser
- Targets redness in scars (PIE) and reduces hypertrophic scars.
2. Microneedling & RF Microneedling
- Tiny needles create controlled micro-injuries, stimulating collagen production.
- RF (Radiofrequency) microneedling can improve deeper scars.
3. Chemical Peels
- TCA Cross (Trichloroacetic Acid Chemical Reconstruction of Skin Scars)
- A high-strength TCA solution is applied to ice pick and boxcar scars, causing collagen remodeling.
- Lighter chemical peels help with pigmentation and overall skin texture.
4. Dermal Fillers
- Hyaluronic acid fillers temporarily plump depressed scars, making the skin appear smoother.
5. Subcision
- A needle is used to break fibrous bands tethering rolling scars, releasing the skin and allowing it to lift.
6. Surgical Excision
- Ice pick and deep boxcar scars can be surgically removed and stitched for better healing.
7. Steroid Injections & Silicone Gel
- Helps flatten hypertrophic and keloid scars by reducing excessive collagen production.
8. Skin Care & Topical Treatments
- Retinoids (e.g., tretinoin) encourage skin cell turnover and collagen production.
- Vitamin C and niacinamide help fade pigmentation.
Which Treatment is Right for You?
The best treatment depends on your specific type of scarring, skin type, and overall skin health. A consultation Dr Welsh can help create a personalised treatment plan for smoother, healthier-looking skin.
