How to Get Rid of Acne Scars
Few skin conditions reduce self-esteem in the same way as acne . It turns out that a face full of painful wounds, not to mention unwanted, deaf advice from both family and strangers, makes people go into hiding. Throw in tons of unverified anecdotes on the Internet about how to get rid of acne permanently and you’ve got a recipe for disaster.
Acne treatment is crazy. Even if your breakouts are under control, you may be left with dark spots, red spots, dents and / or bumps – the ghosts of hellish pimples of the past. Today’s hyper-saturated skincare market offers thousands of products that are said to reduce acne scars, but to be honest, very few of them work. Before you saturate your face with retinol and acids to reduce acne scars, you need to find out what caused them in the first place – and even if it was scars at all.
What are acne scars?
Scar tissue forms when injury or illness interferes with your skin’s ability to produce collagen, the protein that gives skin its structure. As Dr. Megan Feely , a board-certified dermatologist practicing in New York and New Jersey, explained to me in an email, the same process causes acne scars. Inflammation – redness, pain and / or swelling – from deep-seated pimples can damage the surrounding skin cells, altering the collagen they produce to repair damaged skin. According to her, depending on the amount of collagen produced by damaged cells, patients are left with either atrophic or hypertrophic scars.
Atrophic scars occur when skin cells damaged by acne do not produce enough collagen to repair the damaged area, leaving indentations in the skin. Any dimples and dents you notice after the rash has healed are caused by atrophic scars. Typically, these scars are of one of three types: an ice ax (deep and narrow, like pinholes), a boxcar (wide and rectangular), and a roll (wide and rounded). The shape and size of atrophic scars depends on the extent of tissue damage and how your skin usually heals after injury.
When skin cells damaged by acne produce excessive amounts of collagen, they leave hypertrophic scars that are raised and often shiny. Hypertrophic scars are more likely to occur in severe wounds that do not close early in the healing process: a surgical incision is less likely to leave a raised scar than, say, a massive cyst that repeatedly scratches the head. However, whether or not you have hypertrophic scars is mostly genetic. If your family members tend to have lumpy scars, so do you.
Typically, scars only remain after very severe acne. Age and family history influence their development to some extent, but acne depth and duration are the main predictors of scarring, according to board-certified dermatologist Dr. Diane Madfes . The deeper the pimples and the longer they are left untreated, the higher the likelihood of permanent damage, unfortunately, from acne scars.
If you are not sure what you are dealing with, gently slide your fingers over the places of interest. If they are dented or raised, you have acne scars; if they are smooth but discolored, you have something else.
If my dark spots are not acne scars, what are they?
Not all rashes leave scars. Light lesions may not be deep enough to damage the collagen-producing cells , and some deep-rooted pimples do not linger long enough to cause permanent structural damage. However, the inflammation from the rash can irritate the cells closer to the surface of your skin, causing them to function abnormally for a while. Due to this process, some pimples leave dark or red spots as they heal.
The color of the acne spot depends on which cells are damaged. Dark spots are caused by damaged melanocytes , which produce melanin, the pigment that gives our skin its color. These spots are usually brown, but can be purple or bluish depending on your skin tone. This type of discoloration is called hyperpigmentation.
Some rashes leave red spots after healing, which is a sign of damage or irritation of the superficial capillaries. Your body’s first reaction to illness or injury is usually increased blood flow to the affected area, causing temporary redness and swelling known as erythema . Erythema usually resolves after the wound has healed, but sometimes the capillaries around the healing site are too damaged to immediately return to their normal state before injury.
Both of these conditions are caused by inflammation and persist after it disappears, which is why their full name is post – inflammatory hyperpigmentation or erythema – PIH or PIE for short. Superficial cell damage behind PIH and PIE is temporary, although the spots may disappear after months or years.
If your acne spots are not brown or red, you can tell if they are PIG or PIG by gently pressing on them with your fingertip. PIE temporarily disappears when pressed, because this stops blood flow to the affected capillaries. Unlike blood, melanin is static, so PIH tags will look the same no matter how much you poke at them.
What can I do to prevent scarring and pigmentation?
The likelihood of developing scars, PIH and / or PIE mostly depends on genetics, but as Dr. Madfes explains, inflicting additional trauma on already inflamed skin makes the situation worse:
“Some people tend to pick on an acne scar or acne bump because they feel a raised surface. […] A minor injury shouldn’t leave a mark, but if someone is going to pull out, try to remove or manipulate the pus, [they] increase the likelihood of scarring and hyperpigmentation. ”
On the other hand, whatever you can do to promote proper healing is good. In addition to counteracting the urge to squeeze, Dr. Madfes recommends keeping exposed lesions “moist and covered” until they heal — in particular, she says petroleum jelly is an excellent wound protector — and using a ceramide moisturizer. However, she stresses that the best way to prevent picking – and thus PIH / PIE or scars – is to eliminate the acne that is causing it.
How can I get rid of them?
Mild forms of PIH and PIE – without the accompanying active acne – go away on their own within a year. If you wait too long, sunscreen is the surest way to speed up the fading process. When your skin darkens from sun exposure, so does your PIH; Wearing a broad spectrum, high SPF formula daily protects your skin from further damage and promotes proper healing.
However, most people who seek treatment for PIH / PIE and scars also have active acne – and every therapist I spoke with for this story agrees that eliminating chronic acne is the first step towards treating post-inflammatory blemishes. Mild acne can be effectively treated with over-the-counter medications. Medfes doctor recommends to start with a product containingmicronized benzoyl peroxide, such as means Acne.org or cleanser from Differin. The non-micronized particles are too large to penetrate the pores, and their irregular size and shape makes them prone to clumping, making the medication less effective and more irritating. Retinoid adapalene – now available over the counter as Differin – effectively treats acne and PIH, as do ingredients like niacinamide and azelaic acid , albeit to a lesser extent. (I use and like melazepam , which is a cream with 20% azelaic acid.) Whatever treatment you choose, please be patient: topical medication to the results of at least three months.
Moderate to severe acne is helped by professional intervention, and the sooner the better. If your insurance covers this, see a dermatologist as soon as possible. If you’re not insured or have shitty insurance coverage, find a qualified beautician – a licensed professional who specializes in skincare techniques. Licensing requirements for beauticians vary by state and their individual areas of expertise range from waxing to laser resurfacing, so really do research them: visit their website, take a critical look at Yelp reviews, and / or get recommendations from friends and family. (This also applies to dermatologists, by the way.) When you request an appointment, especially ask for an acne specialist to see you. If you have a long wait, put your name on the cancellation list and check back every few weeks. At your appointment, provide your dermatologist or beautician with a detailed history of your acne – including medications you have tried in the past, anything you are currently taking, and your tendency to develop PIH, PIE, or scars – so that they can decide how best to treat … to treat you.
Both dermatologists and beauticians strive to eliminate acne before treating pigmentation or scarring, but many medications and treatments do both at the same time. Topical retinoids (tretinoin, tazarotene, and Adapalene) are well-known multitaskers and dermatologists often prescribe them to treat acne and hyperpigmentation. (Insurance companies have been known to save money on topical prescription drug coverage, so if your tube of tretinoin costs two hundred dollars – no exaggeration – look for manufacturer coupons and drug store discounts to get the price down.)
For patients with active acne and pigmentation, cosmetics prefer chemical peels. Licensed beautician and acne specialist Mary Freihofner told me that she uses glycolic, mandelic and salicylic acid peels for her hyperpigmented acne clients, but once the lesions have healed, she thinks microdermabrasion works faster. Erythema may not respond to treatment for hyperpigmentation, and in these cases, Freihofner considers vitamin C peels to be quite effective. A professional exfoliating face treatment usually costs between eighty and two hundred dollars, depending on your location and the specific treatments you choose.
If my acne scars are permanent, what should I do with the existing ones?
There are effective ways to treat acne scars, but they are not cheap. Because scars are caused by damage to the tissue in the dermis – the middle layer of the skin – treatment requires a certain level of penetration. Many dermatologists, including Dr. Fili and Dr. Madfes, treat acne scars with skin resurfacing techniques, most of which use lasers. Certain types of lasers can penetrate the epidermis – the outermost layer of the skin – to stimulate the collagen-producing cells in the dermis, reducing the appearance of scars over time. Lasers are less invasive than traditional surgical techniques, but any skin penetration comes with a risk: you don’t want to damage nerves or blood vessels while digging there. This is why laser resurfacing is only performed by specially trained, licensed professionals and therefore it is often expensive. A single laser resurfacing session can cost anywhere from a hundred to over a thousand dollars, depending on how long you need under the laser. These procedures are optional and technically not medically necessary, so they are not covered by insurance; always get a quote before scheduling a session.
However, you do not need to see a dermatologist for laser therapy; many skin care clinics offer the same services. Rael Levicke, a licensed cosmetologist and laser technician at About Face Skincare in Philadelphia, uses fractionated lasers and Intense Pulsed Light (IPL) treatments. She explained that superficial treatments – chemical peels, microneedling, and microdermabrasion – are somewhat effective in relieving hyperpigmentation, but literally don’t go deep enough to heal scar tissue. Fractionated lasers are her weapon of choice for acne scars and severe hyperpigmentation, but she prefers IPL treatments for erythema. Depending on the case, her patients see results after two to four sessions.
I know from experience how awful it is to feel like you’re doomed to endless cycles between painful breakouts and scars, so if there’s one point I really want to say is this: find a licensed professional who specializes in acne treatments. A dermatologist who is usually deep in melanoma, or a beautician who mainly does relaxing facials will probably treat you differently than someone with years of experience treating acne. There is someone out there who can help you – don’t give up until you find them.