What Are The Types Of Acne Scars
Atrophic scar: This develops when there is loss of skin tissue.
Ice pick scar: These are usually small and make noticeable holes in your skin.
Boxcar scar: These are depressed areas that are usually round or oval with sharp edges and very similar to chickenpox scars.
Rolling scar: These are typically seen on your lower cheeks and jaws where your skin is thicker. The indentations slope and produce uneven wavy skin.
Hypertrophic or keloid scar: These occur when the skin produces too much collagen to heal acne wounds and causes a mass of raised tissue on the skin. It can be itchy and tender.
|Are acne scars permanent?
Now time for some good news. Christenson says there are definitely things you can do to reduce acne scarring once you have it.
“The best course of treatment depends on the type of scarring you have, with indentation scarring often requiring more advanced treatment,” says Christenson.
For discoloration acne scarring, start by trying the at-home retail topicals aimed at counteracting hyperpigmentation, such as brightening serums or retinol-containing products.
“The one watch-out about using retinol is that it can make your skin more sun-sensitive. It’s always important to use sunscreen to protect your skin, but be even more diligent about applying sunscreen while using a retinol product,” warns Christenson.
Additional Treatments To Address Resistant Scars And To Supplement Results Of Previous Procedures
After performing a collagen remodeling procedure, it is important to assess the patient for treatment response and to determine if any other procedure would be beneficial. Possible treatment options during this phase include all of the aforementioned treatments of Step 1 along with injectable soft tissue fillers.
Dermal fillers are particularly helpful for broad, rolling scars that are soft and disappear when the surrounding skin is stretched. Ice pick scars and other tethered scars typically do not respond well to fillers and can even look worse.
A Collagen Remodeling Procedure
Since atrophic scars result from a loss of collagen, this phase of treatment consists of procedures meant to induce collagen growth. Examples of treatments that can induce collagen growth include traditional ablative laser resurfacing, nonablative fractional laser resurfacing, ablative fractional laser resurfacing, chemical peels, dermabrasion, and skin microneedling with platelet-rich plasms .
Traditional ablative laser resurfacing
This uses either of a 2940 nm erbium:yttrium aluminum garnet laser or 10,600 nm carbon dioxide laser. It is the most effective, but most aggressive procedure that may not be tolerated by all patients. These lasers target water, causing the precise ablation of the epidermis and dermis leading to thermal injury which promotes collagen remodeling. This procedure is rather invasive and requires multiple weeks of down-time.
Nonablative fractional laser resurfacing
As an attractive alternative to traditional ablative laser resurfacing due to less down time , this is a highly effective treatment. Most commonly, the 1550nm or 1540nm NAFR lasers are used to ablate a narrow microscopic column of skin instead of ablating the entire surface. However, the results are more limited and require multiple treatments.
This skin procedure involves the use of tools to remove the epidermis or part of the dermis. This procedure is highly operator-dependent and meticulous, but it allows the doctor to etch scar edges precisely.
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What Is The Treatment For Postinflammatory Pigmentation
Treatments for postinflammatory pigmentation include:
- Careful sun protection even though inflammatory acne lesions may improve, brown marks darken with sun exposure. Apply a broad-spectrum oil-free sunscreen and wear a broad-brimmed hat when outdoors
- Azelaic acidcream this reduces pigmentation as well as effectively treating mild to moderate acne
- Hydroquinone bleaching creams these inhibit the enzymetyrosinase that causes tanning
- Superficial chemical peels containing glycolic acid or Jessner solution.
Volume Replacement For Acne Scarring
In many cases, volume loss occurs under the skin as a result of acne, particularly with cystic acne. Replacing volume with dermal fillers can aid in treating scarring.
Dermal fillers are a quick and effective means of replacing volume loss to improve scarring. By injecting these dermal fillers underneath scarring, they help to replace lost volume, and lift the skin towards its normal level.
Alternately, fat can be transferred from the abdomen, hips or thighs, and be injected underneath the areas of scarring. As well as providing additional volume to the area, fat contains stem cells which help in the skin regeneration process. Fat transfer can be combined with skin needling or laser resurfacing in the same session to synergise the treatments.
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How To Treat Rolling Boxcar And Ice Pick Acne Scars
Even though we know we shouldn’t, we’ve all been guilty of popping our pimples every now and then. It’s just so tempting sometimes especially when it’s a big, juicy whitehead that’s practically asking for you to squeeze it. At first, it’s fine. But then it turns into a scab, and you pick it off. And then the pesky little bugger scabs again, and you pick that one off, too. And then, just as you’d been warned it would, it turns into a scar.
Even though the process of getting them is pretty much the same every time , as it turns out, all acne scars are not created equally. There are three main types of scars that an old zit can leave behind after you’ve messed with it. “Determining what causes the different kinds of scars is more of a soft science, but it has a lot to do with the type of acne a person has in the first place,” says Dr. Rebecca Kazin of The Washington Institute of Dermatologic Laser Surgery. “And often times it comes down to genetics, similar to stretch marks. Its all in the way a persons body reacts or heals. But unfortunately, we cant determine why one type of acne bump would cause a specific type of scar in one person. It could manifest entirely differently in someone else, and each needs to be treated in its own specific way.”
Give Your Skin A Deep Exfoliating Clean With Salicylic Acid
Salicylic acid is a beta hydroxy acid that is lipophilic, which means it likes to mingle with oils. This property allows it to penetrate deep into pores and clean them out. Alpha hydroxy acids, like glycolic and lactic acids, are hydrophilic, so they dont penetrate pores as well, but they are effective at exfoliating dead skin and preventing pores from clogging. Camp suggests cleansing with this gentle face cleanser by CeraVe, which contains salicylic acid and can be used to treat acne on the face, shoulders, and back.
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Things Your Skin Is Trying To Tell You And How To Respond
Fillers A substance such as collagen, hyaluronic acid, or fat can be used to “fill out” certain types of acne scars. Since fillers are eventually absorbed into your skin, youll have to repeat filler injections, usually every few months, depending on the substance used.
Punch excisions This type of skin surgery removes acne scars by individually excising, or cutting out, the scar. The hole left by the incision can be repaired with stitches or a skin graft. A skin graft uses a small piece of normal skin to fill in an area of scarred skin. Bruising can occur for one to two weeks after the procedure.
Microneedling Also called collagen induction therapy, this procedure involves pricking the skin repeatedly with tiny needles to stimulate the growth of new collagen. This can reduce the appearance of scars. Microneedling can improve the appearance of wrinkles, stretch marks, and fine lines. Skin redness may last a few days, according to the AAD.
I Treat Acne Properly
As we all know, prevention is better than cure. So the best way to go about acne scars is to treat acne well as soon as they appear. Seeing your dermatologist is the best way of knowing the type of acne you have and how to go about it.
Even before considering treating acne, you need to prevent the acne from occurring in the first place. You can prevent acne by taking good care of your skin at all times. Shower frequently, washing your back well. Try and shower immediately from the gym or from running to prevent sweat and dirt from clogging the pores and hair follicles. Gym clothes contain a lot of germs and dirt. Dead skin cells are removed every time you cleanse your body.
There are many over-the-counter drugs that you can consider using if your skin is acne-prone. First, use a body wash that has cleansing properties. Very harsh soaps might irritate your skin, causing inflammation and eventually acne. Washing sensitive skin with very hot water might lead to dryness. Dry skin can lead to a lot of flaking that may end up clogging the pores, leading to acne. Knowing your skin type will determine the anti-inflammatory body lotion that you will pick for your use.
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How Much Vitamin C Is Needed To Heal Acne Red Marks
The answer is that you want to look for a serum with the maximum 20% Vitamin C for maximum effectiveness.
The Pumori study explains that, Having a higher concentration of Vitamin From a clinical point of view, it is important to note that the efficacy of the Vitamin C serum is proportional to the concentration, but only up to 20%.
The study explains that Vitamin C is half gone from your skin after 4 days of its application, meaning it does stay in the skin for a few days after you put it on. This does not mean you need to apply it every 4 days however, as maximum photoprotection and positive effects can be achieved by applying every 8 hours as the study explains:
The half-life in the skin after achieving maximum concentration is 4 days. A persistent reservoir of Vitamin C is important for adequate photo-protection, and can be achieved by regular 8-hourly applications.
To summarize, youll want to get Vitamin C with the maximum effective concentration of 20%, and apply every 8 hours for maximum efficacy in helping heal skin and red acne marks as well as protect the skin from future environment and oxidant damage.
How Does Subcision Work On Rolling Scars
One of the methods I use is subcision which remains one of the most effective treatments for tethered, rolling, anchored and bound down acne scars. In this technique, I use a needle or a Nokor needle to untether the fibrous bands underneath the skin surface which are anchoring the scar to the muscle fascia and fat tissue.
Hence, lasers wont work on these types of acne scars as long as they remain anchored. Once I untether the fibrous strands within the scar with the Nokor needle, the skin scar is immediately released and the skin scar is elevated. Hence, subcision gives immediate improvement.
In the same session, I inject a dermal filler underneath the scar. The dermal filler gives volume to the atrophic scar and secondly the filler works as a buffer and prevents the scar from making new adherences.
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How To Get Rid Of Your Acne Scars
Acne is a common skin condition affecting about 80% of those between the ages of 11 and 30 at some point. It can be on your face, chest, back and shoulders. It may seem like the irritation will never go away, but it does. When it goes away, then you can deal with any remaining scars.
Your first line of defense is to consult a dermatologist. They will first focus on getting your acne under control. The fewer breakouts you have, the fewer scars youll get. The good news is that not all acne scars are permanent.
When your doctor turns attention to the scars your acne has left behind, they will typically explore three main treatment options:
1. Laser treatments
Vascular-specific lasers target blood vessels and can help lighten flat or raised scars that are pink or purple and help flatten raised scars. Doctors often use fractional or carbon dioxide ablative lasers to treat acne scars.
Afterward, the skin is swollen and red, and may bleed, for up to five days, says Dr. Kassouf. Also, you may need between three and five treatment sessions.
Laser treatments arent just for acne. Doctors use lasers to treat other types of scarring as well including those from burns, skin cancer and tattoo removal.
2. Chemical peels
Your dermatologist may apply a chemical solution to the skin. This causes it to blister and eventually peel off, creating new, regenerated skin thats usually smoother than the old skin.
Hypertrophic Scars And Keloids
Poonsak Pornnatwuttikul/Alamy Natallia Mikulich/Shutterstock
Some types of acne leave scars that appear as enlarged, raised growths of tissue. These acne scars are caused by too much scar tissue. Hypertrophic scars and keloids look similar, but the latter are more raised than the former.
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How To Get Rid Of Acne Scars Fast Overnight Home Remedies
- Vinegar acts as a peeling agent to remove the topmost layer of skin. This causes cell turnover and promotes healing with the occurrence of new cells.
- Lemon/Lime Juice the juice from lemon or limes helps to generally lighten the shade of acne scars making them less noticeable.
- Apple Cider Vinegar acts similar to vinegar stated above, is good for pH balance and other health benefits. Be sure to dilute it with water a bit before applying directly to skin.
While some of the above home remedies can show you how to get rid of acne scars fast, sometimes if the scars are older or deep you will need to opt for a more stronger solution like a good topical cream or even a surgical procedure as stated above.
Ways To Get Rid Of Rolling Scars
Before you undergo any kind of treatment for your scar, it is important to understand what type of scar you have. Based on that, your dermatologist will chart out your treatment method and help you understand the limitations of the treatment method as well.
Though most type of scars can be considerably reduced with treatment, removing the scar completely might be a challenge and it is important that the patient understands this limitation before the treatment is started. This will help in keeping the expectations to a minimum.
None Invasive Treatment Methods
Several non invasive treatment methods can be used for treating rolling scars. Depending on the length of the rolling scar that you have, treatment can be done with dermabrasion, laser therapy, chemical injections etc.
Laser treatment involves using laser beams for removing the top damaged part of the skin so that new skin growth is encouraged and the length and depth of the scar is reduced to negligible. Laser treatment requires many sittings for the desired results. It is normally done by a dermatologist.
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& 3 Hypertrophic And Keloidal Scars
Whereas atrophic scars create skin indentations, hypertrophic and keloidal scars cause a raised skin growth. Both form when the body overproduces collagen to the point that the scar raises out of the skin.
Even for dermatologists, it can be difficult to determine whether a raised scar is a hypertrophic scar or a keloid. However, a 2020 study published in the British Journal of Dermatology distinguished the differences between the two types of acne scars as such:
- grow larger than the borders of the original wound
- dont grow smaller on their own
- have very thick bands of connective tissue in their inner layer
Though all sorts of skin types can develop hypertrophic and keloidal scars, Dr. Green points out that people with darker skin are more susceptible to developing keloids.
Keloid And Hypertonic Scars
Keloids are reddish, raised nodules that form at the site of an injury. They are typically caused by an overgrowth of grist-like fibers that form after your skin injury has healed completely.
Keloid scars can occur in any part of your body, although they are predominant in the upper back, shoulders, and upper chest. Hypertonic scars are almost similar to keloids only that they are small and can fade away with time.
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An Initial Treatment Phase
The goal of this phase is to treat scar erythema and treat individual scars that may be resistant to collagen remodeling procedures. Treating erythema is important as the redness accentuates the scar and makes it more noticeable.
To target erythema, the treatment of choice is the pulse-dye laser. Typically, it requires three to four treatments spaced out every month.
To treat individual scars that may be resistant to other treatments, typically a surgical approach is preferred. Ice pick and narrow boxcar scars respond to the chemical reconstruction of skin scars technique where a high-strength trichloroacetic acid peel solution is placed at the base of scars with the goal to promote dermal remodeling.Rolling acne scars are typically treated with subcision, a procedure in which a small needle is inserted under an acne scar with the goal of releasing the fibrosis tissue that teethers the scar and causes the depression.
Finally, another option to treat difficult ice pick and boxcar scars is to surgically remove them by punch biopsy.
What Types Of Acne Scars Are There
- Macular scarring this type is characterised by flat areas of increased and decreased pigmentation as a result of acne. Although there are not any indentations in the skin or raised scars, this is considered a scar by many patients who have this problem
- Boxcar scars these are superficial punched out scars that have sharp vertical edges on the cross section, and can be round or oval shaped when seen from above
- Rolling scars these appear as undulations in the skin and are usually caused by tethering of the skin to underlying structures
- Deep divots these are simply very deep scars that involve loss of subcutaneous tissue volume and result in a large divot
- Ice-pick scars deep but small holes in the skin, similar to the indentation left by an ice-pick
- Hypertrophic scarring and keloid scars where there is a raised and often pigmented scar as a result of acne. They may be red/purple, and disproportionate to the size of the initial trauma caused by the acne
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