Acne can lead to scarring when the most severe types of spots – nodules and cysts – rupture (burst) and damage the overlying skin. Scarring can also occur if you pick or squeeze your spots, so it is important to avoid doing this.
There are a number of acne scars:
- Ice-pick scars: small, deep holes in the surface of the skin that look like the skin has been punctured with a sharp object
- Rolling scars: caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance
- Boxcar scars: round or oval depressions, or craters, in the skin
Scars may represent increased collagen namely hypertrophic and keloid scars
- Hypertrophic scars occur within the area of original inflammation
- Keloid scars extend beyond the original inflammation and are most prevalent on the trunk.
- Perifollicular elastolysis (PFE) is commonly found on the trunk and consists of multiple follicular atrophic lesions which can be very unsightly
Treatments for scarring
The best approach to treating acne scars is to prevent them occurring in the first place by early use of effective acne treatments.
However, if you already have acne scars there is a range of treatments that can help to reduce them:
Dermabrasion (or microdermabrasion) removes the top layer of the skin using a laser or specially designed wire brush. After the procedure, your skin will look red and sore for several months, but as it heals, you should notice an improvement in the appearance of your scars.
Laser treatment can be used to treat mild to moderate acne scarring. There are two types of laser treatment:
- Ablative laser treatment: lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin
- Non-ablative laser treatment:lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps repair some of the damage caused by scarring
Punch techniques are a type of surgical treatment usually used to treat ice-pick scars and boxcar scars. There are three types of punch technique:
- Punch excision - used to treat mild ice-pick scars. The scar is surgically removed and the remaining wound is sealed. When it heals, this leaves a smoother and more even area of skin
- Punch elevation - used to treat boxcar scars. The base of the scar is surgically removed but the sides of the scar are left in place. The base is then reattached to the sides but higher up, level with the surface of the skin. This makes the scar much less deep, so less noticeable
- Punch grafting - used to treat very deep ice-pick scars. The scar is removed, and the wound is ‘filled in’ with skin from elsewhere on the body (usually from the back of the ear)
Subcision is a surgical treatment that can be used to treat rolling scars. The upper layer of the skin is removed from the underlying scar tissue, allowing blood to pool under the affected area. A blood clot forms, which encourages the development of connective tissue that pushes up the rolling scar so that it is level with skin surface. Additional treatment, such as laser treatment or dermabrasion, may then be used to further improve the appearance of the scar.
Availability of treatment for scarring
Treatments for acne scarring are regarded as cosmetic surgery. Cosmetic surgery is considered to be non-essential surgery so is not generally available on the NHS. However, exceptions have been made when doctors consider that acne scarring is causing serious psychological distress.
See your GP if you are considering having cosmetic surgery. They will discuss the options with you. Treatment for acne scarring is available at private clinics. Prices can vary widely (from £500 to over £10,000) depending on the type of treatment that is required. Check the website of the British Association of Aesthetic Plastic Surgeons for more information about private treatment available in your area. It is important to have realistic expectations about treatment for acne scarring. It may well improve the appearance of your scars, but will not get rid of them altogether. Most people having treatment for acne scarring consider it improves the appearance of their scars by 50% to 75%.