Types of Acne Scars and How to Treat Them

What are acne scars? Scarring refers to the fibrous process in which collagen is laid down to heal an injury. In those with moderate to severe acne, 30% will experience acne scarring. What are the different types of acne scars and how do you treat them?

In this article, we’ll go through the types of acne scars, and the science behind different treatment options. Additionally, we’ll also include excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Head over to our Ask a Dermatologist page for our skincare community to post your burning question about acne scars.

Types of Acne Scars

• Post inflammatory erythema – pink or purple flat patches that can progress to post-inflammatory hyperpigmentation
• Ice pick dermal scarring – these are deep, narrow, pitted scars
• Boxcar dermal scarring – broad depressions with sharply defined edges
• Hypertrophic/Keloid scarring – thick, lumpy scars
• Comedonal acne – example of poor wound healing

Visual representation of the different types of acne scars

For people who suffer from uneven skin texture and skin scars, what is the best way to smoothen the skin surface texture for good?

The best way to smoothen skin texture is to first diagnose the type of scarring and the cause of it. In the case of post-acne scarring, it can occur in the form of post inflammation hyperpigmentation, and deeper scars which are known as ice pick and box car scars that go down to the level of the dermis. Therefore, it is important to distinguish between acne scarring and other types of pigmentation conditions such as those from underlying skin eczema, sensitive skin conditions that give rise to differences in skin tone, pigmentation, as well as flakiness.

This is because the treatment for eczema and eczema-related scarring is totally different from that of acne scars. For acne scars, the ice pick and box car scars are best treated with fractional CO2 lasers. Because, this helps to injure the skin in a controlled fashion, stimulating the underlying dermis to regenerate and fill up holes in the skin.

In my practice, we use this in conjunction with other treatments. For instance, using topicals like tretinoin, which is a prescription item that stimulates collagen formation in the skin. This is used together with cosmeceuticals like stabilised vitamin C, and intensely concentrated hyaluronic acid serum that work synergistically with the lasers to help skin to regenerate and to heal. Furthermore, it is also possible to combine the fractional CO2 lasers with chemical peels. For this purpose, I use a combination of Glycolic, Lactic and Salicylic acid peels, which stimulate the epidermis and dermis for better healing.

Acne Scar Treatment

The key thing about scar treatment, is that it should start the moment you get the pimple.

Blemish Spot Cream & Hydrocolloid Patches

The Blemish Spot Cream includes botanical actives of chlorella vulgaris for anti-inflammation, argania spinosa for anti-pigmentation, and methionine for wound healing. Apply a thick layer over blemish once detected.

The Blemish Spot Cream is a dermatologist pimple cream formulated using bioactive plant extracts to quickly reduce and inhibit spot inflammation.

Hydrocolloid patches help the skin to heal in a moist environment. It gently absorbs excess fluids like pus and oil from the inflammatory site of the pimple. Additionally, it also protects the wound from dirt and bacteria. This helps to speed up the recovery process and prevent scarring.

The Hydrocolloid Blemish Vanish Patch helps to perform quick healing on inflamed acne papules and cysts. This can help to reduce scarring and prevent secondary infection.

Qraser Polymer Patch

On top of increasing absorption of cosmeceuticals, The QRASER cosmeceutical transdermal delivery patch promotes optimal skin healing microenvironment to regulate healthy collagen production.

The QRASER patch inhibits the growth of bacteria on the skin surface for acne scars. Bacteria, especially over areas of skin injury, such as acne scars, can induce excessive collagen production in scar tissue, causing poor healing.

The QRASER Transdermal Delivery Patch custom cut for cheek scars can be cut into the desired shape. It helps to optimise skin healing, maintain the skin microclimate, and prevent scarring.

Elixir-V Total Recovery Serum

Cosmeceuticals that include the botanical ingredient Centella Asiatica can be beneficial when it comes to anti scarring. This phytochemical has anti-inflammatory and anti-scarring properties for cysts, scars, and sensitive skin.

According to Dr.Teo Wan Lin, accredited dermatologist, “Centella Asiatica can treat wounds effectively, as well as burns and hypertrophic scars. The key components of Centella that is responsible for wound healing are asiaticoside for increasing strength of the new skin at the wound, and madecassoside for collagen formation and anti-inflammation. To illustrate, these compounds are able to increase levels of protein, collagen, and peptic hydroxyproline.”

The Elixir-V Total Recovery Serum contains Centella Asiatica for acne scar lightening, Larecea extract for cell regeneration, Resveratrol as potent antioxidants, and potent Oligopeptides for lifting and repair.

Skin tone and scarring

“Individuals with Phototypes 3, 4, and 5, such as with Asians, Hispanics and African Americans, have more melanin, which appears as pigment in the skin. Skin of color are more prone to developing post inflammatory hyperpigmentation. This is important while undergoing treatment such as laser and chemical peels. For example, lower settings for laser treatments may be necessary to reduce the occurrence of further PIH occuring,” dermatologist, Dr. Teo Wan Lin.

Will exfoliating at home help at all?

Exfoliation is not necessary in skincare from a dermatologist point of view. On the contrary, when one is trying to regulate the rate at which skin cells are being shed, chemical peels and the use of a topical retinoid medicament like tretinoin are much more effective. A lot of times when one grows older, a common complaint is that the skin is less radiant than when one was younger. This is because of a slowing in the skin cell turnover rate. In brief, Chemical peels help to increase the rate of shedding of the skin without overly injuring the skin.

To sum up, exfoliating scrubs often contain bigger beads of certain particles, that essentially rub and abrade the skin. With repetitive use over time, this can cause irritation to the epidermis and give rise to conditions such as eczema whereby the skin is red, itchy and flaky. Therefore, rather than using an exfoliator, I recommend patients to visit a dermatologist instead to get a prescription for topical retinoid and a chemical peel to improve skin radiance.

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