The Skin Nerd: Your guide to skincare for acne scars
The Skin Nerd: What to do when blemishes leave their mark on your skin
Your spot has finally healed – amazing! But it’s left a scar in its wake – not so good... You may have just a small indent, or you could be left with a pitted mark along with pigmentation where the blemish took root – not ideal but also not unusual.
"Acne scars are caused by the body's natural healing process when acne is present," explains Professor Caitriona Ryan, a Dermatologist at Institute of Dermatologists, Ireland.
When acne lesions, such as pimples or cysts, are formed on the skin, they can cause damage to the surrounding tissues. The body responds by producing collagen, a protein that helps repair damaged skin.
The collagen produced during the healing process can be uneven, leading to an uneven skin texture, with depressed or raised scars.
The severity of acne scars can be influenced by various factors, particularly the size and depth of the acne lesions, how severe the acne was, how long it lasted, and the individual's skin type and genetics.
Some people may be more prone to developing acne scars than others due to genetic factors. Picking at or popping acne can also increase the risk of scarring, as it can cause further damage to the skin tissue.
Acne scarring (also known as atrophic scarring) is common, in fact, research published in the Journal of Cutaneous Medicine and Surgery found that 73% of participants with acne reported having scars afterwards.
What this does highlight is that the aftermath of acne can be more problematic than managing the acne itself but whilst acne scars aren’t always simple to remove, it’s possible with the right skincare and treatment.
Inflammatory acne – which includes papules (red, sore bumps), pustules, (sore bumps filled with pus), nodules (large, hard lumps underneath the skin) and cysts (large, sore pus-filled lumps) are the types that are most likely to cause scarring.
I believe that it’s a skin sin to pop any spot of course, but cysts are the most likely to leave a scar – so don’t try to squeeze one.
Although non-inflammatory types of acne such as blackheads and whiteheads bring less risk of scars, squeezing them puts you at risk of infection, which then triggers an inflammatory response and can lead to scarring- so it’s always best to avoid popping them.
- Ice pick scars are narrow and go deep into the dermis – kind of like a toothpick has pierced the skin. Said to make up 60-70% of atrophic scars, ice-pick scars are typically associated with cystic acne as they tend to lie deep within the dermis, where collagen and elastin are found.
- Boxcar scars are thought to account for 20-30% of acne scars and are sunken indents with well-defined edges, similar in appearance to the tiny pits that often remain after your chicken pox marks have cleared.
- Rolling scars are the least common of the bunch, making up 15-25% of acne scars according to research. This type is like boxcar scars but are smoother and shallower, giving them a rippled or “rolling” appearance. To get nerdie, this is because the scar hasn’t healed correctly, and bands of fibrous tissue has pulled the top layer of skin inward.
If you have deep acne scars, you may find that skincare doesn’t help a great deal.
Active ingredients can help to improve the appearance of moderate acne scarring of the shallow indent kind, but treatments performed by a dermatologist or trained aesthetician will give the best results.
If you decide to take this route, remember to always make sure that your aesthetician has qualifications in advanced aesthetics before undertaking any treatment.
Microneedling is a treatment that uses tiny needles to puncture the skin and create micro “wounds” which penetrate deep into the second layer of the skin (the dermis).
This trauma to the skin triggers a repair response and releases growth factor, which subsequently stimulates the production of collagen.
This isn’t a quick fix though - it takes multiple treatments over the course of 12 months for the new collagen to take effect and improve any scarring.
‘Laser treatments can dramatically improve acne scars,’ says Professor Ryan. ‘Fractionated ablative lasers, particularly C02 lasers, are the most effective treatment for acne scarring. Fractionated lasers use microscopic beams of light to penetrate into the deeper layers of the skin, breaking down scarred skin and stimulating the body's own natural healing processes to produce new, healthier skin. The laser targets a pixelated fraction of the treatment area during each treatment session, leaving the remaining microscopically untreated skin to help rapidly heal the treated areas.
The new SecretPro laser combines CO2 fractionated ablation with radiofrequency microneedling for the most effective acne scarring treatment to date.’
Whilst superficial peels (e.g. glycolic acid, lactic acid) won’t penetrate further than the epidermis, medium-depth peels with trichloroacetic acid can reach the top layer of the dermis.
The peel will cause the skin to enter a state of trauma, stimulating collagen production, which brings the scar to the surface and makes it appear less pronounced.
Your acne scars may be accompanied by post-inflammatory erythema (PIE) or post-inflammatory pigmentation (PIH) and skincare can help to address this, along with any redness.
I recommend Skingredients Sally Cleanse 2% Salicylic Acid Oil Control Cleanser (€33, skingredients.com) which is an award-winning active cleanser containing salicylic acid – a powerful beta-hydroxy acid – to remove dead skin cells and exfoliate the surface of the skin.
