Kinds of acne scars – and how to heal them

acne scar healing

About 15% of people are left with post-acne scars after they active acne is reduced.  Wondering what kind of scars, you have, and how you should treat them? 
You’re in the right place! 

There are two main categories of post acne marks. The first category includes flat smooth brown or pink spots that DO NOT change the texture of the skin. Then there’s what’s called “real acne scars,” which DO change the texture of the skin. These real acne scars look like pits (icepick scars), valley-like depressions in the skin (rolling or boxed scars) or elevated hard to the touch bumps. (hypertrophic and keloid scars). 

Why do you get acne scars? 

While a pimple is healing, your skin is producing new collagen fibers to replace the damaged tissue. If this process is defective, these new collagen fibers will pull down A scar may appear as a little pit in the skin’s surface, or a shiny, slightly raised surface. If you pick at a pimple too much, or if an acne pimple is so inflamed that your skin’s collagen is destroyed, and not enough collagen is produced to rebuild the skin, you end up with a depressed (aka atrophic) scar. On the other hand, if the healing response gets a little too enthusiastic, it may result in a raised (aka hypertrophic) scar.

How to treat flat brown acne marks? 

Treatment of post acne brown flat spots is usually pretty easy.  Your first step should be to control your active acne with an effective anti-acne treatment protocol. Do not pick or pop your pimples! This commonly contributes to acne scars. The second step - use an oil-free sunscreen. Excessive sun exposure and visits and avoid the sun or tanning salons will make you post-acne dark spots darker.  The third step – look for a high-quality dark spot corrector for acne-prone skin. Dark spots corrector are not alike. The best Dark spot corrector will contain Hydroquinone. The newest ones add to hydroquinone retinoids and plant-based complexes that help fade the post acne spots faster, with less skin irritation. 
For more resistant brown spots, it’s possible to add superficial peels or intense pulse light treatments — for any of those; you’ll need to visit your dermatologist.

How to treat flat pink and red acne marks? 

The enlargement of microscopic capillaries causes pink or red post-acne spots. They usually fade two to three months after your acne is controlled. If you want to fade them faster, a couple of IPL (Intense pulsed light) or laser treatments will do the job.

What the five main types of real acne scars? 

There are five distinct types of real acne scars. Icepick scars, rolling scars, boxed scars, and hypertrophic acne scars and keloid acne scars. 

What are icepick acne scars? 

Another kind of “real acne scar” is called an icepick scar. These are smaller in diameter (1-2 mm) deep with tracks to the dermis or subcutaneous tissue possible. Although the surface opening is smaller and steep-sided, there may be a wide base that could later evolve into depressed or boxcar scars. Icepick scars are commonly seen on cheeks.

What are boxcar (boxed) acne scars? 

“Boxcar scars” are shallow (0.5 mm) or deep (0.5 mm) and often 1.5 to 4 mm in diameter. They have sharply-defined edges with steep, almost vertical walls. Shallow scar treatment can happen with resurfacing or possibly punch elevation, whereas deep scar treatment is often done by punch excision, elevation or another modality. 

diiferent types of acne scars
What are rolling acne scars? 

Last, there are soft “rolling acne scars”. These can be circular or linear, are often greater than 4 mm in diameter and have gently sloped edges that merge with normal-appearing skin. Treatment is commonly by subcision.

What are hypertrophic acne scars and keloid acne scars? 

Hypertrophic acne scars (Elevated scars confined within the margins of an original pimple) and keloid acne scars (Elevated scars larger in size than the original pimple and commonly found on the chest, back, shoulders and ears. Both hypertrophic scars and keloids have thicker, more abundant collagen that’s stretched and aligned in the same plane as the epidermis. Both have an incidence of 5-to-15 times higher in African Americans and 3-to-5 times higher in Asians (Compared with Caucasians). It’s estimated they affect both the African American and Hispanic populations between 4.5% and 16%.

What are the best treatments for real acne scars? 

Real acne scars are the hardest to treat. But there’s hope — a few new in office technologies show promise. The most popular technologies Dermatologists use to treat acne scars are microneedle radio-frequency, fractional lasers, subcision (cutting under the scar with a scalpel) and injectable fillers (temporary solution). 

Microneedle radiofrequency 

This technology is regarded today as the gold standard for the treatment of acne scars. It uses extra sharp gold-plated micro-needles to heat the deep part of the skin. This minute needles (300 micro width) penetrate gently the ski to a depth of up 3.5 mm, with minimal pain or discomfort. Once they reach the death of the skin (dermis) they produce heat. This heat promotes a natural healing process of the skin that builds new collagen and decreases the depth of the scars. In addition to its efficacy on the treatment of acne scars microneedle radiofrequency causes minimal downtime. The skin is red for a few hours and the patient can go back to school or work on the next day. 

Ablative and non-ablative fractional lasers

Laser treatments come in two forms: ablative and non-ablative. Ablative lasers resurface the skin by removing outer layers. Non-ablative lasers create changes in the dermis without causing damage to the skin's surface.  The most common ablative laser used to treat acne scars is carbon dioxide laser. Ablative fractional lasers create micro burns in the skin that are supposed to trigger the buildup of new collagen. The results are usually similar to microneedle radiofrequency but with more pain, more downtime and more risk for post-treatment hypo and hyperpigmentation.  The usual result of fractional ablative laser treatment is that "new" skin is smoother, atrophic scars are reduced in depth, and the overall look of scarring is softened. After ablative laser treatment, the skin generally heals within two weeks but can remain red for a period of time after healing. The redness fades over the course of several weeks to several months.

Non-ablative lasers tighten the skin and stimulate new collagen formation. These lasers are less effective than microneedle radiofrequency or ablative lasers and have minimal effects on deep, pitted scars. Pulsed dye lasers are another kind of non-ablative laser that are used to improve raised scars and keloids.

Subcision (cutting under the scar with a scalpel) 

One of the causes of depressed scars is collagen fiber that pulls down the surface of the skin. In Subcutaneous incision, also known as subcision, a needle or small scalpel is inserted to run parallel to the skin's surface. The surface of the skin lifts once these bands have been released, smoothing the skin surface's appearance. This procedure is invasive, requires local anesthesia and is more costly than the microneedle or laser treatment. 

Injectable dermal fillers

Similar to wrinkles, Depressed scars can be filled with injectables. These are called dermal fillers. Substances used as dermal fillers can be made of include human and bovine collagen, hyaluronic acid or fat transferred from the patient's own body. A filler substance is injected into the acne scar, elevating the base of the scar so it is more even with the skin's surface. Unfortunately, these fillers degrade with time and procedure should be repeated every few months. 

Conclusions

The best way to get rid of acne scars is to prevent them. Treat you active acne effectively - and you will not have to struggle with acne scars. In case you already have acne scars there are ways to treat them.  if these "scars"  are flat a good Dark Spot Corrector cream will do the job.  If the scars are deeper,  pitted or depressed you will need more than just topical creams.

Acne dark scars - best treatments 2018
The best way to get rid of post-acne dark spots

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