Reduce acne scars

People with severe acne not only have a problem during the period of inflammation. After a severe acne has finally been extinguished, often disfiguring scars remain as a lifelong reminder of the acne. Scarring is less common nowadays because dermatologists in most people with severe acne quickly suppress the inflammation of the skin.

What rest phenomena do we see with acne?

The residual symptoms after a period of acne can be divided into 3 groups:

Red spots

After the inflammation has disappeared for 3 to 9 months red spots remain visible in the places where the inflammations have been. If these spots are completely flat, there is usually no question of scarring. The red spots disappear without leaving.

Dark spots

As with any inflammation of the skin that is exposed to sunlight can cause a dark discoloration on the spot of the burnt out acne fires. With darker skin types and exposure to sunlight, the risk of this hyperpigmentation is greatest. This pigmentation also pulls away again. This can take up to 3 years!

Scars

The actual subject of this leaflet. The different types of acne scars will be discussed below.

What are acne scars?

Scar tissue develops after damage to the skin. In acne, this damage is caused by the severe inflammatory reaction in the skin (for details, see the general leaflet on acne). Usually there is a direct link between the severity of the inflammation and the degree of scarring in response to it. However, some people also develop relatively large scars based on fairly superficial and minor acne inflammations. It appears that the sensitivity to scarring differs greatly from person to person.

What types of acne scars are there?

Acne scars can be divided into 2 large groups.

Scars with tissue loss (ice pick scars e.g.) scars with tissue increase ('wild meat' scars)

Scars with tissue

Loss ice scare scars ('icepick' scars)

These are small and have a steep 'wall' and are called ice pick scars because they are as deep and narrow as if they were bored by an ice pick ... Usually these are very deep scars. Especially on the cheeks.

Acne scars acne scar icepick ice pick

Apple drill

Scars also these scars have a steep wall but are much larger than the ice pick scars. They can be up to a few millimeters in size. It looks like a piece of a small apple drill has been punched out of the skin. The walls and the bottom of this type of scar are often very stiff. Especially on the cheeks.

Sloping scars

In this form, there is no sharply cut out scars, but of supple skin with small sloping subsidence without sharp boundaries with normal skin. Especially on the cheeks and sleeping.

Atrophic scars

With these scars, there appears to be small pieces of highly diluted, fragile skin that can wrinkle like cigarette paper when squeezed together. Ultimately mostly white in color. Appears in the face and on the trunk.

Scars with tissue growth

Hypertrophic scars

At the site where the acne inflammation has been, a large amount of scar tissue is created that lies in and on the skin as a firm feeling lump. These scars can become quite large. When several inflammatory foci have been close to each other, these hypertrophic scars can coalesce into one large scar mass. Especially the chest, back and the back of the head are sensitive to this form of scar formation.

Scar acne scar hypertrophic

Keloid

Scars are very similar to the hypertrophic scars just discussed. The difference is that with keloid the scar tissue also extends beyond the original inflammatory area. Both hypertrophic scars and keloids can be treated with injections of corticosteroids in the scar tissue. This treatment must be repeated several times.

How are acne scars treated?

In the course of recent years, various techniques have been developed to treat acne scars. The choice of treatment strategy is of course strongly dependent on the type of acne scar and on the skin type. Another important factor is the risk of complications you want to walk to make the acne scars less visible.

It is important to realize that scars (and therefore also acne scars) never disappear and that all treatments are aimed at making the scars less visible.

The treatments can be divided into 3 groups

Surgery

Striking, large, deep scars can be cut away after which the skin is sutured. This cutting away can be done in the traditional way or by taking deep punch biopsies after which the skin is sutured. In this technique, the pit-shaped acne scar is replaced by a linear scar. In practice it turns out that the skin after this procedure on the spot of the new stripe-shaped scar often differs again and a new deep scar is created.

Stimulation of connective tissue production

Using certain types of laser, the deeper skin layer can be heated. Through this heating, growth factors are released that stimulate the connective tissue cells in the skin to make new connective tissue. This is a safe method of scar treatment with moderate to reasonable results. Because the extra-produced connective tissue is broken down over time, the effect is temporary in nature. Usually, this treatment must therefore be carried out annually in order to preserve the effect.

Dermabrasion, laser and peeling

In these techniques the superficial layers of the skin are removed by means of a grinding pulp (dermabrasion, the oldest technique), chemicals (peeling) or laser therapy. Superficial scars can sometimes become almost invisible (depending on the depth of the dermabrasion) and deep scars become less noticeable. Especially in the laser treatment there is also the extra benefit of stimulation of the connective tissue production. The result can be very nice and lasts considerably longer than that of the connective tissue stimulation alone. Unfortunately, this treatment requires anesthesia and a much greater risk of complications such as infections, scarring and color differences. For several years the fractional laser is available which also removes the upper skin layers but does this point by point: each laser hole is surrounded by healthy skin so that recovery occurs quickly and the risks of complication are much smaller. However, multiple treatment sessions are required.

Injecting skin fillers in

Recent years, various injectable substances have been developed to fill up wrinkles. The same products are also used to treat acne scars. The results are usually pretty disappointing.

Will I treat my acne scars?

If you decide to treat acne scars, please note the following:

* Scars do not disappear: an improvement of the structure and appearance of the skin is the highest possible.

* Intensive, deep treatment gives the greatest chance of good results but also involves the greatest risks.

* Acne scars can also become spontaneously less obvious over the years

* do not start within 1 year (and preferably 2 years) after stopping an isotretinoin treatment (Accutane) with scar treatments

* Always choose a clinic that dermatologists are also connected to (they are ultimately the skin connoisseurs par excellence!)

How do I prevent acne scars?

In severe and moderately severe forms of acne, the dermatologist will usually start quickly with heavy (but effective) therapy, precisely to prevent scarring. The development of isotretinoin has ensured that acne scars are now much less common than they used to be.

With active acne it is tempting to squeeze pimples. This is very unwise because it is not only sebum is pressed out but also sebum ends up in the skin which in turn gives rise to even more severe inflammations and thus also larger scars. Do not arrive!