tips on how to minimise acne scars

I love waking up to a major pimple (or acne) that's made itself comfortable on my face - said no one ever. But what's worse is the long-term scarring that follows when that pimple decides to f-off.

Even if you're super diligent with your skin, those spots and red marks can outstay their welcome like that uninvited dinner guest. But don't lose hope; there are ways to help fade scarring - or prevent them from forming in the first place.
Kathleen, our resident dermatologist, gives us the lowdown on preventing and getting rid of acne scars—forever.

What causes acne scars?

Unfortunately, having acne generally means scar formation. The more severe and inflamed the pimples are, the more likely it is to develop acne scars. But do you know that others are more prone to acne scarring than the rest? Who are they?

1. Genetics- Yes, it runs in the family.
2. People who started having severe breakouts during their preteens- Acne Vulgaris is more common (~90%) among adolescents, and a few remain into adulthood. However, it can also occur before 13 years of age, and having severe acne at a very young age can make one more prone to having acne scars.
   
   
3. People who don't have their acne treated- Delays in acne treatment, especially when severe, may lead to scarring. 
   
   
4. Those who manipulate their pimples- I know it's tempting to squeeze that pimple or blackhead. But the more you play around with inflamed acne, the more they will turn into scars. Scarring happens as a result of damage to the skin during the healing of active pimples.

Tip: Before you start worrying about your acne scars, control the current acne breakout first. Make sure to continue maintenance treatment which will help avoid future breakouts and minimise acne scarring.

What type of Acne scarring do you have?

A pimple has its natural course; it becomes flat and red (post-inflammatory erythema). After a while, these flat red blemishes become dark or brown (post-inflammatory hyperpigmentation), then these become normal skin. If you are more prone to acne scars, collagen loss on injured skin can produce atrophic scars*, or exuberant collagen production resulting in hypertrophic scars^. In acne, the majority (80 to 90%) of the scars are atrophic.

*Atrophic scars - This is an indented scar that heals below the normal layer of skin tissue, leaving behind imbalanced scarring

^Hypertrophic scar - A thick raised scar that develops when the skin is injured.

Types of Atrophic (depressed) scars

1. Icepick These scars are narrow (< 2mm), V-shaped, which extends to the second (dermis) and third layer (subcutaneous tissue) of the skin. 

2. Boxcar These are wider (1.5-4.0 mm), round to oval or U-shaped scars with sharply demarcated vertical edges. Shallow boxcar scars are 0.1 to 0.5 mm deep, while deep boxcar scars are >0.5mm deep. 

3. Rolling These are the widest scars that may reach up to 5mm in diameter. These are usually M-shaped with superficial shadowing and an undulating appearance. 

Hypertrophic and Keloid Scars
Some of the scars become hypertrophic, which are pink, raised, and firm and develop around the area of skin damage. When the skin area is raised, scars go beyond the damaged area and continue to become more prominent; these are called a keloid.

What are the best Acne scar treatments?

Each type of acne scar, whether atrophic or hypertrophic, respond to a specific treatment. But before you seek out the best acne scarring treatment, control the breakouts first. Secondly, ask for your dermatologist's advice. So, what are available treatments for acne scars?

Atrophic scars

1. Chemical peels 
Chemical peels break through the outer and superficial layers of skin to enhance the repair and renewal of the skin. For flat red or dark acne blemishes, chemical peels work. Examples of chemicals peels are:

Alpha hydroxy acids(AHA) Alpha hydroxy acids are natural acids found in food like sugar cane and lactic acid from tomato juice. AHAs exfoliate the skin improving post-inflammatory erythema, hyperpigmentation, and atrophic scars. 

Beta hydroxy acid (BHA) Salicylic acid, a BHA, is naturally found in the bark of willow trees. Aside from exfoliating the skin, it can perfectly dry pimples by reducing their swelling and redness. It can also remove white and blackheads and prevents their formation.

Trichloroacetic acids (TCA peel) This peel encourages controlled inflammation, which triggers skin shedding to reveal a smoother or tighter surface underneath. 

Lower concentrations (<35%) help on the first layer of the skin, while higher concentrations (>35%) reach the deeper layers. 

So if you use a high concentration (50-90%) of TCA, it can effectively treat isolated ice pick scars in a TCA cross procedure. Or, an applicator with a dull point (like a toothpick) is used to apply the TCA peel. 

2. Microdermabrasion or dermabrasion 
Dermabrasion is the complete removal of the uppermost layer of the skin (epidermis). Some parts of the second later (dermis) encourage skin remodelling or renewal. 

Whereas microdermabrasion removes the uppermost layer of skin, accelerating the natural exfoliation process. A popular procedure, diamond peel, is microdermabrasion that utilises a motorised handpiece with diamond tips.

3. Laser treatment
Lasers ( Light Amplification by Stimulated Emission of Radiation) are excellent treatment options for boxcar and rolling scars. 

There are 2 types:

• Ablative lasers - Removes the top layer of skin
• Non-ablative lasers - Works by heating up the underlying skin tissue without harming the surface

Fractional CO2 laser (ablative) creates thermal wounds (like punched minute holes) with the same depth, surrounded by intact skin. This helps with rapid healing or resurfacing of the scar with reduced downtime.  

Non-ablative lasers like a 1064 nm long-pulsed Nd: YAG laser heats the dermis without visible wounding allowing the skin to heal, resulting in scar remodelling. 

4. Needling 
A roller with fine needles is used to puncture the skin, about 1.5 to 2 mm deep. New collagen formation and resurfacing of the deep scars results when wounds heal.

Hypertrophic scars and keloids 
Intralesional corticosteroid injections are the mainstay treatment for elevated scars. However, pulsed dye laser can also decrease the size and hamper further growth of keloids, making it a good treatment option or as an adjunct therapy. 

How do you prevent Acne scarring?

One approach you should follow to minimise acne scarring is the EARLY TREATMENT of the active pimples. This is the best way to prevent or limit acne-related scarring. And avoid popping those pimples! Instead, use mediations that help reduce pimple swelling, pus, black and whiteheads, and excess oil production. Chat with a trusted board-certified dermatologist for more advice specific to your needs.

What are some natural ingredients that can help with Acne scaring?

Acne scar treatment products with the below ingredients can help control inflamed acne. If you wanna go vegan, look for the following ingredients:

• Salicylic acid Dries out pimples and gets rid of the excess oil. It also unclogs white and blackheads and prevents their formation.

• Tea tree oil An Australian native plant with Melaleuca Alternifolia has antibacterial properties to help fight against Cutibacterium acnes. It also has anti-inflammatory abilities to help ease inflamed pimples. In addition, it was proven to be effective against mild to moderate acne vulgaris. 
  Found in: Hemp blemish face oil