Acne scars - what are they and how do they form?

Acne scars are a bit like being bitten twice, not only did you have to put up with pustules and pimples but then have a permanent reminder of their presence in the form of a scar. However, you are not alone in your suffering as acne scarring is thought to affect 30% of those with moderate or severe acne vulgaris.

Unfortunately, there isn’t one treatment to get rid of all acne scars, in fact true acne scars never actually disappear. The news isn’t all bad though, as most scars will improve over time and there are a number of treatments that can significantly improve the appearance of acne scars.

Not all acne scars are alike, although they are more likely to develop from the same sort of acne called nodulocystic or cystic acne. To help with determining an effective treatment procedure for different acne scars a classification system has been developed. This system classifies acne scars into three different types, icepick, boxcar and rolling scars.

Icepick scars are narrow and sharp and they make the skin appear pitted. They are usually thinner than 2mm and they extend into the deep dermis or subcutaneous layer. Boxcar scars are spherical depressions that have sharp vertical edges. Unlike icepick scars they don’t come to a point at the base. Rolling scars form as a result of tethering of what would usually be normal appearing skin to the subcutaneous tissue underneath. This can give the skin a rolling or undulated appearance.

Acne scars should not be confused with post inflammatory hyperpigmentation (PHI) which is a red or hyperpigmented mark left on the skin after an acne lesion has healed. This process is just the normal remnant of the skin’s inflammatory process that should completely disappear within six to 12 months. However, if there is still a skin defect present 12 months it is likely to be a permanent defect or scar.

The visibility of acne scarring can be affected by age. One percent of dermal collagen is lost annually which combined with reduced skin tone can make scar more visible. The best way to prevent acne scars from forming is to seek treatment for your acne as early as possible.

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