Introduction and background
Acne is a very common skin ailment affecting almost 80% of people during their teens and twenties. It is characterized by increased sebum or oil secretion (seborrhoea), causing different lesions such as blackheads and whiteheads (comedones), pimples (papules/pustules), nodules (large papules) and in some cases scarring. Although many people recuperate from acne without any permanent effects, some people are left with disfiguring acne scars. There are some topical skin care products and medications that can improve mild scarring, but most acne scars are treated with a combination of surgical procedures and skin resurfacing.
Where does acne occur commonly?
Acne affects areas with the highest concentration of sebaceous glands like face, the upper part of the chest, and the back.
At what age is acne common?
Acne occurs most commonly during adolescence, and often continues into adulthood.
What are acne scars?
Acne scars are the result of inflammation within the dermis portion of the skin caused by acne. The scar is created by the wound trying to heal itself resulting in too much collagen in one spot. After an acne lesion has healed, it can leave a pinkish/reddish/brownish/blackish mark on the skin. This is actually not a scar, but rather a post-inflammatory change. The redness or blackening is seen as the skin goes through its healing course, which takes about 6-12 months. If no more acne lesions emerge on that area, the skin can heal normally. Any colour change or skin defect still present after 1 year is considered to be a permanent defect or scar.
How is acne scar caused?
Scars result from a wound or injury. Scars are part of the skin’s normal healing process. Generally, superficial wounds heal without scarring. It is when the dermis is damaged that scars form on the skin.
Acne scars are most often the product of an inflamed lesion, such as a papule, pustule, or cyst. Inflamed blemishes occur when the follicle, or pore, becomes engorged with excess oil, dead skin cells, and bacteria. The pore swells, causing a break in the follicle wall. If the rupture occurs near the skin’s surface, the lesion is usually minor and heals quickly. More serious lesions arise when there is a deep break in the follicle wall. The infected material spills out into the dermis, and destroys healthy skin tissue.
To repair the damage done to the dermis, the skin forms new collagen fibers. Collagen is the fibrous protein that gives the skin its strength and flexibility. Unfortunately, the finished “repair job” never looks as smooth and flawless as before the injury
As the wound heals, the body sometimes produces too much collagen, which creates a mass of raised tissue on the skin’s surface. This type of scarring is called hypertrophic, or keloid, scarring.
More commonly, acne causes atrophic, or depressed, scars. Atrophic scars develop when there is a loss of tissue. Ice pick and boxcar scars are two examples of atrophic scars.
Inflammation is the single greatest gauge of scar development. The greater the inflammation on the skin, the more likely scarring is to occur. Deep breakouts that take a long time to heal also increase the chance of scarring. Blackheads, whiteheads, and other non-inflamed blemishes typically don’t cause scarring because these types of lesions don’t injure skin tissue.
What are the different types of acne scars?
There are several classifications of acne scars. To put it simply:
1. Ice pick scars: Deep pits that are the most common and a classic sign of acne scarring.
2. Box car scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
3. Rolling scars: Scars that give the skin a wave-like appearance.
4. Hypertrophic scars: Thickened, or keloid scars.
Can we prevent acne scars?
Best way to prevent acne scar, is to treat acne early and properly. Other than that a few simple measures may help:
1. Use of effective sunscreens
2. Using tretinoin under the advice of a dermatologist. This speeds up the skin’s remodeling process and helps heal post-inflammatory changes.
3. Using Alpha-Hydroxy Acids (AHAs) and under the advice of a dermatologist.
4. Picking at scabs should be avoided at all costs. Scabs form to guard the healing procedure that is going on below them.
5- Pulling a scab off before it is ready hampers the healing and remodelling process which in turn leads to formation of scar.
6- Use of a quality acne care kit or system: Finally, there are some recommended natural and synthetic at-home acne treatment kits that not only treat acne but can actually help prevent scar formation. As they say, prevention is better than cure, it is better and safer to avoid acne scars by regular application of such acne treatment kitsthat are not only safe but also very affordable.