Acne Scarring

Acne scars can develop when severe or inflammatory acne is untreated. Large pimples that penetrate deeply into the skin, trauma created by picking or squeezing, and cystic acne that ruptures can damage the underlying tissue and lead to long-lasting changes in skin color and texture. Some scars form thickened, raised areas, while others form scalloped or sunken areas in the skin. Early intervention and patient education are imperative to prevent permanent skin damage that can follow patients for a lifetime.

Dermatologists classify acne scars into the following types:

Atrophic scars (depressed scars)

These are the most common types of acne scars and sit below the surface of the surrounding skin. They are divided into three subtypes:

• Ice pick scars: Deep, narrow scars that look like tiny holes or punctures.
• Boxcar scars: Wider, U-shaped scars with sharp edges that create a sunken appearance.
• Rolling scars: Broad depressions with sloping edges that give the skin a wavy texture.

Hypertrophic scars

These are raised, firm scars that form when the body produces too much collagen during healing. They are more common on the chest, back, and shoulders.

Keloid scars

A more severe form of raised scar tissue, keloids, extend beyond the borders of the original acne lesion. They can be itchy, tender, or even painful, and are more likely to occur in individuals with darker skin tones.

Post-inflammatory hyperpigmentation (PIH)

Although not a true scar, PIH refers to dark spots left behind after acne heals. These marks fade over time but can be distressing, especially on visible areas like the face.

Preventing scars begins with effectively managing acne under the care of a qualified dermatologist, such as board-certified dermatologist Dr. Joshua Freedman. The earlier the acne treatment starts, the lower the risk of long-term damage. Steps to reduce the chances of scarring include:

• Avoid picking or squeezing pimples: Touching or popping blemishes increases inflammation and skin injury, which can worsen scarring.
• Use acne treatments early: Over-the-counter or prescription treatments can minimize breakouts before they cause deep damage.
• Protect skin from the sun: Sun exposure can darken scars and make them more noticeable. Daily sunscreen use helps prevent pigmentation changes.
• Seek professional dermatologic care for severe acne: Dermatologists can prescribe medications and perform procedures to keep acne under control and reduce the risk of scarring.

NJ Dermatology and Mohs offer a variety of advanced treatments to smooth and restore the skin. The right approach depends on the type of scars, skin type, and individual goals.

• Topical treatments: Prescription-strength creams containing retinoids, hydroquinone, or other active ingredients may help fade discoloration and improve skin renewal.
• Laser treatments: Fractional laser resurfacing and other laser technologies target scarred tissue and stimulate the production of new collagen. This can significantly improve the texture and appearance of atrophic scars.
• Microneedling: This treatment uses tiny needles to create micro-injuries in the skin, triggering collagen remodeling. Microneedling can soften depressed scars and improve overall skin tone. Sometimes it is combined with radiofrequency energy for enhanced results.
• Chemical peels: Peels use controlled solutions to exfoliate the outer layers of skin, promoting regeneration and reducing the appearance of mild scars and discoloration.
• Dermal fillers: Injectable fillers can temporarily lift depressed scars, making them less noticeable. This is particularly effective for rolling scars and some boxcar scars.
• Subcision: This minor surgical technique involves breaking up the fibrous bands that pull down scar tissue, allowing the skin to lift and smooth naturally.
• Steroid injections: For raised scars, such as hypertrophic or keloid scars, steroid injections can help flatten and soften the tissue over time.
• Surgical options: In some cases, punch excision or other surgical procedures may be recommended to remove or reduce deep ice-pick scars.

Often, the best results come from combining several of these approaches in a personalized treatment plan designed by an experienced dermatologist.