If you are struggling with getting rid of acne or pimple marks and scars, you are not alone. About 80% of people aged 11-30 experience some degree of scarring from acne. Acne scars can be categorised broadly into 2 categories- hypertrophic (raised), or atrophic (indented) scars. Out of the 2, the more common kind of acne scarring is the atrophic kind. Atrophy means to decrease in size. So atrophic scarring refers to scars that form hollow pits, craters, indentation and unevenness on the skin’s surface- also known as pockmarks.
Types of acne scars
Not all atrophic scars look the same.
- Ice pick scars
- Boxcar scars
- Rolling scars
Why do some acne scar and some don’t?/ What causes pockmarks?
Acne occurs when there is an overproduction or obstruction of sebum in the pores. Some acne is small and localised, while some can be widespread and affect deeper layers of the skin. Generally, acne is sorted into 3 categories of severity: comedonal, inflammatory & nodular cystic.
Comedonal acne is categorised as mild acne. There may be blackheads or white heads on the skin, but there is no inflammation. Inflammatory acne occurs when the pores are so filled with sebum and dead skin cells that the pressure from the build up causes a break in the skin. Acne can also get inflamed when the obstructed pores become infected, most often by a bacteria that is native to our skin, called Cutibacterium acnes (previously known as Propionibacterium acnes). When there is significant inflammation, with the presence of pustules or nodules, it will be considered cystic acne.
Inflammation damages the skin. When severe, it leads to scarring. The greater the extent of acne-induced inflammation, the higher the probability of scarring and hyperpigmentation. When wound repair occurs, scar tissue contracts and pulls the skin downwards. When the scar area is large enough, it gives the healed skin surface its indented, uneven texture. Acne scar tissue sometimes also appears red or brown in colour, especially in dark-skinned individuals, due to an overproduction of pigment as part of the normal healing process.
How do I prevent acne from scarring?
- Don’t pick at or squeeze your acne! Not only can this drive infectious material (bacteria & debris) deeper into your body and may even cause widespread infection. Picking will also aggravate and worsen inflammation.
- Seek treatment early. If your acne is worsening, don’t hesitate in seeking the help of a medical professional. Allowing your acne to get worse as you trial and error various over-the-counter creams may allow it to worsen to a point where scarring will occur.
- Wear sunscreen. The Sun’s UV rays are a huge culprit in collagen damage. Inflammation from acne will already bring about some collagen damage, so you would definitely want to minimise further collagen damage by wearing a non-comedogenic sunscreen.