About Acne Scars

After the suffering of acnes, the remaining problem could be the scars formed from acnes. There are different types of scar and they may require different treatments.

Types of Acne Scars:

There are three general types of acne scars, defined by the appearance of them.

1. Depressed Type:
   There are three subtypes of depressed scars, which are boxcar scars, rolling scars and icepick scars. The formation of these scars is associated with the loss of tissues. The depth and look of scars vary because the level of inflammation is different in different people. In fact, it is quite common to see mixed types of scars, including superficial and dermal scars. Boxcar and icepick scars are superficial scars whereas rolling scar is dermal scar.
   • Boxcar Scars:
     Round in shape or oval depressions with steep vertical sides. It gives the skin a pitted appearance.
   • Rolling Scars:
     It causes rolling or "wave-like" undulation across otherwise normal appearing skin.
   • Ice Pick Scars:
     Deep, very narrow scars that extend into the dermis. The skin looks as if it has been pierced by an ice pick. They seem to make a small, deep hole in the skin and some may look like a large, open pore.
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2. Pigment Type:
   Some scars appear in different colors, there are three types in general:
   
   • White scars:
     This is an uncommon type. Part of the melanin is lost due to acne inflammation.
   • Red scars:
     This is the most common type. Excess capillaries appear and more red scar tissues are formed during the healing process of acnes.
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3. Raised Type:
   They usually appear on chest or shoulder areas because the local tension is larger. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn’t fully develop. This condition is sometimes also called "perifollicular elastolysis." The lesions may persist for months to years.

Treatment for Acne Scars:

Depending on the types and condition, there are different ways of medical treatment for acne scars, such as chemical peeling, injection of dermal filler, Q-switched 1064 laser, fractional laser or carbon dioxide laser, etc. For the three subtypes of depressed scars, which are the most commonly seen problem, here are the ways to treat:

1. Boxcar Scars:
   Due to the shallow nature of the scars, some physical methods can be applied to smoothen the rough skin tissues, and to restore new tissues again. Such methods are like chemical peeling and microdermabrasion. Q-switched laser can further be used to stimulate the growth of collagen and skin tissues.
2. Rolling Scars:
   In this type of scar, there are numerous of fiber tissues formed underneath the scar. Hence, the doctor will first apply a method called "subcision", a surgical needle, to cut off the fiber tissues. After weeks, laser treatment can be applied to stimulate new growth of collagen and skin tissues. Also, hyaluronic acid may help.
3. Ice Pick Scars:
   The best way to treat ice pick scars is to use laser, which allows the laser beams to penetrate into the dermis, in order to induce more collage and tissues. Among all kinds of laser, Fraxel re:store is one of the best ways to treat acne scars.

Scars Caused by Loss of Tissue:

Acne scars associated with loss of tissue-similar to scars that result from chicken pox—are more common than keloids and hypertrophic scars. Scars associated with loss of tissue are:

1. Ice-pick scars:
   Usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out.
2. Depressed fibrotic scars:
   Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time.
3. Soft scars, superficial or deep:
   Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.
4. Atrophic macules:
   Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious.
5. Follicular macular atrophy:
   Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin-somewhat like whiteheads that didn't fully develop. This condition is sometimes also called "perifollicular elastolysis". The lesions may persist for months to years.

Prevention of Acne Scars:

As discussed in the previous section on Causes of Acne Scars, the occurrence of scarring is different in different people. It is difficult to predict who is more prone to having scar, how extensive or deep scars will be, and how long scars will persist. It is also difficult to predict how successfully scars can be prevented by effective acne treatment.

Nevertheless, the only method of preventing or limiting the extent of scars is to treat acne early in its course, and as long as necessary. The more that inflammation can be prevented or moderated, the more likely it is that scars can be prevented. Any person with acne who has a known tendency to scar should be under the care of a dermatologist.