Acne involves an inflammatory immune response to P. acnes bacterial infection, resulting in a mix of trauma and contamination in the affected area. When infection occurs, white blood cells rush in to eliminate the bacteria, causing inflammation and swelling of the pores. This leads to internal ruptures, spreading infected material to the surrounding tissue.

As a result, your body’s wound-healing process kicks in, but it’s happening in an unfavourable environment. Wound healing is a highly intricate biological process, and the more complications there are, the greater the chance of flawed healing. Your skin tries to repair the damage by sending collagen and other goodies to the site, but when the infection is severe or long-lasting, the end result is often an inconsistent skin texture, forming a recognisable scar.

So, acne is like a battle between your immune response and bacteria, leaving behind scars that tell the tale.

There are two main types of scarring that can result from acne:

Atrophic Scarring: This type occurs when not enough collagen is produced during the wound healing process, leading to a depressed area in the skin. Atrophic scarring can be further categorized into three subtypes:

Ice pick scars: These are narrow holes (1-2mm in diameter) that reach deep into the dermis, tapering to a point. They are the most common subtype, accounting for 60-70% of atrophic scars.

Boxcar scars: Wider than ice pick scars (typically 1.5-4mm in diameter), these scars are round or oval in shape with clear, steep edges. They can be shallow (0.1-0.5mm) or deep (>0.5mm) and resemble punched-out sections of the skin’s surface. Boxcar scars make up 20-30% of atrophic scarring.

Rolling scars: These scars have a wide diameter (4-5mm) but are shallow, creating a slight indentation in the skin’s surface. Rolling scars are found in 15-25% of cases of atrophic scarring.

Hypertrophic Scars or Keloids: This type occurs when there is an excess production of collagen during the wound healing process, resulting in raised tissue at the site. Hypertrophic scars are typically pink, linear, and remain within the boundaries of the original wound. Keloid scarring, on the other hand, is darker and more bulbous, extending beyond the wound’s original borders.

It is common to have a combination of two or all of the different subtypes of atrophic scarring. Hypertrophic or keloidal scarring is more commonly observed on the body than on the face. Additionally, individuals with darker skin tones are more prone to keloidal scars compared to those with lighter skin tones. The severity of a spot or breakout, especially if picked at, increases the likelihood of developing hypertrophic or keloidal scarring.

Scars can be stubborn and tricky to treat once they appear. The best approach is to prevent them in the first place. The severity and duration of inflammation have a strong impact on scarring development. Therefore, focusing on treatments that reduce inflammation is crucial. Allow me to walk you through some helpful steps:

Step 1: Establish a good acne treatment regime
To lessen the severity of acne, incorporate effective skincare and lifestyle changes. You can find detailed information about these measures on the dedicated acne page.

Step 2: Hands off!
Resist the urge to pick, squeeze, or touch your spots. Although it may be tempting, your fingers harbour bacteria and dirt. Touching an infection site will only make things worse.

Consider two things: first, unless you live in a hermetically sealed laboratory, the area will most likely get dirty again even if you do wash your hands. Second, squeezing a spot can cause blunt trauma, risking damage to surrounding tissue and further skin irritation. So, it’s best to resist the urge.

Step 3: Leave scabs alone!
If you have acne-related scabs, let them fall off naturally. It may not be the most fashionable option, but scabs play a vital role in the healing process. Disrupting this process can actually make things worse.

Step 4: Be gentle with spot treatments
Some spot treatments can be rather aggressive. Anything excessively drying can stimulate the skin’s sebum production, exacerbating the issue. Keep in mind that extreme imbalances tend to cause the skin to overcompensate. So, exercise caution!

Step 5: Moisturise adequately
Contrary to what you might think, drying out the skin isn’t the best approach for acne. Moisture is key, especially for minimising scarring. Numerous studies have shown that scar severity is directly linked to moisture levels.

Remember, taking preventive measures and adopting a thoughtful approach to treating acne can help you achieve better results and minimise the risk of scarring.

If you’re unsure whether your scarring will naturally fade or require treatment, there are two visual aspects to consider: colour and texture.

Discolouration tends to diminish over time, although the process can be slow. Hyperpigmentation or hypopigmentation may start to fade within six months to five years, depending on the scar’s size. However, the fading process is not guaranteed, and even if it does occur, the skin tone may not perfectly match the surrounding area.

Texture refers to the depressions of atrophic scarring or the raised bumps of hypertrophic and keloidal scarring. Improvement in texture takes time, often lasting several months or even years before noticeable changes appear.

Additionally, your age plays a role. If you’re 19 and your skin functions optimally, its natural regeneration processes, like generating new collagen and elastin while remodeling the skin’s surface, can significantly reduce scarring. However, as you age, your skin becomes less efficient in self-repair.

Understanding the factors influencing scarring and its evolution can help you to make informed decisions about potential treatment options.

Scars, although they may fade, rarely vanish completely if left unattended, especially in cases of severe scarring. Even with the passage of time, the discolouration of a scar is unlikely to perfectly match the surrounding skin tone. Similarly, the texture of a scar may become less noticeable, but unfortunately, it won’t completely disappear.

Skin grafts are commonly employed in plastic surgery to address severe scarring, particularly in burn victims. However, their effectiveness in treating acne scars is a bit more complicated due to the wide coverage area but shallow depth of these scars. It’s important to note that using skin from other body parts for grafting onto the face can result in inconsistent texture and tone, similar to the scar you’re trying to conceal. This technique is most suitable for cases of extremely severe scarring. Keep in mind that engaging an experienced plastic surgeon is crucial when considering these options.

Acne scarring is a concern as it affects the skin cells’ actual structure. To physically remodel the skin, relying on overnight home remedies won’t suffice. However, there is a solution that can help move the skin’s surface in the right direction: exfoliation.

Instead of relying on traditional face scrubs for exfoliation, consider using an acid-based product that can exfoliate and lightly peel the skin. While these products may not be as potent as professional clinic treatments, they can still reach the epidermis and effectively remove dead skin cells, resulting in a fresher and more even complexion. Look for products containing alpha-hydroxy acids (AHAs) like glycolic acid or lactic acid. One trusted option is Paula’s Choice 8% AHA Lotion, which is highly recommend to use twice a week. With regular use, you should witness noticeable improvements.

By incorporating exfoliation with the right product into your skincare routine, you can take a step towards addressing acne scarring and achieving a healthier complexion.