How to prevent acne scars and scarring

Unfortunately, acne can leave scars

Acne scarring is a common problem that affects many people. Stubborn and aggressive spots and acne can cause scarring which leaves undesirable marks on the skin. This scarring can often be harder to treat than the original spots, making it frustrating and impacting people’s confidence and happiness.

Acne scars occur because the inflammation under the surface of the skin causes trauma, damaging the skin cells and breaking down the collagen. This damage means your skin is unable to heal back to the same quality as before, leaving a mark or texture. Cystic spots are more likely to scar as the inflammation and trauma are deeper in the skin.

Acne is a very common skin condition that can affect anyone, of any age. Hormonal imbalances, genetics, conditions such as PCOS, and the menopause can all cause excess oil production. This blocks the small channels in the skin, called pores. When the excess oil also combines with bacteria, which is naturally found on the skin, it can cause acne.

What do acne scars look like?

There are three main types of acne scarring:

Atrophic (a destruction or lack of collagen in healing, forming concave scars that trough into the skin)
Hypertrophic (an excess of collagen in healing, forming convex scars that come out of the skin)
Post-inflammatory hyperpigmentation

Atrophic scarring forms indented marks in the skin, which creates unwanted texture, and can be hard to cover with makeup. Atrophic scarring occurs in different shapes and types. Boxcar scarring forms shallow, indented marks with sharp edges, a few millimetres in diameter; they can be larger than the original spot that caused the scar and usually occur around the jawline and on the cheeks. Ice pick scarring forms small, deep, round indentations that are wider at the surface of the skin and narrow to a point deeper in the skin. They form where the skin is thinner, around the forehead. Rolling scars are similar to boxcar scars but have sloping, rounded edges giving the skin a wavy appearance. They tend to appear around the cheeks.

Hypertrophic scarring forms scars that are risen from the skin’s surface and create lumps and bumps. Hypertrophic scarring is often genetic. One form of hypertrophic scarring is keloid scarring, caused by overactive collagen production that can leave undesirable, overgrown scars. Keloid scarring is particularly common in skin of colour.

Scarring doesn’t always leave texture on the skin. Many people Post-Inflammatory Hyperpigmentation (PIH) which impacts the colour of the skin. In lighter skin tones, this will appear as red or pink marks, whereas in darker skin tones it will look dark brown or grey. The patches of colour will usually mirror the areas of acne and can appear on any part of the face.

Why do my acne scars look worse on some days?

Acne scarring may change in appearance from day to day, depending on your skin health. Dehydration, hormonal changes, stress and alcohol consumption all impact the appearance of your skin generally, which will also emphasise any textured scarring or discolouration you may have.

Maintaining a good skincare routine, including ingredients such as hyaluronic acid to hydrate your skin and retinoids to encourage skin cell turnover will improve your overall skin health and help to reduce the appearance of scarring, even on days when you may not be feeling your best.

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How to prevent acne scars

Unfortunately, some people are prone to scarring and may find it isn’t possible to prevent it completely, however there are steps you can take which will reduce your risk of scarring as far as possible.

The most important thing is to prevent any further trauma to the skin, so no picking or squeezing (as tempting as it may be). This also means leave healing spots alone, don’t disturb the scabs and give them the time to heal on their own. It can feel very tempting to use products that dry your spots out as part of the healing process, however this may also increase scarring. Skin heals best when it is hydrated as this encourages skin cell renewal so continue to use products that contain hyaluronic acid to which will hydrate your skin without being greasy and adding to the excess oil on your skin.

Other ingredients to look for are salicylic acid, which will gently exfoliate your skin and break down the oil, unclogging your pores and reducing any breakouts. Vitamin C is an antioxidant which will protect your skin from pollution and environmental damage which may make your scarring worse. Retinoids such as retinol and retinaldehyde will increase your skin cell turnover, strengthening your skin and helping with healing.

It is really important to remember to wear sun protection daily as sun exposure can darken any discolouration and will also slow down the healing process. Look for a broad spectrum sunscreen of SPF 30 or above. If you are heading out and about, take a sunscreen spray with you to top up during the day.

The key to preventing scarring as far as possible is to be gentle with your skin, and keep it protected and strengthened.

How to treat stubborn acne scars

Acne scars can be challenging to treat, especially textured scarring. Skincare ingredients such as rosehip oil, lemon juice, honey, black seed oil and aloe vera are all traditionally used to treat scarring. A combination of hydration and exfoliation are the key reasons why these ingredients are so commonly used to treat scars, but some people may find they need something a bit stronger. A consultation with a dermatologist will provide you with a complete assessment and the best ways to treat your concerns.

For atrophic scarring, consider treatments such as chemical peels to exfoliate the skin, or laser and microneedling to remodel the skin through encouraging collagen production. In cases of deep atrophic scarring, small amounts of dermal filler can be injected to help level the skin’s texture.

To treat hypertrophic scarring, your dermatologist may recommend steroid injections, or surgical removal to remove the excess tissue. When treating keloid scars it is important to remember that they can often reoccur through treatments that involve further opening of the skin.

PIH often calms on its own, however if you have stubborn discolouration, laser treatments and skincare including retinoids and pigmentation inhibiting ingredients such as licorice root, kojic acid, resorcinol and alpha arbutin will help to reduce them quicker.

Treating active acne is different to treating the scarring, and it is important to address the cause of the scars first.

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How many microneedling sessions are needed to treat acne scars?

The amount of treatment you will need will depend on the severity of your scarring. Most people need 6 sessions, spaced 4-6 weeks apart. If your scarring is severe, you may need up to 12 sessions.

If you are interested in microneedling, call our non-surgical patient advisors who will be able to book you in with one of our consultant dermatologists for a bespoke consultation for your acne scarring. They will be able to assess your skin fully and give you information on the best treatments for you based on your needs and concerns.

Acne scarring is a common and unwanted side effect from acne. Many people find acne scarring challenging to treat at home and speaking to a dermatologist will give you the best solutions to treat your individual needs. Book your consultation today and a dermatologist at Cadogan Clinic in Chelsea, London, will assess your concerns and prescribe the best treatment journey for your skin.

Treatments mentioned in this article

Microneedling lightly promotes the growth of fresh skin cells and collagen for a youthful glow.

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Skin Rejuvenation

Micro-Needling (Dermapen)

Microneedling lightly promotes the growth of fresh skin cells and collagen for a youthful glow.

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