Medically reviewed by Minimalist Health Specialist - Written by Mahek Chawla (Dietitian & Nutritionist) on 18th Sep 2020
Clear Skin Can Soon Be A Reality For You, Here’s How to get rid of Acne -Scars
Do acne, breakouts, or zits give you a nightmare?
Well, even more, because they leave behind scars, spots or marks only to remind us of cancelled plans. Scientifically there are many reasons behind why an acne breakout leaves a scar or occurs in the first place, but today we’d like to address the most common causes.
Reasons for acne /breakouts
- Increased sebum production
- A hormonal imbalance
- Androgen activity
- The proliferation of propionibacterium acnes ( P. acnes )
- Change in sebum composition
- Follicle hyperkeratinization ( accumulation of keratin in the hair follicles present on the face )
- Unclogging the clogged pores ( pit hole type scars )
All the above reasons may sound unfamiliar, but these are the most common reasons you will hear after visiting a dermatologist. Acne or scars post-acne are not confined to these but are attributed to multiple factors and their damage.
With extensive research and knowledge, skin specialists and aestheticians have classified acne scars.
Scars originate in the site of tissue injury and maybe atrophic ( loss of tissue ) or hypertrophic ( excess tissue ).
Atrophic scars are caused more commonly than any other type. They are subdivided into three types but have a common mechanism, i.e., lack of collagen that causes a pit.
Hypertrophic scars are rarely seen due to the reasons mentioned above and affect the wounded region only. It is characterized by excessive collagen deposition and raised appearance.
Acne scars that are usually cured by active ingredients or chemical peels or clinical treatments are atrophic.
Types of Acne Scars
These are deep-rooted vertically into the epithelial tissues with a V-shaped superficial appearance. Difficult to treat because of the depth of damage that they cause.
Boxcar scars are round to oval depressions with sharply demarcated vertical edges. They are clinically wider at the surface than icepick scars and do not taper to a point at the base. They are shallow hence more comfortable to treat.
These occur from dermal tethering of otherwise relatively normal-appearing skin and are usually wider than 4 to 5 mm. Abnormal fibrous anchoring of the dermis to the subcutis leads to superficial shadowing and a rolling or undulating appearance to the overlying skin. The scar is shallower than boxcar and is usually treated with fillers to regenerate the tissues.
A detailed study provides the above description of scars, condition or severity may differ from individual to individual. Above all, there’s also a huge confusion between acne scars and acne marks.
Before heading to the treatment of any of these, we need to know the difference between them. Acne scar is a loss of tissue or a visibly damaged surface post-acne either due to picking or squeezing very severe acne or breakout.
The red, painful, or cystic acne usually ends up leaving a scar. Also, many physical extractions or dermabrasions cause scarring for those whose acne is spread. Though several products or treatments are available, it needs a sophisticated and well-tamed treatment like dermal fillers and lasers, amongst others.
Acne marks are spots or patches per se, usually due to inflammation and are called post-inflammatory hyperpigmentation or PIH. They appear flat on the surface in shades of brown, red, or purple and are not permanent if taken care of. They often disappear after a while and, if not, can be treated with anti-pigmentation ingredients to lighten and eventually vanish the spots.
There are certain ingredients to look for in your acne scar products. A few of them have been a part of the daily routine of skin practitioners.
Also they are scientifically proven to be effective.
To make it easier for you to get your hands on any of these, we will classify them into two categories over-the-counter (OTC) products prescribed by experts and home remedies or natural ingredients.
OTC Ingredients to Get Rid of Acne-Scars
Azelaic acid (AzA) is a saturated 9-carbon dicarboxylic acid derived from the fungus Pityrosporum ovale and can be found in rye, wheat, and barley. This agent preferentially targets abnormal and highly active melanocytes with minimal effect on uninvolved skin.
Studies have proved its significant efficacy for hypopigmentation in melasma and PIH. Its mechanism of action is inhibiting various enzymes and DNA synthesis in damaged tissues.
Kojic acid (KA) is a metabolic product of the fungal species Acetobacter, Aspergillus, and Penicillium. It acts as a ROS scavenger, exhibits antioxidant properties, and inhibits tyrosinase. KA is used in several cosmetic skin brighteners and is also used as a food additive to prevent browning. Research shows it is as effective as Hydroquinone in reducing dark spots and hyperpigmentation.
Thus shows effects on irregular facial pigmentation, facial dyschromia, etc. It can be sourced from various fermented products, which usually contain a large variety of bacteria like wine, rice, soy sauce, kefir, amongst others.
Ascorbic acid (AA; vitamin C) is an acidic, hydrophilic ( water-loving) antioxidant most commonly found in citrus fruits and serves as a cofactor for several human enzymatic processes. AA plays a notable role in wound healing, catecholamine (antioxidants ) synthesis, tyrosine ( enzyme ) degradation, bile acid synthesis, iron absorption, neurotransmitter synthesis, and immune system function.
Ascorbic acid’s depigmenting mechanism involves free radical scavenging, collagen synthesis, oxidant formation, and nitrous oxide production. Ascorbic acid has been shown to successfully treat severe melasma, bilateral epidermal melasma, and PIH. Its potency is well known for a multi-purpose role and a superfood for skin and is incorporated in many of the high-end skincare basics.
In addition to the acids mentioned above, there are several other options available in natural sources like ellagic acid, curcumin ( turmeric ), aloesin ( aloe vera ), which have shown effects but with persistent usage of pure or concentrated sources.
Face Acids for Fading Acne Scars
Glycolic acid is an alpha-hydroxy acid, soluble in alcohol, derived from fruit and milk sugars. Glycolic acid acts by thinning the stratum corneum, promoting epidermolysis ( loosening of the dermis ), and dispersing the innermost ( basal ) layer of melanin. It increases dermal hyaluronic acid and collagen gene expression.
These activities ultimately treat acne and scars from within. This acid has good tolerance levels and has shown visible betterment of the skin. Being a precautionary measure, it is also included in many daily face cleansers, serums, or spot treatment creams. More often, you‘ll see this name mentioned in the peel-off masks used in clinics.
Salicylic acid is one of the best peeling agents for the treatment of acne scars. It is a beta hydroxy acid agent which removes intercellular lipids that are covalently linked to the hardened or cornified envelope surrounding cornified epithelial cells.
Thus, it reduces scar tissue damage, redness, acne, and majorly removes dirt from the pores. The most efficacious concentration for acne scars is 30% in multiple sessions, 3–5 times, every 3-4 weeks. The side effects of salicylic acid peeling are mild and transient. These include erythema and dryness. Persistent postinflammatory hyperpigmentation or scarring is very rare, and for this reason, it is used to treat dark skin.
Lactic acid is an alpha hydroxy acid that causes corneocyte detachment and subsequent desquamation (peeling) of the stratum corneum. In layman’s language, it means detachment of keratinized hardened cells that cause flaking.
This happens due to exposure to such AHA and slough off the outermost layer of dead scared cells. Thus improves skin texture and clears the surface.
All these active ingredients promote cell turnover thus making your skin more susceptible to sunburn. Always wear a broad spectrum sunscreen SPF 30 and above while using them. (Minimalist Experts Advice to use Sunscreen always even if you are not using these ingredients as they worsen the acne scars)
They are safe to use at home and should be started with a lower concentration, gradually moving to higher according to the skin’s tolerance levels.
That being said, there are other treatments available to get rid of those stubborn scars that are physical and require a doctor’s or a trained person’s assurance.
These include physical treatments like dermabrasion, fillers, fractional CO2, laser, dermal grafting, and punching technique. Such methods are used for extremely stubborn or hypertrophic scars. The treatment may or may not provide a completely satisfactory look but cures the woes to a great extent.
Hyaluronic acid and retinoid fillers are very popular in claiming a quick fix for scars, but studies in this matter have little to no evidence for such claims. No doubt, they treat acne very efficiently.
Always consult a dermatologist before trying any physical treatments or fillers because even though they may initially show results, they usually last for a short period as they don’t treat the root cause.
Prevention is better, always
We all know the primary action to keep scars and marks at bay is by addressing or treating acne in the first place. Here’s how you can do that...
- Look for active ingredients that suppress your active acne before it gets bad.
- Cleansing and exfoliating is the most basic thing you should include in your daily routine.
- Masks containing clay, mud, acid, or hydrating ones are must at least once a week.
- Hydrate your skin not just internally but externally by using an apt moisturizer. Look for hyaluronic acid to retain the moisture in your cells.
- Opt for non-comedogenic makeup products.
- And lastly, visit a dermatologist or an expert before things get out of control.
There are a lot of synthetic and natural products available in the market. Always take a patch test on less sensitive areas like hands or neck before trying on your face.
Also, like a Chinese proverb says, “ Knowing your enemies is half the battle won” so, know your issues before selecting any ingredient.
That being said, while there are no quick fixes to deep-rooted problems, always take enough care and have patience when your skin is healing on its own.