Medically reviewed by Minimalist Health Specialist - Written by Viddhi Patel (Journalist) on 28th Dec 2020
What are Acne Scars? What is the difference between acne scars and marks?
A breakout is bad by itself and causes enough problems for a mental breakdown! But what comes after is not a pretty picture either. The skin throws at you irregularities in its texture and discoloration, and we have all been there. If you have suffered from acne breakouts, you may have suffered your share of scarring.
The frustration that haunts us even after acne clearing, the blemishes, is daunting. The bumps, the dents, the red and brown, dark spots, in all the blemishes that come after acne are not smoothing we look forward to.
What are these scars and marks? Are they the same? And can you treat them? The answers are all here.
What is acne?
The inflammatory skin condition, acne vulgaris, or acne, is a skin condition caused by hormones, a rise in sebum production, clogging of dead skin cells, bacteria, etc. Acne affects the areas with many sebaceous glands on the face, chest, back, and chest.
What are the acne scars?
Whatever the pimple, however ugly and painful, and how much ever glaring in appearance, it doesn't end our suffering after it subsides. It leaves behind a mark that overstays its welcome and runs deeper due to the damage that has broken the skin's deeper layers' support system.
The bigger the pimple that has subsided, the bigger the mark that will be left. Severe and moderate acne that runs to the deeper layers and damages them leaves a deep scar glaringly visible on your face.
When the internet, the doctor, and your mom warned us of not messing with the zit, we should've listened no matter how tempting. The mild breakout you popped your way through now left behind a scar that pretty much seems permanent. Collagen and elastin suffer and break down when the acne is severe or even moderate. This damage leaves behind an indented scar that you will most likely notice in the years to come.
Types of Acne Scars
The treatment of your acne scars requires identifying their type.
When acne's wound healing process takes an alternate route and chooses to scar, they cause textural scars: atrophic and hypertrophic.
When the collagen in your skin is damaged and destroyed during the wound healing process, indented scars are formed. These are called atrophic scars.
And when the collagen produced is in excess during wound healing, raised scars are formed called hypertrophic scars.
The depressed scars are formed majorly due to inflammatory acne and appear on the forehead and cheeks. They can be shallow or extend to deeper skin layers.
These scars are further classified into:
1. Rolling scars
Like their name, these scars have sloping edges and are broad depressions into the skin. With age, the appearance of these scars worsens as the skin loses elasticity. Long-term inflammatory acne is mostly what causes these scars.
2. Boxcar scars
These scars have defined edges and are broad and rectangle indents. The edges are sharp, and this makes it difficult to treat.
3. Ice pick scars
These can also be identified as scooped-out pores. These are the deepest indents and are narrow.
4. Hypertrophic scars
Raised scars are often an outcome of cystic acne. Scar tissue forms in cystic acne, and too much of it creates a bulge protruding from the skin. They are comparatively less common and are likely to occur on the chest, back, or jawline in the place of your cyst.
What are Acne Marks?
The above types were textural, as in they either formed dents or bulges in the skin. These are mostly classified as mild, moderate, or severe and are caused due to collagen's overproduction or underproduction. But there is another form of scarring that acne causes, referred to as 'acne marks' and is termed as 'macular acne scars.'
Post-inflammatory hyperpigmentation marks or dark marks have been a cause of concern for people suffering from acne. They are light or dark brown marks, a result of mild to moderate acne breakouts. The acne healing process triggers the melanin, and this eventually fades.
If you have dark spots resulting from cystic acne, inflammatory acne, or moderate acne, the marks will last long. Inflammatory acne results in more melanin secretion in the skin's dermal layer, meaning the deeper layers of the skin, and hence, these marks take longer to fade.
The acne marks are further bifurcated into PIH and PIE.
Post-inflammatory hyperpigmentation: these are red and occur on fair skin.
Post-inflammatory erythema is brown and occurs in darker skin tones.
Both of these are caused by inflammatory acne. Still, while PIH is caused by melanin overproduction, PIE results from blood vessel dilation associated with the wound healing process. The appearance of PIE worsens as the skin is thinner during the healing process.
Dark marks left behind by acne are not scars and can be treated comparatively more easily, while you can return to your clear, even-toned skin.
Acne marks vs. Acne scars
The evidence that pimples leave behind their tracks comes in different shapes and forms. Different kinds of acne cause these. A dark spot appearing with a soft texture is not a scar and is just discoloration that will fade away with time, mostly 3-6 months.
A scar, on the other hand, is permanent damage to your skin and takes professional treatments. Acne scar brings shifts in the texture of the skin, indents, or raised bumps. You know that the damage runs deeper when the indentation is deeper. The treatment has to penetrate deeper than just the surface to treat the damage.
The best treatment is prevention. Do not pop pimples or prod pimples. This will damage the skin. Treat acne not to let the scars form, and when you notice a bump protruding, treat it immediately with the help of your dermatologist.
Acne scarring is best treated early as this can evade the future effects of acne scarring that may turn into the long term. A low spot from a pimple should be consulted with a doctor as soon as you can.
Acne scars and acne marks differ majorly.
Overproduction or underproduction of collagen results in acne scarring, namely atrophic or hypertrophic, respectively, during the wound healing process.
On the other hand, acne marks result from inflammation that has stayed back, the triggered melanin due to inflamed skin, and the slow breakdown of the dead acne-causing bacteria.
PIE and PIH marks get resolved with time and are different from the ordeal like stubborn acne scars.
Treatment of acne scars
Treatment of scars should be performed after the acne has subsided, as hastening during the procedure may result in the continued formation of scars. Treating early acne is the best way to treat acne scars, prevention being the best cure.
Scars that have distorted skin's texture will need a medical procedure to see changes and transformation.
Microneedling, laser resurfacing, dermabrasion, chemical peels, derma fillers, radiofrequency, subcision, and excisional techniques cut under the skin and remove scars. Even laser therapy is a treatment option that eases the collagen built up.
Acne scars are difficult to treat than acne marks as acne marks distort the skin's texture, and they notify damage in the deeper skin layers making it hard to treat with surface-level treatments.
Raised scars or hypertrophic scars are responsive to laser resurfacing treatments, aiming to smooth the raised skin areas.
Depressed scars or atrophic scars require aggressive treatments like fractional laser treatments, intense pulse light phototherapy that improves skin's texture post-acne.
However, the treatment's effectiveness depends on the edges' steepness and the indented scar's depth.
1. Laser treatments
The resurfacing of skin with concentrated light beams and revealing younger skin helps reduce scarring by concentrated light.
The process/procedure of using tiny needles to puncture the skin and create micro holes into the skin's deeper layers. The micro-needling creates a controlled wound in the skin that triggers the body's wound healing properties, initiating collagen production, and deposition. This process opens up the skin and makes it more receptive to other skincare products. Acne scarring improves considerably with micro-needling procedures. Acne marks do not get treated through this procedure.
3. Chemical peels
Chemical peelings act on small, depressed scars but not as much as on boxcar and ice-pick scars. Using hydroxy acids to clear off the dead skin layer and penetrate deeply to clear out pores and triggering collagen production.
4. Dermal fillers
The procedure uses soft tissue fillers based on collagen to reduce scars' appearance.
Topical treatments for acne scarring
1. Salicylic acid
2. Alpha hydroxy acids
The acids exfoliate the skin's surface, smoothening it, and improve the scars' texture and appearance.
3. Lactic acid
Lactic acid helps in softening and evening the texture of the skin.
Treatment options for Acne marks
Types of hydroxy acids like AHAs, BHAs, and PHAs exfoliate the skin and remove dead skin cell layers. Acne marks improve dramatically through the cellular turnover caused by the peeling process.
AHAs act on hyperpigmentation and inhibit tyrosinase that causes melanin production. OTC level milder options increase the ceramide levels in the skin and reduce the water loss. The stratum corneum is hence strengthened, improving the PIE marks.
Acne marks also improve dramatically through topical options as compared to acne scars. There aren't many options available that can treat acne scars as effectively as procedures do. Although acne marks fade away on their own in a few months, they can be accelerated to fade faster through topical treatments.
Topical treatments for PIH involve inhibiting tyrosinase, an essential enzyme in melanin production, or triggering cellular turnover to kickstart the speed at which pigmented skin is shed.
PIE topical treatment involves repairing the stratum corneum, increasing the hydration, decreasing inflammation, and dilating blood vessels.
Topical Treatments For Acne Marks
Hydroquinone is effective in treating post-inflammatory hyperpigmentation marks by inhibiting tyrosinase. It decreases the appearance of dark spots considerably by destroying melanocytes and melanosomes, important components in melanin synthesis.
AHAs, BHAs, and PHAs are hydroxy acids that increase cell turnover and inhibit tyrosinase enzymes.
Retinoids effectively treat both PIH and PIE related acne marks as it increases epidermal turnover while inhibiting inflammatory pathways that trigger melanin.
4. Azelaic acid
The effective acid also inhibits tyrosinase activity and reduces inflammation that, in turn, reduces the appearance of dark spots.
The vitamin B3 decreases the melanin synthesis by reducing the pigment from reaching the cells and stabilizing the skin barrier, hydrating, reducing inflammation, and promoting wound healing. Niacinamide is effective in fading all types of acne marks.
6. Vitamin C
The antioxidant inhibits tyrosinase and forms regulate stratum corneum. The vitamin also triggers wound healing, all the while reducing inflammation.
Other viable topical options that reduce the appearance of pigmented spots left behind by acne are kojic acid, alpha arbutin, licorice extract, and ceramides.
Minimalist's word of advice
The acne marks, PIE, and PIH are treated when you answer the acne's inflammatory condition, which will prevent future blemishes from haunting you.
Avoid prodding, picking, popping, scratching, and rubbing the affected area.
Avoid UV exposure.
The Final Word
Acne marks and acne scars target our self-esteem but can definitely be treated. There is no reason for you to keep suffering from glaring residual scars.
Acne marks are textural irregularities, and acne scars cause discoloration that can be bifurcated into brown and red marks.
Stubborn scars require medical treatments with a dermatologist's help, while regular acne marks can be treated with OTC treatments.