If cystic acne has held you tight in its sebum-y grip (and it's likely that it has: according to data from healthcare provider Bupa, about 'eight in 10 people have acne at some point between the ages of 11 and 30') then you'll likely be well acquainted with acne scars.
These can manifest as either little dents or nicks in the skin, or a bumpy, raised surface to your complexion. Given that handling the skin condition itself can be jarring enough, it's also the last thing you want to address, when it's finally under control.
Acne scars: why does acne leave scarring?
'Acne is an inflammatory process – it causes redness, swelling and tenderness,' explains Dr Justine Kluk of the British Association of Dermatologists spokesperson and an acne expert.
The more severe the inflammation, the worse your scarring is likely to be. 'Inflammation is a key aspect of acne – and the deeper the inflammation in the skin, the greater the risk of persistent pigmentation and scarring,' adds dermatologist Dr Sam Bunting, whose newly released Flawless Moisturiser has been designed for acne-prone skin. But one thing to note: 'There are also individuals who are genetically predisposed to scar more easily,' – so there's not always going to be a rhyme or reason as to why you're more affected than your BFF whose complexion has gone through the same issues.
So, why does said inflammation cause scarring? 'Part of the reason for acne scarring is that, after the inflammation, the skin tries to heal itself,' continues Dr Kluk. This means that you'll produce lots of collagen, for the sake of repair. Too much can cause an uneven texture on your skin's surface; too little can cause pitted scars.
'Acne scars can also be a consequence of of scratching and picking acne spots', she adds.
As to the darker shading that can appear on post-acne skin? 'This isn't technically scarring, but you may also experience post-inflammatory hyperpigmentation – brownish or purple-y red discolouration on the skin, after acne spots have settled down,' says Dr Kluk. This is something else that you might look to address, if you are dealing with acne scars.
'This discolouration can linger for as long as six to 18 months, [after you no longer hace active acne] depending on your skin type,' adds Dr Bunting. 'The more melanin in your skin, the longer it tends to last.'
Types of acne scars
Before you start any sort of treatment, it helps to understand what sort of acne scars you've got.
First off, there are:
These are raised, and are a result of too much collagen being produced in a bid to heal your skin.
These are indented, and happen when your skin can't regenerate tissue
Atrophic scars are then divided into sub types.
- Ice pick scars: these are deep and have a tiny, have a narrow opening
- Boxcar scars: these are rounder, or more oval and shallower than ice pick scars
- Rolling scars: these cause wavy, shallow indents across a patch of the face
How long does it take for acne scars to heal?
'Scars start out as pink in colour as more blood goes into them, as the scars mature they lose their pinkness as the blood supply lessens,' says aesthetic surgeon Mr Douglas McGeorge MBE, co-founder of Science of Skin.
'The time it takes for the scars to fade is dependent upon a number of factors, but it can take a number of months. Ultimately, people heal in different ways; it depends on the type and severity of scar, plus, age will play a factor.'
Acne scar treatment products
Your first line of action in treating acne scars? Nice and straightforward over-the-counter products. First things first, though: make sure that your acne is actually laid to rest. 'The most important thing is to know that your acne is under control, before starting any treatments,' says Dr Kluk.
'Otherwise, you'll get locked in a vicious cycle of trying to treat the effects of something that's still going on, which is disheartening.'
Next, head to the shops.
'Wearing sunscreen on a daily basis will help prevent UV from worsening your post inflammatory hyperpigmentation,' says Dr Bunting.
'A vitamin C product is good for applying topically, as it regulates pigmentation,' says Dr Kluk.
'While retinol can help to boost your collagen, if you have indented scars.'
If you head to your GP, you can also see about getting prescribed a stronger retinoid product, for the same reason. ('There is some evidence that prescription retinoids like tretinoin and tazarotene help our natural repair processes along – 35% of scars resolve by themselves over the course of three years, and topical retinoids can potentially reduce this timeframe,' adds Dr Bunting.)
'Exfoliators won’t get rid of scars, but can help acne-prone skin by helping to resurface the complexion, preventing pores from clogging and fading pigmentation marks,' adds Mr McGeorge. 'Glycolic acid based products and peels can also help by exfoliating and minimising the depth of the scar, helping stimulate collagen and elastin – as well as reducing any discolouration.'
Cosmetic acne treatment
Quick note. Because a cosmetic procedure for acne scars is seen as non-essential by the NHS, you'll probably have to shell out for the below, unless you can prove that the scars are causing you significant psychological distress. For context, in the 12 months after being told that they have acne by a doctor, a person's risk for a depression diagnosis spikes by over 60%, according to a 2018 paper published in the The British Journal of Dermatology.
Prices will vary according to where you are in the country and the grade of dermatologist that you visit, so scope out clinics in your area and go from there.
Acne scar treatment: surgical removal
'If you have small, indented scars, they can be removed surgically,' says Dr Kluk. 'You don't need to treat your entire face – instead, a dermatologist can use a tool to puncture the skin surrounding the scar and then stitch the skin back together.'
Acne scar treatment: microneedling
This is great for scars over a bigger surface area. Microneedling is sometimes used as an aesthetic procedure, to stimulate collagen production for anti-ageing, but is often used in scar treatment, too. 'It works by inflicting a controlled injury to the skin,' explains Dr Kluk. 'Needles pierce the dermis where collagen is made, so that the cells increase their collagen production. This can improve the skin texture.'
Acne scar treatment: laser surgery
This is the same idea as microneedling – causing deliberate injury to the skin so that it produces extra collagen – but using a controlled laser beam, instead. You probably won't have any anaesthetic, but don't worry – you'll just feel a slightly warm tingle, rather than a harsh zap.
'There are two types of laser treatment – ablative laser treatment, where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin, and non-ablative laser treatment, where lasers are used to stimulate the growth of new collagen which helps to repair some of the damage caused by scarring, and improves the appearance,' explains Mr McGeorge.
Time frame-wise, you'l probably need between four to eight sessions, with a couple of weeks inbetween each one.
Acne scar treatment: cortisone injections
If your scars are raised and bumpy, than a type of steroid, cortisone, could be injected directly into the affected area, in order to flatten the area down. This will take a course of injections. 'You might four to six treatments over the course of six to eight weeks,' says Dr Kluk.
Acne scar treatment: TCA peels
'If you have ice pick scars, TCA peels can be effective,' says Dr Kluk. 'This is a type of acid peel, which gets deep into the skin to encourage cell regrowth, for smoother skin.' She notes that there is a risk in doing this sort of peel over your entire face, as you can face a) a lot of recovery time and b) you can make pigmentation worse.
'But if you do it targeted on the scars, in little areas, you can cause a burn and stimulate new tissue to fill the gap.'
Acne scar treatment: subcision
This is for really stuck down, deep scars. 'This involves sticking a needle under the skin, and breaking up the scar tissue. The release of the scar tissue – and the new collagen created – can help to smooth out the surface of the skin,' explains Dr Kluk.