A Thorough Analysis of Acne Causes and Acne Scars Treatments

Acne occurs when excess sebum (oil), dead skin cells, and bacteria accumulate in our pores. Pores appear as minute openings in the skin that allow oil and sweat to flow from the glands to the skin’s surface. This can lead to inflammation and the growth of acne lesions (pimples).

Smaller clogged pores often result in blackheads and whiteheads. However, inflammation can lead to other more severe types of acne.

Hormonal changes often result in teenage acne. While hormones can play a role in the formation of adult acne, acne can also be caused by several different factors; including stress, environmental triggers, menstrual cycles, excessive use of oil-based products, or the use of birth control pills.

What are the types of acne commonly encountered?

Acne is a persistent skin condition that may present in different forms. The most common signs of mild acne are the development of blackheads and whiteheads. Mild acne usually heals without leaving behind scars, but more severe types of acne, such as papules, pustules, nodules, or cysts, may leave behind scars if not properly treated.

The following types of acne can lead to scarring:

• Papules: Pink or red coloured raised bumps on the skin that may feel sore when touched.
• Pustules: Small pus-filled lesions or bumps on the skin that resemble whiteheads but are larger. Pustules can appear as red bumps with yellow, pus-filled centres or as firm yellow bumps that feel tender when touched.
• Nodules: These look like solid and painful lesions, which usually extend deep into the skin. It is often accompanied by the absence of a whitehead or tip. Unlike papules or pustules that heal within a few days, nodules are larger and may persist for weeks or months.
• Cysts: Cystic acne is considered one of the more severe forms of acne as it is the most likely type of acne to leave a scar. Cystic acne resembles swollen pus-filled red or white bumps on the skin that are painful when touched. This type of acne forms when a cyst develops deep beneath the skin.

How does acne scarring occur?

Acne scars are the result of tissue damage suffered by the skin when acne blemishes become inflamed. During inflammation, the acne pore swells and causes the follicle wall to break. Usually, small or shallow lesions heal swiftly, but larger breaks in the follicle wall can lead to the acne blemish spilling substances into the surrounding tissue, thus deepening the lesion.

Following an acne outbreak, the body will respond by forming new collagen fibres to repair the acne lesions. Over or underproduction of collagen fibres during the repair process leads to hypertrophic scarring (raised scar) or atrophic scarring (depressed scar) respectively.

Types of acne scars

Acne scars can be atrophic or hypertrophic depending on the collagen or skin tissue regeneration rate. Common types of atrophic or depressed scars include:

• Ice-pick: Scars resembling marks made by an ice pick tool. Ice-pick scars are wide at the top and narrow to a point as the scar goes deeper beneath the skin’s surface. Ice-pick scars are one of the most common types of acne scarring but are challenging to treat due to their depth. You can find ice-pick scars on areas with thinner skin, such as on the forehead and upper cheeks.
• Rolling: Scars with uneven, sloping edges that appear as pits on the skin with varying depths. Rolling scars usually appear on the lower cheeks and jaw where the skin is thicker.
• Boxcar: Scars that look like indents on the skin with sharp edges that dig deep into the skin. Boxcar scars may be dark brown or red in colour and appear on the jaw or lower cheeks.

Hypertrophic scars form when the body produces an excess of collagen fibres. The overgrowth of collagen will result in scar tissue being raised above the skin’s surface. They can usually be found on the back, chest, shoulders, or jaw. A type of hypertrophic raised scar would be:

• Keloids: Thick raised scars that can form due to an acne lesion. While they primarily do not cause discomfort or pain, Keloids can sometimes feel itchy, sore, or painful.

Are acne scars permanent?

Acne scars can become permanent once they form and is frustrating to deal with if left untreated.  The good news is: there are many different treatments available to remove acne scars and make the scarring less noticeable.

Secret RF, Infini RF, Edge Fractional CO2 laser, Pico MLA, Vbeam laser, and Q-Switch laser are treatments that are notably effective in combating acne scars.

Acne scars can be stubborn and hard to treat, and no single treatment is deemed the “best” or “most well suited” for treating everyone. Responsiveness to treatment depends on an individual’s skin type, acne scar type, or severity of acne scarring.

However, a general recommendation is to do a combination of two or more treatment types simultaneously to improve the appearance of the skin texture and tackle scarring.

Types of acne scar treatments available at The Clifford Clinic

The type of treatment used is dependent on the type of acne scar being treated. The Clifford Clinic offers a wide range of treatments suitable for both atrophic and hypertrophic scarring.

Treatments most suitable for, but not limited to, treating deep atrophic scars include:

Treatments using needles:

Secret RF

Secret RF is a non-surgical treatment that utilises non-insulated microneedles and fractional radiofrequency (RF) to treat depressed acne scars. During the treatment, the use of RF microcannulas allows for the precise and controlled penetration of the deep dermal layer of the skin to deliver RF energy into scar tissue.

Once the non-insulated microneedle is inserted, RF energy denaturalises the tissue surrounding the insertion site, “cutting” scar tissues and allowing for collagen stimulation.

As a result of new collagen production producing firming and tightening effects, Secret RF is recommended for patients who suffer from facial sagging or for patients with rolling scars, as tightening the skin helps make rolling scars less visible.

INFINI RF

INFINI RF is similar to Secret RF but utilises insulated microneedles instead of non-insulated microneedles. INFINI RF is a non-surgical treatment that uses an insulated microneedle system with radiofrequency (RF) to penetrate up to a depth of 3.5mm into the skin’s dermis, making INFINI RF suitable for treating deep-reaching scars.

Like Secret RF, delivery of RF into the treatment area allows for the cutting and remodelling of scar tissue and stimulates collagen regeneration. Certain scar types that do not respond well to Secret RF may respond better to INFINI RF, and vice versa.

It is best to do both Secret RF and INFINI RF together as a combination treatment because Secret RF and INFINI RF complement each other and have a synergistic effect when used together.

Treatments using lasers:

Edge Fractional CO2 laser

Edge Fractional CO2 laser is a skin resurfacing laser that uses precise microthermal beams to create thermal injury zones in the treatment area. As the delivery of microthermal beams is highly accurate, the Edge Fractional CO2 laser can selectively create thermal injuries only in targeted areas without damaging the surrounding tissue.

Controlled thermal injury then kickstarts the skin’s natural healing process, stimulating collagen growth. The Edge Fractional CO2 laser is suitable for treating ice-pick, rolling, and boxcar scars.

However, due to the ablative nature of the laser, patients will experience an extended downtime after treatment.

Pico MLA

Pico MLA is the abbreviated name for a Picosecond laser with a HEXA MLA (Microlens Array Technology) extension. Pico MLA works by firing ultra-short pulses of energy at the skin. Due to the extremely short duration of each energy pulse, each pulse can be fired at a much higher energy level and intensity, shattering pigments in the skin and causing controlled thermal injury to the treatment area.

Similar to the other treatment options listed previously, thermal injury to the skin stimulates collagen production and the natural repair and remodelling of the skin. The HEXA MLA extension increases the ability of the laser to focus light energy to a point, allowing for more delicate and precise control of the laser to target acne scars.

The Pico MLA laser is also known as “Bubble Laser” because it induces microscopic damage, which resembles tiny “bubbles” under the skin. These “bubbles” are very small and do not cause any damage to the skin but can lift and push depressed acne scars up and smoothen the skin’s surface.

Laser treatments that are suitable for treating acne marks and dark pigmentation caused by acne include:

Vbeam laser

Vbeam laser is a pulsed-dye laser that treats vascular and pigmented lesions by exposing the skin to gentle bursts of light energy in long pulses.

The laser selectively targets blood vessels and heats the vessels to break them down using heat energy and jumpstart the body’s natural healing process. The broken-down vessels are then naturally absorbed into the body and removed after treatment.

Red spots or redness left behind after an acne outbreak are usually the results of broken or damaged capillaries. The Vbeam laser can target these capillaries and acne lesions on the skin, reducing redness and scarring in the treatment area.

Q-Switch laser

Q-Switch lasers deliver light energy in the form of a non-invasive, high-energy laser pulse of a specific wavelength to the skin in short bursts. Pigments absorb the laser in the skin, which causes the pigments to break down and be either naturally cleared away or absorbed by the body.

This treatment is very effective against brown spots left behind by acne scars. As the Q-Switch laser treatment has almost no downtime and is quick to perform, this is ideal for patients looking for a fast and convenient acne scar treatment that they can do during lunchtime.

Aren’t acne scars permanent? Can these treatments really permanently remove acne scars?

In short, the answer is yes! Treatments typically work to mask the scar or make the scar less noticeable.

However, using a suitable treatment or a combination of treatments that specifically target the acne scar type can be highly effective and significantly reduce the size and appearance of the scar or permanently remove it.

Continuous and repeated treatment over a prolonged period can also increase the chances of removing the scars for good.

The best treatment for acne scars is to prevent them from forming in the first place. Prevention is better than cure, as once the scar gets a chance to form, it can be a long and complicated process to remove it permanently. Acne is a chronic skin condition, and patients are less likely to develop acne scars if they have acne breakouts less frequently.

During an acne breakout, avoid picking, popping, or squeezing any of the blemishes. Doing so will irritate the skin and damage the underlying tissue, leading to more severe scarring or numerous scars.

We also highly recommend treating the problem at its root cause. At The Clifford Clinic, we offer acne treatments in Singapore such as AGNES and Gold PTT that are game-changers when it comes to treating patients suffering from the most stubborn cystic acne. Contact us for your first consultation today.