Successfully clearing your acne doesn’t always mean the fight is over – way too often, patients find themselves plagued with “souvenirs” from a breakout in the form of dark or red marks on the skin.
But did you know that it is possible that what you see isn’t truly acne scars?
Many acne sufferers do not realize that several types of residual damage can happen after acne has gone away.
Each type is a symptom of a different response to our skin to the inflammation and trauma and can linger on our skin for months, years or even become permanent!
In general, these are the 3 types of “acne scars” that you should watch out for after a breakout:
- Post-inflammatory hyperpigmentation (PIH)
- Post-inflammatory erythema (PIE)
- Atrophic scarring (e.g. icepick, boxcar or rolling scars)
Each one has its own root cause which requires a different treatment approach — so before jumping into any acne scar treatment, make sure you recognize the differences as it will impact your results!
Why PIH and PIE occurs
Otherwise known as “pseudo scarring”, patients often mistake PIH or PIE for acne scars due to their similar appearance at first glance.
Essentially, both PIH and PIE are responses to inflammation and irritation to the skin that can not only be caused by acne but any type of trauma to the skin.
In the case of post-inflammatory hyperpigmentation — rashes, sunburns, cuts and even aesthetic treatments can trigger the skin to overproduce melanin as a way to heal itself; resulting in flat areas of discolouration that are brown or black on the spots where acne previously called home.
On the other hand, post-inflammatory erythema is caused by the increased blood flow in the superficial capillaries and damage to the tiny blood vessels that reside under your skin; resulting in red, pink or purple patches on the skin. Its appearance is worsened by the fact that our skin is thinner during the natural healing process.
PIH is often more prevalent in patients with darker skin tones due to their overactivity of cells that produce melanin, while those with fairer skin tones are more susceptible to PIE. However, this isn’t always the case and it is possible for you to have both.
Sun exposure can also worsen the appearance of PIH and PIE and prolong its duration long after the initial inflammation is over.
Although both PIH and PIE can be distinguished from their colour, you can also try conducting a simple “pressure test” — apply some light pressure on the mark and observe any colour changes; if it momentarily disappears, it’s PIE. If it doesn’t, it’s PIH. This happens because the pressure of the fingers are constricting the blood vessels; causing the discolouration to disappear temporarily!
While PIH or PIE can naturally fade over time, typically anywhere between 3–24 months, acne scars are often much more stubborn and harder to remove without the help of a professional aesthetic doctor.
Why acne scars occur
Acne-prone patients should be familiar with “true acne scars” by now – these are your atrophic or hypertrophic scars that are caused by either an underproduction or overproduction of collagen after trauma; resulting in areas of the skin that either sink down or protrudes to form a raised bump.
The most obvious difference between “pseudo scarring” and “true acne scars” is that atrophic and hypertrophic scars lead to textural changes on the skin. Acne scars also tend to be trickier to treat since there is actual damage found in the pores and follicles.
Picking at your scars can also worsen acne scarring since it leaves an open wound for bad bacteria to enter your skin and trigger more irritation and infection. It’s a vicious cycle indeed — just remember that the more bacteria inhabit your skin, the more inflammation and deeper and longer your scars will remain.
How to treat PIH and PIE
The goal of treating PIH is to focus on inhibiting melanin production and speed up cellular turnover while the goal of treating PIE is to minimize inflammation and aimed at improving the skin’s natural protective barrier.
As mentioned earlier, both PIH and PIE will naturally fade over time; however, this might not always be the best-case scenario for the majority of patients.
The first line of therapy is then to use topicals such as topical retinoids, vitamin C, hydroquinone, niacinamide and alpha hydroxy acids (AHAs) which have been shown to be effective for fading pigmentations.
A retrospective study on PIH caused by acne noted an optimal clearing of PIH 3 months after using topical lightening agents.
Should you see unsatisfactory results, you can then consider undergoing laser treatments like the Vbeam or Q-switch laser. Vbeam is especially effective for fading specifically red lesions by using the principles of selective photothermolysis to target the haemoglobin and treat the underlying vascular processes that are responsible for the redness.
On the other hand, the Q-switch laser is effective for breaking down melanin pigments so that they can be naturally removed by the body. Both these treatments also work to destroy the P.acnes bacteria while stimulating collagen production in the process to further accelerate recovery with zero downtime!
In one study, both acne scarring and redness were by 68% after just one or two treatments with pulsed-dye lasers. It has also been shown to improve the appearance of indented scars.
How to treat acne scars
The goal of treating atrophic scars is primarily collagen stimulation. This is often done by creating tiny wounds in the skin to boost healing and trigger remodelling of the skin.
By far the gold-standard of treatment is the fractional CO2 laser which has demonstrated significant immediate and long-term improvements in atrophic acne scarring after just one session! In one study, 60 patients experienced a 69% improvement in their scars one month after treatment, which later increased to 79% 18 months after the first session.
The only problem is, fractional CO2 laser requires some downtime and can be painful for patients. While the laser can help to brighten our skin tone, it also runs the risk of temporary erythema and hyperpigmentation in patients with darker skin types.
A good alternative is micro-needling treatments such as INFINI RF that offers excellent results to stimulate the production of healthy collagen and help raise depressed scars without damaging the surrounding skin.
Using fine micro-needles to puncture the skin and deliver radiofrequency energy up to 3.5mm deep within the skin, the insulated needles used offers a higher safety profile and lower downtime as compared to fractional CO2 laser, which can only reach up to a maximum of 1.5mm below the epidermis.
Unlike traditional laser treatments, INFINI uses photothermal energy instead; which means it can also be used for patients with darker skin types! Studies show an improvement in acne scar appearance by 25-75% after 3 to 4 treatments sessions.
As compared to PIH and PIE, proper intervention from an experienced doctor is your best bet to clearing up acne scars!
Tried every possible solution to no avail? Visit The Clifford Clinic!
Just like treating acne, acne scar removal is a process that requires patience and time. However, following a good treatment strategy that is recommended by an experienced dermatologist can help expedite the process.
At The Clifford Clinic, our doctors have carefully curated a range of products, technologies and treatments that are clinically proven to work and provide results for our patients ranging from the FUE hair transplant and Gold PTT treatment to AGNES!
As it isn’t uncommon for our doctors to see patients dealing with both hyperpigmentation and acne scars at the same time, they believe in combining several treatments to create a customized plan for each patient.
This includes chemical peels, TCA cross, fractional CO2 laser, Fraxel Dual laser, PICO + HEXA MLA Laser, INFINI and SECRET RF, subcision acne scars treatment as well as PDRN injections like Rejuran Healer.
Ultimately, the best way to treat acne scars is prevention — any form of treatment should always focus on treating any active acne and reducing the inflammation to minimize the occurrence and severity of acne scars that may form.
With over 18 years of experience in Aesthetic Medicine, our doctors have developed a unique set of methods and protocols for our acne treatment that has allowed us to achieve a 90% clearance of acne for our patients!
If you have been dealing with acne marks and scars that are hindering your progress in achieving clear, flawless skin — give us a call to book your appointment today!