Acne scars

Sophie Matzik is a freelance writer for the medical team.

More about the experts All content is checked by medical journalists.

Acne scars form after severe cases of acne or after unprofessional treatment of the condition. Since they mostly occur on the face, they can have a major impact on the everyday life of those affected and, if left untreated, represent a lifelong burden. Read everything you need to know about acne scars - how they develop and how they are treated.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses.They can be found, for example, in doctor's letters or on certificates of incapacity for work. L70

How do acne scars develop?

If scars develop in acne, the illness is usually particularly severe - or the pimples, pustules or blackheads have been treated unprofessionally. If you squeeze out pimples and blackheads yourself, bacteria very quickly get into the wound, which can multiply well in the secretion they contain and cause inflammation. The normal connective tissue is destroyed and replaced by non-specific tissue. This differs in appearance from the rest of the tissue, is less well supplied with blood and can harden and move inwards. This is why acne scars are so noticeable. In terms of color, acne scars are initially red, later they become white.

Whether acne scars develop depends not only on the type of acne but also on the individual skin type and age. In older people, the skin does not regenerate as well as it did in younger years, which is why acne scars are a common consequence of the disease.

Various acne scars

Not all acne scar is created equal. Depending on the place of origin and form, a distinction is made:

Atrophic acne scars

They are slightly below the level of normal skin, so they look like they are pulled inwards. The reason for this is that not enough new connective tissue was formed during the tissue repair. Another characteristic of these acne scars is that they are more or less pigmented than normal skin.

Atrophic acne scars are mainly caused by long-term inflammation and suppuration, such as can occur when you push around on pimples yourself.

In detail, doctors differentiate between different types of atrophic acne scars:

• Worm-like scars (V-shaped scars) have a diameter of less than two millimeters and extend deep and steep-walled in a funnel shape into the lower dermis or even into the subcutaneous tissue.
• Varioliform scars (U-shaped scars) are similar to chickenpox scars. They have a diameter of 1.5 to four millimeters and are flat or deep, round or oval and steep-walled.
• Wavy scars (M-shaped scars) are falch and have a diameter of more than four to five millimeters. They arise from connective tissue strands that connect the dermis with the subcutaneous tissue.

Hypertrophic acne scars

These acne scars stick out from the skin and form visible, rough thickenings because too much new tissue has been formed to repair the wound. They are whitish or skin-colored and may be itchy or painful. Hypertrophic acne scars occur primarily on the shoulders and cleavage in people with a genetic predisposition.

Hypertrophic acne scars also include bridge scars and keloids.

How to remove acne scars

Depending on the size, shape and location of the acne scars on the body, different methods of removing them can be considered. Basically, the following procedures are available for the treatment of acne scars:

• Laser therapy
• Surgical scar correction
• Icing treatment
• Grinding treatment
• Chemical peel
• Dermabrasion
• Microdermabrasion
• Cortisone injection
• Injection of collagen

These treatment methods are carried out by a dermatologist (dermatologist) or a plastic surgeon. Treatment of very large acne scars can sometimes require hospitalization, depending on the procedure. In many cases, however, the treatment is carried out on an outpatient basis. Most of these treatments, however, require multiple visits to the doctor.

Also important to know: Surgical scar corrections, freezing treatments and laser therapy require extensive aftercare. Those affected can be absent from work and private life for a few days after the treatment.

The treatment options in detail

Laser therapy

Laser treatment can be used for both hypertrophic and atrophic acne scars. There are various laser technologies to choose from:

The standard method for removing acne scars is functional laser therapy with a CO2 laser or an Erbium: YAG laser. The CO2 laser is primarily used to carry out deeper ablations. The Erbium: YAG laser is used to shoot small holes in the skin (fractionated lasers). These heal with healthy connective tissue, which smooths and tightens the skin.

Alternatively, the doctor can also use a laser to remove excess scar tissue in layers. He then uses a small needle to introduce a pulse of heat into the skin that stimulates the growth of normal, smooth collagen tissue, which replaces the hardened collagen tissue in the acne scars.

If people with acne want to have their scars lasered, they have to plan some pre- and post-treatment. Overall, the treatment extends over several appointments.

One possible risk of laser therapy is incorrect application of the technology. Then the surrounding tissue can be destroyed and the skin can be severely irritated.

Surgical scar correction

Acne scars can also be removed with surgery. The surgeon first removes the excess tissue with a special cutting technique. Then he puts the wound edges close together and sutures them together. It cannot be ruled out that a scar will also remain, albeit a smaller one.

Surgical scar correction is only done for rather large acne scars.

Icing treatment

During an icing treatment, the scar tissue is iced up at minus 180 degrees with liquid nitrogen. The tissue dies and can then be removed in an operative procedure.

Grinding treatments

Abrasive treatments are used on acne scars with sharp edges as well as hypertrophic acne scars. The doctor grinds off excess tissue with a diamond bur. The patient is given general anesthesia for this.

Small bumps often remain after the treatment.

Chemical peel

With a chemical peel, a special substance is applied to the skin, through which the skin is peeled off to a greater or lesser depth. The result is a smoother complexion.

Highly concentrated trichloroacetic acid (TCA) is often used for this form of acne scar treatment. The acid content can be between ten and 100 percent. Up to an acid content of 30 percent, acid peelings can be carried out independently, from 30 percent by a beautician or a dermatologist and from 40 percent only by a dermatologist.

At the beginning, the skin has to get used to the acid slowly, which is why very short exposure times are recommended, which are then increased over several weeks. For up to seven days after an acid treatment, those affected should avoid direct sunlight on the treated areas.

Acid treatment is painful and, depending on skin type, can cause irritation and reddening of the skin. Also, it doesn't always improve the appearance of acne scars. Very good results are only achieved when using highly concentrated acid. Afterwards the skin is reddened for a long time.

Dermabrasion

With dermabrasion (translated: skin abrasion), the doctor grinds the top layer of skin with a fine burr and can also remove excess scar tissue. The skin becomes smoother and more uniform.

Dermabrasion is mainly used for large, superficial and sharp-edged acne scars. It is often performed under general anesthesia under inpatient conditions. After the treatment, those affected must not expose the treated skin area to UV light (sun, solarium) for several months.

Microdermabrasion

With microdermabrasion, fine, small crystals are shot onto the skin in order to remove the top layer of skin. This method is a little gentler than the previously mentioned techniques and does not actually leave any marks on the face after the treatment. The effect corresponds to that of a mechanical peeling. Depending on the size and depth of the acne scars, several sessions over several weeks are necessary. A session lasts around 15 to 30 minutes and is usually painless.

Injection of acne scars

The doctor injects cortisone directly into the scar. This causes the scar tissue to die and the scar to flatten. However, this method does not renew the tissue, which means that the somewhat whitish scar tissue still stands out from the skin after the treatment. This treatment is particularly suitable for hypertrophic scars.

Injection of collagen

This method of treatment is used for atrophic acne scars. The doctor injects collagen into the scar - he fills it up artificially, the scar tissue lifts and adapts to the level of the surrounding skin.

Acne scars: prognosis

In the last few decades, the field of possible treatment methods for acne scars has expanded significantly: Adapted to the respective skin type and acne type, those procedures are used that cause the skin as little damage as possible. Your dermatologist will decide which therapies are suitable for you based on the clinical picture of your acne. The result of the treatment also depends on the skin type.

In general, the prognosis for acne scar treatment is good. In many cases, acne scars can be removed in such a way that they are barely visible or no longer visible.

In general, of course, more superficial and smaller acne scars can be treated faster and with better results than larger and deeper acne scars. In some cases deep scars cannot be made completely "invisible" even with several treatments.

Prevent acne scars

Acne scars cannot always be prevented. However, it is definitely helpful if you do not express pimples and blackheads yourself, so that there are no "self-made" foci of inflammation on the skin. In severe acne cases, however, you can no longer control the inflammatory processes of the skin yourself. Acne should therefore be treated medically as early as possible so that inflammation of the hair follicles and the skin can be reduced and bacterial infections can be fought early. This can help prevent acne scars later on.

Tags:  baby toddler sleep first aid