AcneNet This Month
Fall 1999 Special Feature

Questions and Answers About Acne Scars

If you have acne, you may wonder if the acne is going to leave permanent scars after the lesions heal. If you already have some acne scars, you probably want to know if you can prevent any more from forming, or if you can eliminate or cover up scars after you have them.

Are you going to have acne scars after your acne heals? No one can give you a definite answer to that question because there is no single way in which skin responds to the inflammatory lesions of acne. All that can be said for sure is that (1) only inflamed lesions cause scarring because it is inflammation that provokes the scarring response, and (2) some people with acne are more likely than others to form scars, but it is difficult to predict who will scar and who will not. Probably most people with severe inflammatory nodulocystic acne will form scars, but also will some people with more superficial inflamed lesions.

Again, it is impossible to give an answer that applies to all people with acne scars. Scars may well stay visible for a lifetime, but in some people there may be a remodeling of skin over time that slowly makes scars less apparent. It is also possible that some people gradually become accustomed to the appearance of their scars and find they are quite comfortable with the way they look. It is probably unlikely that acne scars will completely disappear without some kind of dermatologic treatment.

Because the likelihood of scarring is unpredictable on a general basis, the prevention of scarring must be individualized to each person with acne—and even then the prevention of scarring is not completely assured. Scars form in response to the damage caused by inflammatory lesions; therefore, treatment that is directed to the control of acne and the lessening of inflammation is the best approach to prevention of scarring. Isotretinoin and antibiotics are medications prescribed for more severe forms of inflammatory acne. One of the things you can do to promote inflammation is to pick and squeeze acne lesions. Picking and squeezing can force sebum and bacteria deeper into the sebaceous follicle, and can cause breakdown of the follicle wall with injection of sebum into the nearby tissue, causing more inflammation. (click on Why and how acne happens for more information about causes of inflammation in acne). If you are interested in scar prevention, do not pick and squeeze acne lesions.

The purpose of cosmetics is to improve appearance, so there is nothing wrong with using cosmetics to make acne scars or postinflammatory macules less visible. However, you must be sure that the cosmetics you use are noncomedogenic—that is, they do not cause formation of comedones. You also must be sure to remove the cosmetics with gentle cleansing in a regular program of acne hygiene. If you have acne scars, you already know that you are more prone to get acne, so don’t do anything that makes acne more likely.

Scars can be removed or made less visible by a variety of procedures carried out by a dermatologist. In all cases, the person with acne scars and the dermatologist should discuss all appropriate procedures and agree on the procedure that is deemed most appropriate. Different types of scars require different treatments—e.g., keloid scars and pitted "ice-pick" scars would probably be treated quite differently in order to maximize the effectiveness of treatment and minimize the possibility of causing new scarring. For example, dermabrasion—a treatment in which surface skin is abraded away—may not improve "ice-pick" scars and may even make them more noticeable because ice-pick scars often have many "tunnels" branching off the main "ice-pick" pit.

Scar treatments that may be discussed with a dermatologist include dermabrasion, laser surgery, collagen injections, local steroid treatment, and surgical excision. Another option is no treatment—i.e., letting scars slowly become less apparent over time. Whatever choice of treatment is made, it must be the choice that you and the dermatologist agree is best for you.