Inflammation and Tissue Damage
Acne begins when hair follicles become clogged with oil, dead skin cells, and bacteria (the acne triad.) In more severe cases, the follicle wall can rupture, leading to the release of bacteria and debris into the surrounding skin. This triggers an inflammatory response as the body attempts to repair the damage. However, the inflammatory process can also damage collagen and elastin, critical components of healthy skin structure.
Collagen is a vital protein that gives the skin its structure, strength, and elasticity. Inflammation from severe acne can disrupt the normal collagen production and remodelling process. Excess collagen can be produced during the healing process, leading to raised scars known as hypertrophic or keloid scars. Conversely, insufficient collagen production can result in depressed scars, such as ice pick, boxcar, or rolling scars. Depending on the type of scar, specialised treatment can be performed to reduce or remove them. For example, a raised scar may require a laser to treat, whereas a depressed or atrophic scar may require injections to replace the lost volume in that area.
Types of Acne Scars
Different types of acne scars manifest based on how the skin heals after inflammation. Ice pick scars are deep, narrow pits; boxcar scars are wider with defined edges; and rolling scars create a wave-like appearance due to tissue distortion beneath the skin. Understanding the specific type of scars is crucial for effective treatment planning. Other than injecting atrophic scars, subcision is a helpful procedure to free the skin surface from uneven tethering to the deep tissue.
Delayed Healing and Pigmentation
Individuals with darker skin tones are more susceptible to post-inflammatory hyperpigmentation (PIH) following acne. Inflammatory responses can stimulate melanin production, leading to dark spots that fade over time. Unfortunately, these dark spots can contribute to the appearance of acne scars even after the active acne has resolved. A laser treatment is usually the answer to this problem. For example, the Pico laser can safely and effectively remove excess pigments left over from prior inflammation.
Improper Handling and Picking
Picking or squeezing acne lesions can exacerbate inflammation and increase the risk of scarring. Manipulating acne lesions can introduce bacteria deeper into the skin, leading to more severe inflammation and damage to surrounding tissue. It’s essential to avoid picking at acne to minimize the risk of scarring.
Genetic and Skin Type Factors
Genetics play a role in how an individual’s skin responds to inflammation and heals after acne. Some people may have a genetic predisposition to scarring due to their skin’s inherent healing properties. Additionally, factors such as skin type, ethnicity, and susceptibility to inflammation can impact the likelihood and severity of scarring.