There are two general types of acne scars, defined by skin tissue response to inflammation:
Types of Acne Scars
(1) scars caused by increased tissue formation, and (2) scars caused by loss of tissue.
Scars Caused by Increased Tissue Formation
The scars caused by increased tissue formation are called keloids or hypertrophic scars. The word hypertrophy means “enlargement” or “overgrowth.” Both hypertrophic and keloid scars are associated with excessive amounts of the cell substance collagen. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar.
The typical keloid or hypertrophic scar is 1 to 2 millimeters in diameter, but some may be 1 centimeter or larger. Keloid scars tend to “run in families”—that is, abnormal growth of scar tissue is more likely to occur in susceptible people, who often are people with relatives who have similar types of scars.
Hypertrophic and keloid scars persist for years, but may diminish in size over time.
Scars Caused by Loss of Tissue
Acne scars associated with loss of tissue—similar to scars that result from chicken pox are more common than keloids and hypertrophic scars. Scars associated with loss of tissue are:
Ice-pick scars usually occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch. Soft scars can be improved by stretching the skin; hard ice-pick scars cannot be stretched out.
Depressed fibrotic scars are usually quite large, with sharp edges and steep sides. The base of these scars is firm to the touch. Ice-pick scars may evolve into depressed fibrotic scars over time.
Soft scars, superficial or deep are soft to the touch. They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.
Atrophic macules are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious.
Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn’t fully develop. The lesions may persist for months to years.
Treatments for Acne Scars
A number of treatments are available for acne scars. The type of treatment selected should be the one that is best for you in terms of your type of skin, the cost, what you want the treatment to accomplish, and the possibility that some types of treatment may result in more scarring if you are very susceptible to scar formation.
You can use Elicina to prevent and repair acne scars and/or seek surgical treatments.
A decision to seek surgical treatment for acne scars depends on:
The way you feel about scars. Do acne scars psychologically or emotionally affect your life? Are you willing to “live with your scars” and wait for them to fade over time? These are personal decisions only you can make.
The severity of your scars. Is scarring substantially disfiguring, even by objective assessment?
A dermatologist’s expert opinion as to whether scar treatment is justified in your particular case, and what scar treatment will be most effective for you.
Before committing to treatment of acne scars, you should have a frank discussion with your dermatologist regarding those questions, and any others you feel are important. You need to tell the dermatologist how you feel about your scars. The dermatologist needs to conduct a full examination and determine whether treatment can, or should, be undertaken.
The objective of scar treatment is to give the skin a more acceptable physical appearance. Total restoration of the skin, to the way it looked before you had acne, is often not possible, but scar treatment does usually improve the appearance of your skin.