Almost all of us have experienced acne at some point. According to the American Academy of Dermatology, it’s the most common skin condition in the country. For some patients, severe acne can lower self-esteem, and acne scars only prolong these emotional side effects. Fortunately, through prevention and treatment, it is possible to improve acne and reduce the potential for scarring.
Acne occurs when a mix of dead skin cells and excess sebum becomes trapped in a hair follicle. Non-inflammatory acne is characterized by whiteheads and blackheads, while inflammatory acne includes papules, pustules, and often-painful cysts and nodules. Inflammatory acne most often leads to scarring, as the rupture of the follicle creates an injury that the skin is unable to repair.
This injury to the skin damages collagen fibers and may cause small depressions, such as pitted or icepick scars, to develop. The redness and irritation caused by blemishes can also lead to red or dark spots, known as post-inflammatory hyperpigmentation.
Properly treating active acne is key to prevent scars from forming. First and foremost, avoid picking at blemishes: Picking or popping pimples prevents the skin from healing properly and will only exacerbate irritation. Proactive treatment with physician-grade products also helps to eliminate mild to moderate acne at the source, thus lessening the chances of scar formation.
If a patient has severe acne—typically categorized by cysts that reach at least four millimeters wide or more—the best treatment protocol includes antibiotics such as doxycycline, or a high strength retinoid such as Accutane, the last line of defense for treating severe acne that is unresponsive to other treatments. Your physician may also suggest occasional in-office cortisone injections to reduce the swelling of cysts or nodules and lessen the likelihood of scarring.
Professional peels, such as the SkinMedica Vitalize Peel®, can also make a vast difference in improving the appearance of acne scarring. However, these results will only be temporary if the patient is not committed to an at-home regimen. I’ve had great success with my patients using the SkinMedica Acne System, which includes a salicylic acid face wash, toner, and a benzoyl peroxide treatment lotion. I may also incorporate Tri-Retinol Complex™ ES or TNS Recovery Complex®, which enhances speedier rejuvenation of the skin.
Despite the long-standing myth that the sun improves acne, it can actually make it worse by increasing inflammation and further darkening spots. I recommend diligent use of SkinMedica Daily Physical Defense™ SPF 30+ Sunscreen; this is especially important if the patient is using products containing retinol or salicylic acid, since these ingredients make the skin more sun-sensitive.
Isolaz® is a fairly new, non-invasive treatment combining vacuum-like suction, which extracts excess oil from the pores, and broadband light, which destroys acne bacteria. This painless procedure is indicated for mild to moderate acne, including pustular and comedonal acne, and can be used in conjunction with traditional topical or oral acne therapies.
When addressing scars as opposed to active acne, exfoliation is key. Treatment with retinol and a series of SkinMedica Rejuvenize Peels™ (formulated with salicylic and lactic acids) will help to smooth the skin’s surface so that skin looks healthier overall. For patients looking to improve scars while fighting the signs of aging, the same adage of “out with the old, in with the new” applies: Proper exfoliation and feeding the skin with rejuvenating products will promote a smooth, youthful complexion.
Deep, pitted acne scars result from damage to multiple layers of the skin and thus necessitate a more aggressive treatment approach with a laser like Pearl Fractional. Pearl uses laser pulses to create microscopic “wounds” in the skin, removing damaged tissue (scars) and allowing fresh, new collagen to be produced in its place.
The aforementioned treatments are especially effective when the patient does their part at home, using topical products with retinol, growth factors and of course, sunscreen. Patients with severe acne and acne scarring will often go to great lengths to improve their skin—in fact, they are typically my most compliant group of patients.
Though acne scars all have a similar origin, they can take on different appearances as your skin changes over time. Your dermatologist or skin care specialist can cater a treatment plan to your skin type to best stop acne at the source and prevent future scars from forming.