Common skin ailments (2) – Acne scarring

Now that we’ve discussed acne in the previous post, I’ll go on to discuss what worries us most about acne in the first place – the scarring that occurs after the pimple settles down.

Just as not all skin is created equal, scarring occurs more for some people than others.  Genetic factors come into play and the duration of acne also affects the likelihood of scarring.  In general, the longer inflammatory acne is left untreated, there is a higher chance of scarring.  Scarring can be just a minor issue for some but much more devastating for others, affecting a person’s self-esteem and self confidence.  Many people with acne scarring are hesitant to leave home without the appropriate make up on to hide these blemishes.  Scarring has also been shown in many cases to lead to depression as people feel helpless and don’t know what they can do to improve their acne scars.

If you suffer from acne scars, you should at least know that there are different treatments available to minimize the scars effectively.  First of all, we’ll look at the different types of acne scars that are commonly seen.

Acne Post-inflammatory Hyperpigmentation (PIH)

acne PIH

Acne PIH is the discolouration that you see in your skin after inflammatory acne settles.  The inflammation leads to production and deposition of excessive pigmentation in the skin.  This is in fact not a ‘true’ scar as PIH is often a self-limiting condition but may require between 6 months to 1 year to resolve.  In some cases, longer.  This feels like a life-time to many sufferers who then look for treatments to lighten the pigmentation.  In my opinion, the best treatment is still prevention:

  • Prevent acne and treat it early with the appropriate steps discussed
  • Avoid excessive sunlight (use sun protection) as UV rays selectively darken these pigmented areas even more, making the PIH even more obvious
  • Avoid picking at the acne (this includes going for frequent extraction procedures) as the trauma to the skin often causes worse PIH

If you already have acne PIH, here are some treatment options:


Over the counter treatments: Alpha-hydroxy acids (AHA), Beta-hydroxy acids(BHA) and Vitamin A and C.  These are commonly found in many over the counter skin lightening products and are effective in milder cases of PIH.

Hydroquinone:  Hydroquinone works by inhibiting the enzymes which produce melanin.  It is available in different preparations (stronger preparations e.g. 3% and 4% are only available by prescription).  They can be used by themselves or in combination with other substances e.g. vit C which tend to make them more effective.

Topical retinoids (e.g. retin-A, differin): topical retinoids works by increasing exfoliation of skin cells; this can also help areas of PIH.

Glycolic acid: this also works via exfoliation of skin cells

Tips to usage:

  1. avoid accidental application to areas of normal skin to avoid unwanted lightening
  2. These substances can lead to dryness, irritation and photosensitivity especially with initial usage. In such cases, consider application only on an every other night basis until the skin becomes less sensitive.

Procedural treatments:


Chemical peels: A chemical peel is the exfoliation and also resultant peeling of a layer of the skin by means of application of a chemical substance (e.g glycolic acid) to allow new skin growth – normally resulting in smoother texture and clearer skin appearance. Chemical peels are an effective way of treating acne PIH.  Different acids at different concentrations can be used to achieve this; although it can be done at home, you are advised to seek medical advice from a physician who will be better equipped to help you perform this effectively and safely.


Lasers: Post-inflammatory hyperpigmentation has also been shown to be treated effectively by lasers e.g QS Nd:YAG laser.  This normally requires several sessions to break down the pigments sufficiently to be reabsorbed by the body.  These treatments are usually safe with minimal down time and effective in most cases.

The above-mentioned treatment methods can and are often used in combination to produce faster and better results.


Atrophic scarring

Acne atrophic scars are the depressed pitted scars that are left behind by acne and are normally permanent if left untreated.  It is still unclear why some people develop these scars and others do not.  In fact, the degree of scarring does not always correlate to the severity of the acne in the first place.  Nonetheless, these are the scars which frequently are the most disfiguring and cause the most distress and sense of hopelessness.

Different types of atrophic scarring:



Prevention of acne atrophic scarring is exactly the same as the prevention of acne PiH i.e.

  • Prevent acne and treat it early
  • Sun protection
  • Avoid picking


Resurfacing procedures – these are procedures which remove skin from top down and also stimulating collagen, leading to smoother healthier new skin

1) Chemical peel – as discussed earlier

2) Lasers – Resurfacing using either ablative/non ablative lasers have been shown to be effective in acne scar treatment.

a) Ablative lasers – Ablative lasers vaporises the epidermis and causes thermal injury to the dermis to  stimulate new skin growth.  The most commonly used ablative lasers in acne atrophic scar treatment are the CO2 and the Er:YAG lasers. CO2 ablative lasers are traditionally thought to be slightly more effective than the Er:YAG laser but with higher risk of side effects.

What to expect with ablative laser therapy: Prior to treatment, you will be given a topical anesthetic to numb the skin.  The procedure itself may take about 30 minutes.  After ablative laser treatment, treated areas will be red, raw, swollen and may itch.  These areas may become weepy and crusts will form.  Your doctor will advise you on how to care for your treated skin.  Most people prefer to rest at home in the initial period after the laser (for about 5 days).

b) Non-ablative lasers  – Non-ablative lasers leave the epidermis undisturbed.  Instead, the laser induces dermal collagen healing and remodelling to improve the appearance of acne scars.  Treatment with non-ablative lasers typically require more sessions but come with minimal downtime and have much fewer side effects than ablative lasers.

3) Radiofrequency microneedling – This is a relatively newer technique to improve acne scarring.  It works by using microneedles to deliver radiofrequency energy to the dermis to induce collagen stimulation and remodelling.  As this treatment spares the epidermis, there are fewer side effects and minimal downtime.

Intracel Radiofrequency Microneedling

Lifting Procedures – These are procedures which ‘free’ the scar and raise it up so they don’t appear so deep and obvious

1)  Subcision: This is a safe effective way to help improve rolling and some box car scars.  The doctor will use a needle to free up the fibres which tether the scars down to the underlying tissue, thereby improving its contour and appearance.  It is normally used in combination with other scar improving treatments.

acne injection

2) Fillers: Soft tissue fillers can be used to volumise and buttress these scarred areas to make the scars less obvious.  This treatment is normally more effective for rolling scars.  Done properly, this is a safe and effective treatment.  Your doctor will advise you further on the choice of fillers available and examine your scars to see if you’re a good candidate for this type of treatment.



After having read this, I hope you better understand what options are available to you to improve your acne scarring.  Don’t suffer in silence as there are effective, safe methods of getting rid of those unwanted scars today.  You just have to take that first step in seeking and getting the help you need.


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