How to tackle acne scarring and win

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Dermatologists know that “letting acne run its course” is bad advice. There is little doubt that treating acne boosts self-esteem. Moreover, without treatment, dark spots and scars can appear on the skin as the acne clears and can be much more of a challenge to manage. Scarring can occur at any site affected by acne. Scars on the face are often ‘atrophic’ i.e. they are depressed, pitted or form craters. Scars on the breast bone (sternum), back and shoulders are often raised or ‘hypertrophic’. The risk of scarring is higher in individuals with acne cysts and nodules and stronger treatment is usually needed. Dark marks or blemishes, known as post-inflammatory hyperpigmentation, are more problematic in skin of colour and may take several months to fade, if at all. Keloid scarring, an overgrowth of scar tissue, is also more common in people with black skin. The sooner acne is brought under control, the lower the risk of permanent scarring. The following tips provide a summary of interventions for preventing and treating acne scars and are best managed under the guidance of a consultant dermatologist or plastic surgeon.

What You'll Need

  • Sun protection moisturiser (broad-spectrum SPF 50, non-comedogenic).
  • Non-comedogenic make-up or skin camouflage.
  • Advice about prescriptions or procedures from an accredited dermatologist or plastic surgeon.

What You'll Do

  • See your doctor early if over the counter treatments are not working. The first step in preventing or treating acne scarring is to get breakouts firmly under control and you may require a topical or oral prescription.
  • Some topical prescriptions used to treat acne also actively reduce scarring and pigmentation. Examples of these are azelaic acid (Skinoren, Finacea) and retinoids (Differin, Isotrex etc). These can be used alone, but are often combined with oral antibiotics.
  • If you have acne cysts and nodules, or if you are starting to notice depressed or raised scars, you should bring this to your doctor’s attention as it may be appropriate to see a dermatologist for a prescription drug called isotretinoin (Roaccutane). Whilst it has some important side effects that you will need to be counselled about, it can be extremely effective for more severe cases or when other treatments have failed.
  • Do not squeeze or pick your spots. This can introduce infection and ultimately makes scarring worse.
  • Protect your skin in the sun. Ultraviolet light causes dark spots and scars to become even darker and more prominent. Apply a broad-spectrum (UVA/ UVB) SPF 50 sun protection moisturiser each morning before leaving the house. Ensure that the product is labelled as non-comedogenic so that it doesn’t aggravate your acne.
  • Once the acne is controlled, scarring tends to improve even without intervention in the following 6 to 12 months as the skin undergoes natural rejuvenation. The degree of improvement is variable, however, and many pursue further treatment.
  • Skin resurfacing procedures can be helpful for atrophic scars. Examples include laser resurfacing, dermabrasion, medical needling and chemical peels. A type of chemical peel technique known as TCA cross can be very helpful for small deep pitted scars (ice-pick scars).
  • Hypertrophic and keloid scars may be treated with a course of steroid injections into the scars themselves (intralesional injections). Injections are typically repeated every 2 or 3 months until the scars have flattened. For less prominent scars, a steroid ointment or tape may be preferred. Other treatments include surgery, laser and medical needling. Silicone sheets or gels can also be helpful and may need to be applied for a number of months.
  • Dark marks can be treated with azelaic acid and/ or a topical retinoid as above. Skin lightening creams containing hydroquinone are also sometimes used. It can take several weeks or months before an improvement is appreciated and strict sun avoidance is the rule.
  • There are some really excellent foundations and concealers designed for people with acne and scarring e.g. Dermablend. Check that the products are labelled non-comedogenic. Your dermatologist can point you in the right direction.
  • There are also charitable organisations who can advise on skin camouflage e.g. Changing Faces.
  • Low self-esteem and psychological distress is not unusual in acne sufferers. Many people with severe acne report feeling bad about themselves, avoiding social situations and missing school or work due to embarrassment about their skin. Please don’t suffer alone and seek medical advice if this is you - there are lots of effective treatments available!
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