One of the most heartbreaking aspects of acne is that it can form scars, both physical and psychological.
Why Acne Scars Form
Acne is caused by the inherited tendency of the lining of the pores to shed too many skin cells at once, forming tiny, sticky plugs called microcomedones. These microcomedones begin working their way to the surface, gathering more dead skins cells and growing larger along the way. When they reach the surface they appear as a blackhead and are eventually expelled naturally.
Sometimes, particularly in people who have the inherited tendency, the plug grows too large before it reaches the surface and it breaks through the follicle wall, spilling the dead skin cells, the excess oil, and the p. acnes bacteria into the surrounding tissue. The immune system sends white blood cells to the site to deal with this invasion, resulting in inflammation. But the immune system doesn’t just send white blood cells. It sends a digestive enzyme to try to rid the body of this hard plug of sticky, dead skin cells.
The very outer layer of our skin is made up of remarkably tough, keratinized, skin cells and it is these tough skin cells that form the microcomedones and larger comedones. They are impervious to the digestive enzyme the immune system sends, but sadly, the surrounding tissue is not. The surrounding tissue gets eaten up by these digestive enzymes, which leads to the classic ice pick and box car acne scars so familiar to cystic acne sufferers.
These types of pitted or depressed acne scars often take a more aggressive medical approach to see results. To review what is available in the field visit http://www.acne.org/acne-scar-treatment.html.
Unfortunately for those who already have the scars, the best treatment for acne scars is still prevention. If your sons and daughters have inherited your acne, don’t wait. Get them into treatment so we can head it off before the scars form.
Sometimes people refer to the dark spots left when acne lesions heal as acne scars and these are much more responsive to treatment.
These spots are referred to as hyperpigmentation, or more accurately “post inflammatory hyperpigmentation” or PIH. PIH happens following any inflammatory wound and can be pink, red, purple, brown or black, depending on your skin tone. The inflammation causes the melanocytes to produce too much melanin and the discoloration remains after the lesion has healed.
Fortunately, areas of PIH are not true acne scars, and we can treat them very effectively. The chemical peels we use as part of the acne clearing treatment lift the dark spots as well. The dark spots usually take somewhat longer to go away than the lesions. We also incorporate appropriate home care into fading the spots, and encourage our clients to always wear sunscreen.
Non-Acne Dark Spots
As we age, darker areas form on our skin for lots of reasons. The most usual culprit is sun damage, but they also can form due to hormonal changes and sometimes trauma to the skin, leading to PIH.
We also have success in treating these other kinds of dark spots for people who haven’t had acne. The treatment does require time and a bit of patience, as we gradually bring the color to the surface by lifting through chemical exfoliation, but you will be happy with the results.