We’ve all had acne. Many of us have gotten acne scars. And we all want to treat them. But understanding how to treat acne scars first requires understanding what causes them, which I’m going to share with you today.
Not all acne turns into acne scars, but when scarring does occur, it usually results from inflammatory acne lesions like red pimples, pus pimples, and cysts. And the worse the inflammation, the worse the scar. The visible component of these types of acne is inflammation of the top two layers of your skin, the epidermis and the dermis. The dermis is the key here. It's the second layer of your skin, and it’s where your oil glands, collagen, hair follicles, nerves, and blood vessels are. When the dermis is damaged to the point that any of the tissues I just mentioned are actually destroyed… you get a scar.
The destruction of healthy dermal tissue is usually caused by the inflamed, swollen… sorry, it’s about to get gross!… pus filled pimple or cyst rupturing inside the skin, which allows the damaging pus to leak into the surrounding healthy tissue.
Dermal tissue is destroyed by both the pus itself and also the body’s reaction to the pus.
When healthy dermal tissue is destroyed, the body tries to repair it… but the repair process is quite imperfect because the body can’t rebuild the destroyed healthy tissue. Instead, it does what it can which is to make hard fibrous collagen, which you’d recognize as scar tissue. It usually starts out red or pink but fades over a period of time to become lighter than your normal skin color or even white.
The most common type of facial acne scar is atrophic, meaning the body didn’t make enough collagen to replace all the destroyed tissue so the scar is depressed below the level of the surrounding normal tissue. The scar can have curved, sloped walls like a crater, so it’s called a crater scar, or it can have walls in the shape of the letter, “V,” almost like someone stuck an ice pick in the skin… so that’s an ice pick scar. And last, the walls can be vertical with a flat bottom, shaped like a box, so that’s a boxcar scar.
But sometimes the body produces too much collagen, which creates a bump of raised tissue above the skin's surface. This type of scarring is called hypertrophic and while it’s common on the trunk, fortunately it’s rare on the face.
So……… That’s enough on acne scars for one day, but now that you know what causes scars, the good news is that there are things you can do to help prevent them… which I’ll explain in a future episode.