Scars in relief or in hollow … To fade the stigmas of acne, there are many solutions, more or less effective. But the best way to prevent them is still to prevent the development of acne by consulting a dermatologist as soon as the first symptoms appear.
Acne is a chronic inflammatory disease of the follicle pilosebaceous. It can last into adulthood, and its sequelae can have a lasting impact on patients, especially on a psychological level. Unlike eczema or psoriasis, it can cause permanent scarring on the face, neck or chest.
“In consultation, I see patients traumatized by their acne, whose adolescence was spoiled by pimples and who still today are complexed by these residual lesions”, confirms Dr Naima Midoun, dermatologist. How to take care of them? Are all acne scars permanent? Can they disappear naturally? What about the effectiveness of peels?
How do acne scars form?
“Acne scars follow inflammatory lesions that are part of the middle layer of the skin, the dermis”, explains the dermatologist. They can be definitive, and all the more embarrassing because they are often located on the face. At first, they take on a red or pink color, then gradually whiten.
As a reminder, acne results in a set of skin lesions. It begins with the formation of comedones (retentional lesions) which can spontaneously disappear, persist, or burst. When these comedones erupt in the dermis, they cause an inflammatory lesion which results in the formation of macules (non-palpable skin spots that do not leave a scar). Deeper lesions, such as papules (visible, palpable and small pimples ) or nodules (visible, palpable and larger pimples) may then appear and generate scarring.
Different types of acne scars
Most often, the scars are superficial, rather inconspicuous, and not permanent. But this is unfortunately not always the case. There are several types of real scars:
- Hollow scars: “craters” (shallow) or “ice picks” (deeper and narrower);
- Scars in relief: botriomycome (small or large) and keloids (more voluminous and unpleasant because they move).
- Small whitish balls with a soft consistency (perifollicular elastolysis), can also appear on the face and the trunk of people with dark skin.
Are some skins more at risk?
Some skin, which is thinner and less resistant, marks more quickly and is, therefore, more exposed to the risk of scarring. Patients with severe forms of acne, such as cystic or lumpy acne are also at greater risk.
In cases of excoriated acne, the risk of scarring is also greater. People who suffer from this anxiety disorder cannot help but grind and/or scratch their blemishes compulsively and obsessively, which in the case of acne makes inflammation worse.
Note, you can promote the appearance of scars by piercing your pimples yourself, but they can also form spontaneously in cases of untreated inflammatory, nodular or fulminant acne.
When and who to consult for acne scars?
The management of unsightly scars should be performed by a dermatologist. The ideal is to consult again the professional who prescribed and followed the treatment of acne in the inflammatory stage.
Regardless of the age or type of skin lesions, it is always best to consult a dermatologist. Even more so if there is a heavy acne history in the family. “Acne is not just a matter of age. It should not be trivialized during adolescence. We sometimes see very severe forms linked to genetic determinism that can damage the skin for life. the longer you leave it lying around, the more you risk exposing yourself to scars, especially on the face, ”insists Dr Midoun.
Think about teleconsultation
If you cannot see a dermatologist near you, or if the waiting times are too long, do not hesitate to turn to teleconsultation. You can thus be taken care of before obtaining a face-to-face appointment. ” Even in teleconsultation, we can make a precise diagnosis and prescribe the appropriate treatment, while patients find a dermatologist available near them”.
Prevent acne, the best solution get rid of acne scars
The more severe the acne and the later the initiation of treatment, the greater the risk of scarring. The best treatment for acne scars, therefore, is the prevention of acne itself!
There are several types of treatment, administered depending on the form and severity of the disease, the patient’s age, the impact on his quality of life, the treatments he has already followed, etc. Locally, acne can be treated with topical drugs (especially retinoids used in retention acne). Local anti-inflammatory drugs, such as benzoyl peroxide, can treat inflammatory lesions.
In addition, orally, some antibiotics are also effective. To complete these treatments, skin cleanings consisting of piercing and emptying the retentional lesions can be performed by dermatologists. Finally, if this is not enough, the doctor may suggest a second-line treatment with isotretinoin (prohibited in pregnant women or women of childbearing age who do not take contraception).
This management must be sustainable to avoid recurrence. It is not because we have nothing left on the skin that acne will not come back. You must watch for resurgences and do not hesitate to return to your dermatologist if necessary.
Camouflaging your acne scars is possible!
Covering foundation, corrector, powder … It is possible to wear make-up during acne treatment, and of course afterwards, to better support certain scars.
If they are red marks
The red marks (erythematous spots), often the result of fair skin, can persist for several months, but in the vast majority of cases, they disappear on their own and completely. During the transitional period, makeup will effectively camouflage these marks. A concealer brush applied to the area to be corrected is sufficient. Pat lightly and blend outlines with a cotton swab.
Which cream to use?
The dermatologist may also prescribe a moisturizer and a cosmetic based on alpha or beta fruit acids (salicylic acid) to accelerate the disappearance of these marks which are not considered to be real scars since they disappear spontaneously.
If they are brown spots
Dark to dark skin is the most affected by these pigment spots. Among cosmetics, there is a variety of depigmenting agents such as kojic acid, resorcinol, vitamin C … “with modest efficacy”, warns Dr Midoun.
More effective, depigmenting preparations are prescribed by the dermatologist and prepared by the pharmacist. “The classic preparation, the Kligman trio, is hydroquinone, combined with vitamin A acid (retinoic acid) and corticosteroids. I often prefer to prescribe a duo with hydroquinone and vitamin A acid, starting with low-dose active ingredients and then gradually increasing them. The first results are visible from three months, “says the dermatologist.
When these tips fail to hide the reliefs and other imperfections, there are aesthetic treatments that allow you to find a more even and smoother skin, but without any guarantee of results.
Acne scars: which effective treatment?
Light marks can go away on their own, sometimes after several months or weeks.
Depending on the type of lesions, hollow or raised, pigmented or not, and depending on their age, different techniques can be used and reduce or remove acne scars.
Better to contact a health professional, who can assess the situation, judge the type of scar and choose the most suitable method. But nothing can be done until the acne is completely healed.
Likewise, this type of treatment is practised more in winter to avoid any risk of pigmentation by the sun.
Peeling with fruit, glycolic or salicylic acids can give good results on red pigmented spots associated with acne. Above all, it helps restore radiance to the complexion and possibly tighten the pores of the skin.
Dermabrasion acts as a mechanical micro sanding of the skin. Abrasion removes the outermost skin layer to force the epidermis to regenerate. The operation is performed under local or general anesthesia and the result is obtained after one week. No sun exposure for at least 2 months after dermabrasion.
3. Depigmenting creams
Depigmenting creams are more intended for dark spots.
If the laser is recommended, the technique will be different depending on your type of scar:
- Vascular laser (LED, Q-Switched) is indicated for spots pigmented in red, without relief.
- Fractional laser (Erbium, CO2 ablative or not) corrects large and shallow hollow scars in several sessions.
- Ablative laser (CO2, Erbium) is dedicated to raised and cord-shaped scars. This involves burning the skin under anesthesia to generate renewal of the skin tissue and smooth the skin. At least one week of work stoppage and social exclusion.
5. Needling or micro-needling
Needling or micro-needling consists of using a kind of electric pen equipped with micro-needles. The idea is again to induce healing by perforating more or less deeply the areas to be treated.
6. Hyaluronic acid injections
Hyaluronic acid injections may be enough to fill light hollow acne scars (called atrophic), which are precisely the most frequent.
Surgery is reserved for deep and narrow scars, it requires at least a week of social exclusion and should be followed by laser sessions for surface finishing of the skin.
8. Injection of corticosteroids
The injection of corticosteroids gives results on raised scars of the keloid type, when the skin is blistered. This involves reducing the volume of scars before smoothing them with an ablative laser.