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Ever found yourself noticing that an acne ‘mark’ simply isn’t going away?

It could possibly be an acne scar instead; and these can be difficult to improve if left untreated for an extended period of time.

It’s tough enough to deal with the hustle and bustle of daily life. Acne-related anxiety doesn’t have to be added on top of the other stresses in life.

“Just don’t pick at your acne!” or “Leave it alone! It will heal in time,” are common comments patients often receive from well-meaning peers. With all due respect, in reality, without proper treatment, acne scars CAN get worse in time. 

In this article, allow me to explain: 

• Factors that cause the worsening of acne scars 
• The difference between acne marks and acne scars 
• When is the right time to treat acne scars 

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Can acne scars get worse? 

Acne scars can get worse with age. 

This is not so much due to the worsening of the scar per se; but the result of our skin losing collagen and elasticity as we age. This collagen loss can cause depressed or atrophic scars to look more noticeable with age.

Certain areas of the face –such as the temples and mid cheek– also experience fat loss. Loss of volume in these areas may also accentuate the appearance of depressed scars. 

Besides age, factors that accelerate collagen loss include; 

• Excessive UV exposure
• Smoking 
• Unhealthy lifestyles 

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Do acne scars affect adults and teenagers differently? 

Yes, acne can affect men and women differently. 

Men are more likely to get acne when they are older and prone to longer duration or severity of active acne. Male patients also tend to have more severe scarring compared to female patients.

In terms of age, comedonal acne is more common in adolescents and cystic acne are more common in adults[1]. This is due to the intense inflammation generated by cystic acne, thus increasing the likelihood of scarring.

Severe acne and acne scarring can contribute to psychological distress. If untreated, this may result in poor self-esteem and even depression. This is why it is important to treat acne and acne scars as early as possible for effective treatment results.

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What is the difference between acne marks and acne scars? 

Acne marks, known as pigmentation, are the result of acne. Acne marks are not scars, are temporary and will fade over time.

There are three types of acne marks:

• Post-inflammatory hyperpigmentation (PIH) - Brown pigmentation
• Erythema - Redness / red pigmentation
• Hypopigmentation - Least prevalent marks

Unlike acne marks, acne scars can permanently damage the skin without proper treatment. Acne scars can also change the texture of the skin.

There are two types of acne scars:

• Atrophic - Depressed or indented scar that heals below the normal layer of the skin tissue and forms when the skin can no longer regenerate tissue. These scars can be the result of severe acne or chickenpox.
• Papular - Minimally raised scar with a cobblestone-like appearance, commonly present on the back, nose and chin.

Between the two, acne marks are easier to treat and will show results much faster. 

Depending on your skin type, PIH can improve over time even without treatment. This is the same as post-inflammatory erythema (PIE). Hypopigmentation can take a longer time to treat.

Acne scars usually require physical treatment such as energy-based devices, subcision or chemical peels to show improvement. 

It’s best to treat acne scars sooner than later. Waiting does not help with such scars and topical treatment often shows little to no results!

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Are my scars bad enough to treat?

Acne or acne scars are not only physically distressing (painful or itchy), but psychologically distressing[2] as well.

Acne scars are never “bad enough” to treat; if it bothers you, treat it!

Early treatment of acne improves and speeds up your desired results. More cycles of acne inflammation causes more damage to the skin, increasing the likelihood of more scars in the future. 

In short, the longer you wait to treat your acne scars (regardless if they are bad enough or not), the longer it will take to see improvement.

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References 

1. Gan, Eveline. “Acne in adults a pain to manage; experts zoom in to study Singapore’s cases.” today online, https://www.todayonline.com/singapore/acne-adults-pain-manage-experts-zoom-study-singapores-cases

2. “Acne can affect more than your skin.” American Academy of Dermatology Association, https://www.aad.org/public/diseases/acne/acne-emotional-effects