SKIN DEEP

The expert advice on how to treat acne scarring

Thanks to the amplification of the body confidence movement, a growing number of women are now embracing bare skin – and it’s a trend I wholeheartedly applaud. But many of my clients continue to tell me that they find their acne scars distressing, and ask me what they can do to reduce their appearance.

Here’s what’s going on: acne causes inflammation of the skin and presents as whiteheads, blackheads, pustules, nodules and cysts. If these lesions remain untreated, they can cause long-term scarring to the skin, and they do so in around 30% of moderate-to-severe acne cases – though these numbers are higher in cases of nodulocystic acne. This is one of the most extreme types of acne, and looks like large, red boils that reside deep beneath the skin’s surface. These cysts destroy the skin tissue, which isn’t replaced during the healing process; once the cyst is emptied and the area repairs itself, an indentation is left, aka the scar. It’s worth noting that you’ll need to treat any current acne before you begin to treat acne scars, which can be done using a combination of topical, oral and light-based treatments, such as laser or blue-light therapy. And since it’s easier to treat recent scars than it is older ones, visiting a dermatologist or aesthetician early on is always a good move.

As to how you reduce the scarring, there are several options your derm will talk you through, with the type of treatment you go for depending on the sort of scarring you have. Superficial scarring is, as you might expect, the mildest type and the easiest to treat. Topical options – such as glycolic and salicylic acid and prescription-strength vitamin A creams, like tretinoin – work by gently resurfacing the skin, and can be applied as part of your normal skincare routine.

Moderate-to-severe acne presents in several different ways. Boxcar scars are shallow-to-medium depressions in the skin and have well-defined edges; ice-pick scars are deep and narrow; rolling scars present as deep depressions in the skin; and if the scar feels lumpy or raised, it’s a hypertrophic or keloid scar, which occurs when the skin produces too much collagen during the repair process. If your scarring resembles any of these, you’re likely to need a clinical-grade treatment, performed by a qualified medical practitioner in a clinical setting, to help improve the skin’s texture. These can harm the skin if performed incorrectly, so make sure you do a background check via the Joint Council for Cosmetic Practitioners (jccp.org.uk) before committing.

There are several clinical-grade treatments available. Chemical peels (akin to the AHAS in your bathroom cabinet, but much stronger) involve the controlled removal of the outer layers of the skin to encourage cell renewal and regeneration. They tend to be more affordable and less aggressive than laser, but can be risky for anyone with dark skin because hyperpigmentation may form as a response to the peel.

Next on the list are microneedling – in which a small instrument creates tiny wounds all over the skin to stimulate the formation of new collagen and elastin – and radiofrequency technology – in which a current is passed through the skin to stimulate new collagen. Both are considered effective and safe, will deliver results after three to five treatments and can generally be used on all skin types – though those with darker skin may have to prepare their dermis for six weeks prior to these procedures with hydroquinone, which helps to suppress melanocyte activity, so hyperpigmentation doesn’t occur.

The final and most aggressive form of skin resurfacing for acne scarring is a CO₂ laser, which deeply wounds the skin in order to stimulate collagen renewal and resurfacing. It’s a one-off treatment and is considered the gold standard for severe acne scarring. That said, it’s unsuitable for darker skin types – again, due to the risk of hyperpigmentation. It also comes with one or two weeks’ downtime and can cost a few thousand pounds. Dark skin tones can opt for fractionated laser treatment, such as Picosure, which regenerates skin and improves collagen production by delivering pressure to targeted areas via heat.

Whatever route you go down, thanks to the advances in dermatology and various treatment options in recent years, it’s unlikely that your acne scarring can’t be treated. So, if it’s affecting your confidence, discuss it with your GP.