Acne is a chronic inflammatory disease of the pilosebaceous follicle. It can last into adulthood, and its sequelae can permanently mark patients, in particular on the psychological level. Unlike eczema or psoriasis, it can cause scar marks final on the face, neck or thorax.
“In consultation, I see patients traumatized by their acne, whose adolescence was marred by pimples and who still today are complexed by these residual lesions”, attests 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?
“Acne scars follow inflammatory lesions that are part of in the middle layer of the skin, the dermis “, explains the dermatologist. They can be definitive, and all the more embarrassing that they are often located on the level of 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 may 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) can then appear and generate scars.
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);
- Raised scars: botriomycomas (small or large) and keloids (larger and unpleasant because they move).
- Small whitish balls with a soft consistency (perifollicular elastolysis), can also appear on the face and trunk of people with dark skin (phototype IV to VI).
“Some people have a single variety of scars, for reasons that are not well identified, while others have several (hollow, small or large and keloid, etc.),” says Dr. Midoun.
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 the case ofexcoriated 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 the event ofuntreated inflammatory, lumpy, or fulminating acne.
When and who to consult for acne scars?
Support for unsightly scars should be performed by a dermatologist. It is ideal 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 about age. It should not be trivialized during adolescence. There are sometimes very severe forms linked to genetic determinism which can damage the skin for life. And 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 manage to make a precise diagnosis and to prescribe the appropriate treatment, while patients find a dermatologist available near them “.
Prevent acne, the best solution against scars
The more severe the acne and the later the start 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 medications (especially retinoids used in the context of retentional acne). The local anti-inflammatory drugs, like benzoyl peroxide, can treat inflammatory lesions.
In addition, orally, some antibiotics are also effective. To complete these treatments, skin cleansings consisting of piercing and emptying retentional lesions can be performed by dermatologists. Finally, if this is not enough, the doctor may suggest treatment with isotretinoin in second intention (prohibited in the pregnant woman or of childbearing age who would 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 wearing makeup during acne treatment, and of course afterwards, to better support certain scars.
If they are red marks
Red marks (erythematous spots), often the case of fair skin, can persist for several months, but in the vast majority of cases they go away 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 those marks which are not considered to be real scars insofar as they disappear spontaneously.
If they are brown spots
Dark to dark skin are 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 efficient, 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.
What treatments for what type of acne scar?
Acne lesions should be treated as soon as possible, because once they have set in, they are more difficult to overcome. Moreover, scars can only be treated when the acne is considered “cured”, that is to say when it is not observed. no recurrence for at least a year. Intervening too early could cause an inflammatory reaction … and a new acne breakout.
Treat raised scars (botriomycomas, keloids)
These more or less swollen scars can be treated surgically, then post-surgical, using local corticosteroid injections (Kenacort delay, for example) whose objective is to flatten the scar and prevent it from reforming. These injections can also be performed by dermatologists over several months, knowing that the results are always random.
Which laser to erase and remove scars?
Small indented scars can also be “raised”, surgically in the most severe cases. The larger ones can be taken care of thanks to resurfacing lasers, both ablative and non-ablative. In general, it is necessary to use both: the ablative laser, first, on atrophic scars, then the practitioner can homogenize the whole with a non-ablative laser. Goal ? Plan the epidermis to harmonize the relief of the skin. This technique is heavier and can be performed under anesthesia. Some may set up a file with their patient to request social security coverage.
Perifollicular elastolysis does not go away and there is no treatment offered because it is the elastic tissue of the skin is broken and cannot be repaired.
Are Peels Helpful Against Acne Scars?
The principle of a peel? Peel the skin, the epidermis in particular, by applying a solution (often glycolic acid). Its main interest is to give a boost to the skin by removing its superficial layers. Most of the peels offered at the Institute are so-called “superficial” peels, which do not reach the dermis. They can have an impact on the even skin tone and large pores, but in no case on acne scars.
On the other hand, some so-called “medium” peels (trichloroacetic acid) or “deep” (phenol), performed by experienced dermatologists may be effective on some scars, but less effective on deeper scars such as ice picks. Depending on the quality of the skin, several sessions may be necessary. However, these treatments require careful preparation and monitoring. “On black and dark skin, peels can cause a significant risk of hyperpigmentation“.
Are essential oils useful for acne and scars?
“In no case essential oils where the masks that they are with clay, honey or lemon – have no effect on acne or acne scars. But perhaps they can calm the mind, “says Dr Midoun.
However, we must remain cautious, because improperly used, they can be the cause of contact eczema, as can homemade products (DIY). As for beauty masks, they remain cosmetics: they do not reach the dermis and do not pose many health risks.