This Conscious Beauty blog series is part of my podcast launch – Dermatologist Talks: Science of Beauty. Are you searching for acne scar advice? This article focuses on the most effective methods to treat and prevent acne scars.
Acne scar treatment tips from a dermatologist
Acne scarring can make one feel self conscious. The good news is that there are effective ways to treat acne scars which you can discuss with your dermatologist if you already suffer from scarring. Certain active ingredients in skincare can help reduce the chance of developing deep acne scars and help inflamed pimples heal faster. Do note that if you still suffer from active acne, you will need to have it medically treated.
Acne vulgaris is an inflammatory condition that starts most commonly in one’s teenage years and may persist into adulthood. Effective treatments include oral medication such as antibiotics i.e. tetracyclines and/or blue light therapy. For severe cases of cystic acne, oral isotretinoin (known by its trade names Accutane, Oratane, Nimigen) may be necessary to reduce acne bumps and cysts.
This article focuses on advice for acne scars specifically and not treatment of active ongoing acne. If you are wondering if your mild on-off breakout qualifies as active acne, this is a good benchmark- I would consider having anything more than 5 new pimples a month a sign of moderate-persistent acne that requires medical attention. If you have less than 5 pimples a month, especially if it coincides with your menstrual cycle, you may first try an over-the-counter blemish spot cream. However, if that does not work or makes your acne worse, you may have irritation from the pimple cream and would most likely require oral medications by an accredited dermatologist.
Identify the type of acne scar that you have
Acne scarring is classified into two main types. Firstly, post-inflammation hyperpigmentation which arises from post-inflammation erythema. This refers to the redness associated with acute inflammation of acne papules. Scar redness subsequently turns into hyperpigmentation. The second type of acne scars would be dermal scars. These would be deeper scars that result in irregular skin texture. This type of acne scar will worsen as one grows older because of skin aging.
Acne Scar Treatment Tip #1 Use a “Prescription-Emollient Device” moisturiser on your acne scars
To reduce acne scarring, after the acne bump has healed, using a moisturiser with barrier repair and anti inflammatory properties moisturizers such as those containing ceramide. Moisturisers containing ceramide and anti-inflammatory ingredients have a steroid-like effect- also known as a prescription emollient device (PED). However, certain moisturising cream formulas may cause a greasy sensation in acne-prone individuals and best used at night. An emulsion formula-oil in water vs cream or ointment may be suitable for those living in tropical climates, as the latter can be comedogenic in humid environments.
Acne Scar Treatment Tip #2 Use a pimple cream with botanical actives to reduce inflammation
Post-inflammation erythema can improve with topical treatments. This can include pimple creams with targeted botanical actives. When you apply a pimple cream to your acne bump, it should help reduce the pimple swelling, prevent it from becoming infected and become a cyst. If it contains anti-inflammatory ingredients, it can also reduce the chance of developing post-inflammation hyperpigmentation. Ingredients to look out for in an over-the-counter anti-acne blemish spot cream include the following.
Botanical-derived active ingredients for acne
Chlorella vulgaris is an algae extract that controls sebum (oil) production. It is also anti-inflammatory, calming infected acne bumps quickly and preventing acne cysts. Centella asiatica, also known as CICA, will help reduce post-inflammation hyperpigmentation type of acne scars. Berberine is a plant used in traditional chinese medicine, which has been proven to target multiple pathways in acne. These include regulating sebum production, reducing inflammation, killing surface bacteria and preventing post-inflammation redness and hyperpigmentation.
Traditional acne spot creams formulated with benzoyl peroxide, retinols, salicylic acid, sulfur, tea tree oil are astringent and can cause irritant contact dermatitis when used under a face mask. Botanical active ingredients are preferred for the treatment of maskne.
Vitamin C serums
Vitamin C serums as well can be helpful for preventing post inflammation hyperpigmentation that usually develops at least a month after the acute inflammation stage after the acne bump and redness resolves. Active forms of vitamin C serum include L-ascorbic acid and sodium ascorbyl phosphate. I use the latter in my formulation because of its neutral formula as opposed to the L-ascorbic acid variant which can sometimes cause stinging and irritation for individuals with sensitive skin. If you experience skin sensitivity when using vitamin C serums, do consider those formulated with sodium ascorbyl phosphate instead of L-ascorbic acid.
Acne Scar Treatment Tip #3 Switch to a fabric face mask made from a biofunctional textile
The material of your fabric mask makes a difference. In my book Masking Up- A Dermatologist’s Guide to Maskne, I share about the occlusive effect on skin that face mask wearing creates. This unique microenvironment created by wearing a face mask means that it is more prone to acne and secondary infection. A healthy skin microbiome is the balance of good bacteria on skin that protects it from infection with bad bacteria.
I invented a fabric mask designed with a biofunctional textile to treat and prevent acne- this concept was published in my paper “Diagnostic and management considerations of maskne in the era of COVID-19” by the Journal of the American Academy of Dermatology in October 2020. These are synthetic textiles that we incorporate with metallic ions such as copper and zinc that are not just anti-microbial, but bactericidal and have skin healing benefits. This means that it will kill acne-causing bacteria on contact, reducing the need for topical antibiotic treatment which can cause antibiotic resistance in the long term.
In addition, the CUIONS nanoparticle textile is a fabric face mask that can treat acne scars. I discussed in my resesarch paper the benefits of such a reusable fabric mask. The mask material releases active copper ions at 1% which are proven to stimulate collagen production in both cell and human studies. Increased collagen production means that scars can heal faster and better. The fabric face mask treats maskne and also reduces post-inflammation hyperpigmentation that develops after maskne.
The use of ultraviolet protection factor UPF 50+ in the treated material of the face mask offers additional sun protection. This is also important to reduce scarring from sun-exposure which worsens post-inflammation hyperpigmentation. An ultra-violet protective fabric face mask solves the issue of wearing sunscreen under the face mask, which can worsen sunscreen comedogenicity.
These fabrics with skincare benefits are a novel invention – textile cosmeceuticals. Cosmeceuticals are active ingredients which have drug-like benefits on skin. Textile cosmeceuticals are unique in that they are reusable and can withstand washing. The technology of impregnating metallic ions ensures that the fabric mask fibres permanently release the active skincare ingredients even after washing. Topical zinc is another nanoparticle that helps to treat acne and maskne. It has an anti-inflammatory effect and also reduces oil production. It is an effective way to control oily skin which can reduce acne formation. Excess sebum on skin is a risk factor for developing acne.
How can a dermatologist help with acne scars?
The treatment for different types of scars is different. Certain lasers are suited for specific types of acne scars. For post-inflammation hyperpigmentation, the best form of scar treatment will be in the form of a cosmeceuticals combined with non-ablative lasers. Chemical peels are synergistic with laser toning. A1064 q-switched laser is effective for reducing post inflammation hyperpigmentation. Topical retinoids are prescription-only and include variants such as tretinoin or adapalene. Retinoids work for acne scar treatment by helping to stimulate collagen production. This can result in quicker resolution of the post-inflammation hyperpigmentation.
Visit an accredited dermatologist for laser resurfacing for ice-pick and box-car scars
For proper treatment of deeper dermal scars, consider an ablative laser such as co2 laser resurfacing. Such scars are categorised as ice-pick or box-car type acne scars. However, co2 laser resurfacing is associated with downtime, and is significantly more costly than laser toning. You should discuss with your dermatologist first your expectations. It will be subsequently decided if co2 laser resurfacing is the treatment of choice for you.
My experience with patients with deep acne scars is this. Patients with icepick or boxcar type acne scars will require at least three sessions of co2 laser resurfacing combined with a recovery phase of intensive post-treatment skin recovery. Cosmeceuticals are used in my dermatology practice and include peptides, retinoids and anti-oxidants. It’s important to make sure that acne scar treatment only takes place after the initial acne flare-ups have resolved. This is because treatments for acne scarring can cause acne to flare up and get worse.
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“It is natural for individuals to be self-conscious about their appearance-but to me that also means we can influence collective societal perceptions to enable individuals to become conscious of their unique beauty, instead of their faults,”
– Dr. Teo Wan Lin