People with visible facial differences are hardly represented, and when they do make their appearance in the media, their cameos, more often than not, epitomise that of a villain. Lord Voldermort from Harry Potter, Freddy Krueger from a Nightmare on Elm Street, Darth Vader from Star Wars and Thanos from Avengers: Infinity War — these are just some of the characters with prominent facial scarring who represent the “dark side”.

Acne faces a similar stigma. It is one of the most prevalent skin diseases, affecting approximately 650 million of the world’s population. Acne is a multifactorial disease encompassing comedones, papules, pustules, nodules and scars. Scarring can remain for life and acts as a prominent and visible reminder of the disease.

Acne can have a huge impact on a person’s quality of life. It can cause depression, which may lead to impaired social functioning and suicidal ideation. In addition, the social, psychological and emotional problems experienced by individuals with acne can be worse than those experienced by individuals with other long-standing debilitating illnesses, such as asthma, epilepsy and arthritis.

Scarring is often the primary concern of a person suffering from acne. It has been known for a long time that acne scarring can cause depression and is a genuine risk factor for suicide.

More data are now beginning to emerge on the impact of acne scars, specifically on the quality of life. Individuals want to hide or cover their scars and feel embarrassed, self-conscious or less self-confident. Scars are also a source of frustration, sadness, anger and anxiety. People who develop acne scars feel their appearance interferes with their professional relationships and chances of future employment.


What are Acne Scars?

Scars are formed when a breakout penetrates the skin deeply and damages the tissues beneath it. In severe acne, large pus-filled spaces, known as acne cysts, are formed. These cysts destroy skin tissues, which are not replaced during the healing process. When the cyst eventually empties and the area heals, it usually leaves behind an indentation (or scar) on the face.


Types of Acne Scars

Squeezing or pinching your pimples can make the process worse, but acne can cause scarring, even without pimple popping.

Atrophic scars are the most common on the face. A depressed scar sits below the surrounding skin. It is formed when not enough collagen is produced while the wound is healing.

How big of a scar you will be left with after a blemish, if any, depends on the depth of the outbreak. If you see scars forming, they are likely to be one of these three types of atrophic scars:

Ice-Pick Scars

As the name suggests, ice-pick scars are very deep acne scars that look like the skin has been punctured with an ice pick. When the body produces too little collagen in response to an injury, depressed scars, such as ice-pick scars, can form. They are usually the most difficult to treat.

Boxcar Scars

Boxcar scars are also depressed, but they tend to be broader and boxier than ice-pick scars. Depressed acne scars, like boxcar scars, form when too little collagen is produced during wound healing. They can be shallow or deep. The shallower they are, the better they respond to skin resurfacing treatments.

Rolling Scars

Also considered as depressed acne scars, rolling scars have smooth edges and look like tiny hills and valleys.


How to Treat Acne Scarring

There are many solutions available for acne scars, which can improve and soften the appearance of the scarring. Depending on the severity of the acne scarring, a combination of treatments may be required.

The ideal treatment will depend on four main factors:

  • The individual’s skin type, in accordance with the amount of pigment in the skin
  • The type of scars (ice-pick, boxcar, rolling, etc.)
  • The time it will take for the skin to heal after the procedure
  • Cost of the procedure

It is best to consult your dermatologist for an accurate assessment of your scarring condition and further advice on the appropriate treatment route for you. However, bear in mind that the ultimate goal for treating acne scars should be improvement, rather than the complete disappearance or a cure. It is unrealistic to expect your skin to return completely to normal, following treatment. Moreover, the degree of improvement you will experience is dependent on your scar types and your skin colour.


Prevention is Better than Cure

Some of us are more at risk for acne scars than others, although there is no way to predict for sure who will develop scars after acne and who will not. These scars tend to occur more commonly after inflammatory acne, especially when it is not treated early and aggressively.

The prevention of acne scars, therefore, needs to be viewed as a major goal in the treatment of inflammatory acne. Early, aggressive and appropriate treatment of acne before scarring occurs is important, as it may effectively decrease the risk of acne scarring.

And whatever you do, avoid popping or squeezing those zits at all costs. It will only prove difficult to forget your pimpled past if your face remembers — in the form of scars.