As if having acne isn’t bad enough, you can be left with a permanent reminder in the way of scars from the damage to the important structures deep in the skin. Before discussing these, it is worth mentioning some marks that could be regarded as scars but are not due to the same destructive processes.
They are visible but should improve with time. The first of these ‘scars’ appears as red flat marks where spots used to be. Called macules, they are the last sign of the inflammation in the skin and can last for up to six months.
The other ‘scar’ is the brown discoloration where the acne used to be – called post-inflammatory hyper-pigmentation. A result of the inflammatory process stimulating the pigment cells in the skin, it is more common the darker your skin is and can last for up to 18 months.
True scars are longer lasting and are a result of both the injury to the skin caused by the acne and the way the body tries to repair the damage. Some people will scar much more easily than others. The process is not well understood but it most often happens with severe acne nodules and cysts. Scars can be looked at under two headings: extra skin tissue and loss of normal skin tissue.
What Are Raised Scars (Extra Skin Tissue)?
These are called keloid or hypertrophic scars (‘hypertrophic’ means enlargement or over-growth). The over-growth relates to the collagen in the skin, a protein that gives strength to its complex structure and prevents easy damage from rubbing, stretching, etc.
Excess collagen becomes piled up as firm fibrous lumps – which can be much bigger than the original spots, varying from 1–2mm to 1cm or even bigger. The scars tend to last for years but in some cases will flatten off and shrink.
Your skin type can also influence the chance of your getting this type of scarring – the darker your skin, the greater chance of your developing these scars.
What Are Sunken Scars (Loss of Skin Tissue)?
These are much more common than the raised scars, and show up as depressions or pits in the skin. There are several different types:
- Ice-pick scars. As the name suggests, these are like wounds from an ice-pick. They are small, with a jagged edge and steep sides, and usually occur on the cheeks.
- Depressed scars. These are larger ice-pick scars, with sharp edges and the same steep sides. The base of these larger scars is quite firm to the touch. Often scars can be shallow or deep but are much softer. They tend to be small, and have much more gently sloping edges that merge into the normal skin.
- Atrophic patches are flat scars where the skin seems very shrunken and thin (atrophy). They are usually small on the face but can be 1cm or more on the body. The thin skin can look bluish at first but usually ends up as an ivory white colour with time.
- Follicular macular atrophy (small atrophic patches) is most likely to appear on the chest and back after extensive acne. It results from damage to the elastic fibres in the skin around the pores.
These fibres normally keep the skin stretched and flat, so, where they are damaged, the skin bulges up into soft little lumps that often look like whiteheads. They can improve after months or years as the skin repairs the damage.
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