Scars in relief or in hollow... To blur the stigmas of acne, there are many solutions, more or less effective. But the best way to prevent them is still to prevent the development of acne by consulting a dermatologist as soon as the first symptoms appear.
Acne is a chronic inflammatory disease of the pilosebaceous follicle. It can persist into adulthood, and its after-effects can leave a lasting impression on patients, particularly on a psychological level. Unlike eczema or psoriasis, it can cause permanent scarring on the face, neck or chest.
"In consultation, I see patients traumatized by their acne, whose adolescence was spoiled by pimples and who even today are complexed by these residual lesions," says dermatologist Dr. Naima Midoun. How can they be managed? Are all acne scars permanent? Can they disappear naturally? What about the effectiveness of peels?
How do acne scars form?
"Acne scars are caused by inflammatory lesions in the middle layer of the skin, the dermis," explains the dermatologist. They can be permanent, and all the more embarrassing because they are often located on the face. Initially, they take on a red or pinkish color, then gradually whiten.
As a reminder, acne results in a set of skin lesions. It begins with the formation of blackheads (retentional lesions) that can disappear spontaneously, persist, or burst. When these comedones burst in the dermis, they cause an inflammatory lesion that 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) may then appear and generate scars.
Different types of acne scars
Most often, the scars are superficial, rather discreet, and not definitive. But unfortunately this is not always the case. There are several types of real scars:
Hollow scars: "craters" (shallow) or "ice picks" (deeper and narrower) ;
Raised scars: botriomycomes (small or large) and keloids (larger and unpleasant because they move).
Small whitish balls with a soft consistency (perifollicular elastolysis) may also appear on the face and trunk of people with dark skins (phototype IV to VI).
"Some people present a single variety of scars, for reasons that are not well identified, while others present several (sunken, small or large and keloid scars, etc.)," says Dr. Midoun.
Are certain skins more at risk?
Some thinner, less resistant skin marks more quickly and is therefore more exposed to the risk of scarring. Patients with severe forms of acne, such as cystic or nodular acne, are also more at risk.
In cases of excoriated acne, the risk of scarring is also higher. People suffering from this anxiety disorder cannot help but compulsively and obsessively triturate and/or scratch their blemishes, which, in the case of acne, aggravates the inflammation.
It should be noted that the appearance of scars can be encouraged by piercing one's own pimples, but they can also form spontaneously in the case of untreated inflammatory, nodular, or fulminant acne.
When and who to consult for acne scars?
The treatment of unsightly scars should be performed by a dermatologist. Ideally, the professional who prescribed and followed the treatment of acne in the inflammatory stage should be consulted again.
Regardless of the age or type of skin lesions, it is always best to consult a dermatologist. All the more so if there is a heavy acne history in the family. "Acne is not just a matter of age. It should not be trivialized at the time of adolescence. We sometimes see very severe forms linked to a genetic determinism that can damage the skin for life. And the longer you leave it, the more likely you are to be exposed to scars, especially on the face," Dr. Midoun insists.
Thinking about teleconsultation
If you don't have the opportunity to see a dermatologist near you, or if the waiting times are too long, don't hesitate to turn to teleconsultation. This will allow you to be taken care of before getting a face-to-face appointment. "Even in teleconsultation, we are able to make a precise diagnosis and prescribe the appropriate treatment while patients find an available dermatologist near them".
Preventing 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 is therefore the prevention of acne itself!
There are several types of treatments, administered according to the form and severity of the disease, the age of the patient, the impact on his quality of life, the treatments he has already undergone, etc. Locally, acne can be treated with topical medications (especially retinoids used for retentional acne). Local anti-inflammatory drugs, such as benzoyl peroxide, are used to treat inflammatory lesions.
In addition, by oral route, certain antibiotics are also effective. To complete these treatments, skin cleansing consisting of piercing and emptying the retentional lesions can be performed by dermatologists. Finally, if this is not enough, the doctor may propose isotretinoin treatment as a second line of treatment (not recommended for pregnant women or women of childbearing age who are not taking contraception).
This treatment must be long-lasting to avoid recurrences. It is not because you have nothing left on your skin that acne will not come back. It is important to monitor for recurrences and not hesitate to return to your dermatologist if necessary.
Camouflaging acne scars is possible!
Covering foundation, concealer, powder... It is possible to wear make-up during the acne treatment, and of course afterwards, to better support certain scars.
In the case of red marks
Red marks (erythematous spots), often caused by fair skin, can persist for several months, but in the vast majority of cases they disappear on their own and completely. During the transitional period, make-up will effectively camouflage these marks. A corrective brush applied to the area to be corrected is sufficient. Tap lightly and blur the contours with a cotton bud.
Which cream to use?
The dermatologist may also prescribe a moisturizing cream and a cosmetic based on alpha or beta fruit acids (salicylic acid) to accelerate the disappearance of these marks which are not considered real scars as they disappear spontaneously.
In the case of brown stains
Dull to dark skins are the most concerned by these pigmentary spots. Among cosmetics, there is a wide range of depigmenting agents such as kojic acid, resorcinol, vitamin C... with "modest effectiveness", warns Dr. Midoun.
More effective, depigmenting preparations are prescribed by the dermatologist and prepared by the pharmacist. "The classic preparation, the Kligman Trio, is based on hydroquinone, combined with vitamin A acid (retinoic acid) and corticoids. 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 as early as three months," says the dermatologist.
When these tricks do not succeed in masking reliefs and other imperfections, there are aesthetic treatments that allow you to recover a more homogeneous and smoother skin, but without any guarantee of results.
What treatments for what type of acne scar?
Acne scars should be treated as soon as possible, because once they are established, it is more difficult to get rid of them. Moreover, scars can only be treated when the acne is considered "cured", i.e. when there has been no recurrence for at least one year. Intervening too early could cause an inflammatory reaction... and a new acne flare-up.
Treating raised scars (botriomycomes, keloids)
These more or less swollen scars can be treated surgically, and then post-surgically, with injections of local corticoids (Kenacort retard, for example) whose objective is to flatten the scar and prevent it from re-forming. 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 sunken scars can also be "lifted", surgically in the most severe cases. Larger scars can be treated with resurfacing lasers, both ablative and non-ablative. In general, both should be used: the ablative laser, first, on atrophic scars, then the practitioner can homogenize the whole with a non-ablative laser. What is the objective? To plane the epidermis to harmonize the skin's relief. This technique is heavier and can be performed under anesthesia. Some people can set up a file with their patient to ask for social security coverage.
Perifollicular elastolysis does not disappear and there is no treatment proposed, as the elastic tissue of the skin is broken and cannot be repaired.
Are peels useful against acne scars?
The principle of a peel? Peel the skin, especially the epidermis, by applying a solution (often glycolic acid). Its main interest is to give the skin a burst of radiance by removing its superficial layers. Most of the peelings proposed in the Institute are so-called "superficial" peelings, which do not reach the dermis. They can have an impact on the homogeneity of the complexion and dilated pores, but in no case on acne scars.
On the other hand, some so-called "medium" (trichloroacetic acid) or "deep" (phenol) peels performed by experienced dermatologists may be effective on some scars, but less so 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 follow-up. "On black and matt skin, peels can cause a significant risk of hyperpigmentation".
Are essential oils useful against acne and scars?
"Under no circumstances do essential oils or masks - be they clay, honey or lemon - have any effect on acne or acne scars. But perhaps they can soothe the mind," Dr. Midoun says.
However, we must remain cautious, because when misused, they can cause contact eczema, as can homemade products (DIY). As for beauty masks, they remain cosmetics: they do not reach the dermis and do not present many health risks.
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