Acne scarring

Acne scarring can sometimes develop as a complication of acne when the most serious types of spots, nodules and cysts, rupture (burst) damaging nearby skin.

Scarring can also occur if you pick or squeeze your spots, so it is important to avoid doing this.

There are three main types of acne scars:

• Ice-pick scars: small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object.
• Rolling scars: caused by bands of scar tissue that form under the skin giving the surface of the skin a rolling and uneven appearance.
• Boxcar scars: round or oval depressions, or craters, in the skin.

Availability of treatment for scarring

Treatments for acne scarring are regarded as a type of cosmetic surgery. As cosmetic surgery is elective, non-essential surgery, it is not usually available on the NHS. However, in the past, exceptions have been made when it has been shown that acne scarring has caused serious psychological distress.

See your GP if you are considering having cosmetic surgery. They will be able to discuss your options with you, and advise you about the likelihood of having the procedure carried out on the NHS.

Many private clinics offer treatment for acne scarring. Prices can vary widely (from £500 to over £10,000) depending on the type of treatment that is required.

The website of the British Association of Aesthetic Plastic Surgeons provides more information about the private treatment that is available in your area.

It is important that you have realistic expectations about what cosmetic treatment can achieve. While treatment will certainly be able to improve the appearance of your scars, it will not be able to get rid of them altogether. Following treatment for acne scarring, most people will notice a 50% to 75% improvement in appearance.

Types of treatment for scarring

Some of the available treatments for acne scarring are explained below.

Dermabrasion 

Dermabrasion involves removing the top layer of skin using either lasers or a specially made wire brush.

After the procedure, your skin will look red and sore for several months, but as it heals, you should notice an improvement in the appearance of your scars.

Laser treatment

Laser treatment can be used to treat mild to moderate acne scarring. There are two types of laser treatment:

• Ablative laser treatment: where lasers are used to remove a small patch of skin around the scar in order to produce a new smooth-looking area of skin.
• Non-ablative laser treatment: where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps repair some of the damage caused by scarring and improve appearance.

Punch techniques

Punch techniques are a type of surgical treatment usually used to treat ice-pick scars and boxcar scars. There are three types of punch technique:

• Punch excision
  Punch excision is used to treat mild ice-pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it will leave a smoother and more even area of skin.
• Punch elevation
  Punch elevation is used to treat boxcar scars. The base of the scar is surgically removed leaving the sides of the scar in place. The base is then reattached to the sides but lifted up so that it is level with the surface of the skin. This makes the scar much less noticeable.
• Punch grafting
  Punch grafting is used to treat very deep ice-pick scars. As with a punch excision, the scar is removed, but the wound is then ‘plugged' with a sample of skin that is taken from elsewhere on the body (usually from the back of the ear).

Subcision

Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue that pushes up the rolling scar so that it is level with the rest of the surface of the skin.

Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar.

Depression

Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to those with acne becoming depressed.

You (or your child) may be depressed if during the last month:

• you (or your child) have often felt down, depressed, or hopeless, and
• you (or your child) have little interest, or pleasure, in doing things.

If you think that you or your child may have depression, it is important that you speak to your GP.

The charity getconnected.org.uk provides a website and helpline for teenagers and young people with emotional and other difficulties, which you may find useful.

Glossary

Anxiety

Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.

Depression

Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.