Acne & Acne Scarring: Causes, Treatments, and Solutions
Acne affects more than 50 million people per year. While acne is not considered a health risk, a single one can affect self-esteem and cause emotional distress, anxiety, and depression.
Acne most commonly occurs between ages 12 and 24 as our bodies undergo an internal hormonal evolution. But that is not always the case— post-pubescent men and women can demonstrate symptoms of acne at any age due to various causative factors.
Scarring is an unfortunate complication of acne, which worsens with the delay of proper treatment. Fortunately, both common skin concerns are easily treatable with appropriate education and treatment modalities.
What is Acne?
Acne, one of the most common skin problems, is a skin condition that occurs when the pores of the skin become clogged with bacteria, oil (sebum), or dead skin.
Acne often gives the skin an uneven texture, accompanied by hyperpigmentation, redness, swelling, and is tender to the touch.
Fortunately, we have many effective options to treat your acne.
Types of Acne
- Blackheads: Blackheads are open comedones that appear dark on the surface of the skin.
- Whiteheads: Whiteheads are closed comedones that appear as raised bumps on the skin's surface.
- Papules: Papules appear as small, red, raised bumps usually resulting from infected hair follicles.
- Pustules: Pustules are inflammatory skin lesions that appear as small red bumps with pus on the skin’s surface.
- Nodules: Nodules can be painful lumps or inflammatory lesions that appear below the skin's surface.
- Cysts: Cysts are large, painful lumps below the skin’s surface and contain pus.
What Causes Acne?
Acne occurs when your pores become blocked. This can happen due to:
- An overproduction of sebum from the skin’s sebaceous gland
- A build-up of dead skin cells
- A build-up of bacteria (P. acnes)
Acne Risk Factors
The following may make you more likely to experience acne breakouts:
- Hormonal Changes
- Endocrine Disorders
- Lack of Sleep
- Using Skin Care Products That Contain Oil
- Some Medications
- Family History of Acne
- Diet (White Sugar, White Flour, Processed Foods)
One out of five people with acne develops acne scars. While scarring is preventable, we all have been subjected to the inevitability of picking and prodding at acne breakouts.
However, some forms of acne are more likely to provoke scarring or discoloration, even if you refrain from meddling in the healing process. Inflammatory acne lesions like papules, pustules, nodules, and cystic acne tend to drive a higher risk of leaving behind an imperfection.
Types of Acne Scarring
There are three categories of acne scarring— atrophic, keloid, and post-inflammatory hyperpigmentation.
1. Atrophic Scarring
When the skin is unable to regenerate tissue properly, an indentation known as atrophic or depressed scarring is formed. This indented appearance is due to healing that occurs beneath the expected skin layer.
Different forms of atrophic scarring include
- Ice Pick: Ice pick scars appear as a “hole” on the skin surface that tends to be wider, narrowing to a point as it penetrates the skin.
- Rolling: Rolling acne scars appear as skin indentations with sloping edges, giving the skin a wavy, uneven appearance.
- Boxcar: Boxcar acne scars often appear on the jawline and cheeks and are deep indentations with sharp edges.
2. Keloid Scars
Keloid, or hypertrophic scarring, results from an overproduction of tissue. Keloid scars are raised scars caused by an overgrowth of collagen. They most commonly appear on the body (chest, back) and can be painful.
3. Post-Inflammatory Hyperpigmentation
Post-inflammatory hyperpigmentation refers to the red or brown patches that appear after acne has healed. Discoloration often occurs due to picking or damage from severe acne.
In all cases, this is a temporary effect that resolves naturally and gradually with the help of proper sun protection.
What Causes Acne Scarring?
Acne scars occur for two reasons:
- A cause from picking or squeezing the pimples
- A cause of your body’s attempt to heal the inflammatory acne lesions
How to Treat Acne & Acne Scars
You don't have to suffer through the stigma of acne and scarring. The distinguished Dr. Sheila Nazarian typically recommends a combination therapy approach to treat nearly all forms of acne and scarring.
Combinations of various laser, light, and energy treatments, aesthetician services, and medical-grade skincare can help eliminate these imperfections to revitalize and smooth the skin of the face and body.
It is always a good idea to consult with an experienced skincare specialist to determine the best treatment for your specific case.
Cosmetic Treatments for Acne
Light and energy-based device technology has evolved to target the underlying causes of acne and scars. Below are some treatments we use to help combat adult acne and heal the skin for a smooth and radiant complexion.
Forever Clear BBL
Forever Clear BBL delivers three wavelengths of intense pulsed light (IPL) energy deep into the skin. This energy calms overactive sebaceous glands, eliminates acne-causing bacteria, and breaks apart acne scars.
- Blue Light: The blue light targets the bacteria that cause acne
- Yellow Light: The yellow light calms inflammation from acne lesions
- Infrared Light: The infrared light heals the skin damage from acne breakouts
Halo by Sciton is a hybrid fractional laser that works wonders on acne scars and the uneven skin texture left behind from acne breakouts. Halo combines fractional ablative and nonablative wavelengths that fire simultaneously to transform damaged skin into glowing, healthy-looking skin.
Morpheus8 combines the power of radiofrequency with tiny microneedles to rejuvenate skin by creating controlled microtraumas in the skin layers, resulting in collagen and elastin stimulation. Morpheus8 can help treat acne scars and skin texture issues resulting from acne.
Similar to Morpheus8, Vivace also combines microneedling with radiofrequency energy. It is a minimally invasive procedure with proven efficacy in eliminating acne scarring on the face and other body areas.
Chemical Peels are a highly customizable skin resurfacing treatment where a chemical solution removes the outermost, damaged layers of skin to stimulate healthy new tissue to form. This rapid exfoliation is an excellent option for those with excess oil, clogged pores, pimples, and scarring.
Profractional Laser Treatment
Profractional Laser Treatments focus on remodeling and revitalizing skin texture and tone. This laser system stimulates cell regrowth and collagen production. It is an excellent treatment option for those looking to eliminate acne scarring and irregular skin texture.
Skincare for Acne & Acne Scarring
Topical skincare products are vital to successfully control acne breakouts, help prevent scarring, and prolong the results of other acne treatments. Creating a simple yet balanced skincare routine with the proper key ingredients provides an at-home remedy to reduce the effects and symptoms of adult acne naturally.
Key Ingredients for Acne Prone Skin
Selecting the finest products for your skin might be challenging because there are so many options available for acne-prone skin. When choosing products for your acne skin routine, be sure to seek the following key ingredients.
Salicylic acid is a beta hydroxy acid that exfoliates dead skin, which helps keep your pores from getting clogged.
Alpha Hydroxy Acid
Alpha hydroxy acids, like glycolic acid, help acne-prone skin by sloughing off dead skin cells, encouraging new skin cell production, and reducing inflammation.
Retinoids are topical skin products containing Vitamin A. Retinoids unclog pores, prevent acne breakouts, and encourage skin cell turnover.
Niacinamide is a form of Vitamin B3. Niacinamide helps acne-prone skin by reducing pore size, inflammation, oil production, and the appearance of papules and pustules.
Skincare Routine for Acne & Acne Scarring
It is vital to follow a skincare routine to help control sebum production, which clogs your pores, causes breakouts, and can lead to acne scarring. Listed below is our Plastic Surgeon recommended acne skincare routine with some of our favorite products to help you create a regimen suited to your individual needs.
Cleansing your skin is the first step to controlling acne breakouts. Cleansing removes dirt, makeup, irritants, and bacteria that cause acne breakouts.
EltaMD Foaming Facial Cleanser is a gentle, oil-free amino acid blend cleanser that clarifies and purifies without stripping the skin’s acid mantle. Maintaining the acid mantle is a vital step in preventing acne breakouts.
NazarianSkin- Clear 1 and NazarianSkin Clear 2 are physician-formulated cleansing products— an absolute powerhouse combination for combating and preventing acne. The glycolic acid serum and pads contain 2% Salicylic Acid USP to unclog the pores and accelerate the removal of dead skin cells.
Toners help remove oil from your skin and help balance your skin's pH.
NazarianSkin Gly/Sal Pads are pharmaceutical-grade glycolic and salicylic pre-soaked pads used after cleansing as a toner. They are also great to use post-workout to prevent impurities from turning into breakouts. This product is not only corrective but preventative.
NazarianSkin- Soothe is a gentle hydrating mist that soothes and hydrates the skin for a more refined complexion. The key ingredients and botanical extracts contain potent soothing properties to calm irritated skin, reduce pore size, and remove excess oils. Excellent for those with sensitive or post-procedure skin.
NazarianSkin- Illuminate is a convenient pad application toner system consisting of soothing antioxidants and botanical skin brighteners to even the skin tone. You can customize your product with varying strengths of hydroquinone with NazarianSkin- Illuminate HQ to eliminate the post-acne discoloration.
Exfoliating your skin helps remove dead skin cells, clogging your pores, and causing acne breakouts. Exfoliating skincare products should not be used daily on acne-prone skin, only once or twice weekly.
NazarianSkin- Polish is a gentle exfoliating scrub containing bio-friendly microbeads to remove dead skin cells and excess oils. With key ingredients such as Glycolic Acid, Salicylic Acid USP, Green Tea Polyphenols, and nourishing vitamins, this mild scrub naturally brightens, smooths, and calms the skin. Its non-comedogenic formula is highly suitable for those struggling with acne and enlarged pores.
SkinCeuticals Micro-Exfoliating Scrub is a gel scrub that exfoliates your skin without irritating it. This scrub is suitable for all skin types.
Serums contain cosmeceutical active ingredients that treat specific skin concerns like inflammation, acne, hyperpigmentation, and scarring.
NazarianSkin Retinol+Serum is a unique serum that combines retinol and ferulic acid with bakuchiol, an Indian plant seed extract. Bakuchiol offers the benefits of harsher retinoids without irritation— it can even be used on sensitive skin. Furthermore, it provides luminosity to your skin, which isn’t possible with traditional retinoids.
Moisturizing is an essential but often overlooked step in acne skincare routines due to the fear of clogging the pores with oil-based products. On the other hand, most skincare ingredients that treat acne tend to dry out the skin, so failing to moisturize can lead to more irritation.
NazarianSkin Triple Antiox is a revolutionary moisturizer for those dealing with post-adolescent acne. The synergistic formula contains key antioxidants to supply the skin with intense hydration while killing the bacteria that cause acne.
EltaMD Barrier Renewal Complex is an oil-free moisturizer containing natural enzymes and antioxidants to improve dry skin without clogging pores.
Sunscreen is a vital step in any skincare routine. In acne-prone skin, it is essential as many active acne skincare agents and topical medications for acne make your skin photosensitive or more susceptible to sun damage.
EltaMD UV Clear SPF 46 is an oil-free sunscreen that calms and protects the skin from the sun's damaging rays and is safe for acne-prone skin and rosacea.
At-Home Devices & Tools
Advances in medical technologies have impacted not only professional cosmetic devices but those you can use from the comfort of your own home. Light energy treatments and microneedling devices can help reduce acne and breakouts and expedite the healing of post-acne scarring. Adopting these at-home devices into your acne & acne scarring skincare routine can significantly benefit and enhance the effects of your skincare regimen.
LightStim- for Acne is a handheld device that uses UV-free red and blue light to eliminate acne-causing bacteria and calm inflammation without drying or damaging the skin.
The Dermabeam Pro LED Mask uses 115 therapeutic lights to reduce redness, inflammation, and discoloration while stimulating blood flow, increasing skin elasticity, and expediting wound healing.
Microneedling devices such as Environ's Cosmetic Gold and Stainless Steel Rollers use ultra-fine needles to improve the texture and tone of the skin. These devices stimulate natural collagen production and cellular regeneration to heal the skin and reduce the appearance of scarring and discoloration.
How to Customize Your Skincare Routine Based on Skin Type
While there are general guidelines for developing your acne skincare routine, customization may be necessary depending upon your skin type.
Individuals with oily skin should look for products that are oil-free and non-comedogenic, which means they tend not to clog your pores.
Also, do not skip a moisturizer just because you have oily skin. Failing to moisturize can cause further irritation, which causes your skin to overproduce oil.
Acne & Acne Scarring Products: Oily Skin
- Biopelle- Gel Cleanser (10% Glycolic Acid)
- Epionce- Renewal Lite Facial Lotion
- NazarianSkin- Clear 1
For dry skin, look for cleansers that are creamy in consistency and do not over-exfoliate or scrub the skin. Also, you might only need to use toner every other day instead of daily to avoid drying out the skin.
Acne & Acne Scarring Products: Dry Skin
If you have sensitive or compromised skin, look for products that do not contain many ingredients and avoid ingredients you cannot pronounce.
These ingredients tend to be harsher chemicals or preservatives that irritate the skin. Also, avoid products with fragrances; they are the leading cause of skin irritation.
Acne & Acne Scarring Products: Sensitive Skin
- Clinical Resolution- Peptide Aqua Gel Face Mask
- iS Clinical- Pro Heal Serum Advance +
- NazarianSkin- Soothe