Acne Scars vs Acne Marks: How to treat Acne Scarring

Acne scarring occurs as a result of an alteration in the healing process of skin inflammation. Acne scars are typically the result of an acne healing process.  The healing process usually comprises of four distinct stages, including:

• Hemostasis

During a skin injury, hemostasis is the first healing response, helping with the prevention of bleeding. At this stage, platelets are deployed to seal off any affected blood vessels preventing any further bleeding.

These platelets will link with collagen, secreting various substances like the growth factors, and initiating the second wound healing phase. In the case of acne scarring, this stage will only occur if the acne abrasions are picked.

• Inflammation

After intense blood flow to the injury stops, the blood vessels relax, causing the skin to become reddish (erythema). Also, there may be a stimulation of melanin production.

Since the wound repair process requires communication, there is a presence of growth factors and cytokines. While the cytokines stimulate cells’ movement, the growth factors encourage cell division or the release of certain substances such as collagen. Collagen is necessary for the formation of ECM (extracellular matrix).

• Proliferation

Proliferation entails the development of blood vessels in the injured area, collagen deposition, wound contraction, granulation tissue growth, and epithelialization. The growth factors encourage fibroblasts multiplication and enables them to move to the healing acne wound. The fibroblast will, in return, help to grow new collagen.

• Extracellular Matrix Remodeling

During this stage, cytokines cause the epithelial cells and fibroblasts to release enzymes called the MMPs (Matrix Metalloproteases), which helps destroy the ECM, allowing for remodeling.

Tissue inhibitors known as TIMPs are specifically secreted to deactivate and control MMPs. If not balanced, MMPs can easily degrade the new tissue and collagen, or even kill the growth factors.

Acne Scarring Resulting from Altered Cascade of Healing

When acne is healing, any variance in these two enzymes, (MMPs and TIMPs) will cause scarring. For instance, if the imbalanced enzymes favor MMPs, collagen is destroyed in the skin’s dermis layer, causing atrophic scars.

On the other hand, if the imbalance favors the TIMPs, this leads to collagen overproduction, which consequently leads to hypertrophic scarring. Typically, atrophic scars come from collagen destruction, while hypertrophic scars occur due to overproduction of collagen when the skin is healing. Also, while atrophic scars appear as indents, hypertrophic scars appear as elevated scars.

Acne Scars or Acne Marks? Which is it?

Besides the textural acne scarring, there is also another category of scarring that results from acne healing, known as acne marks (macular acne scars). This means that acne breakouts can either leave acne scars behind or acne marks.

Although many people don’t even realize it, there is a huge distinction in acne scars and acne marks. The main difference between the two is evident both in their formation causes and appearance.

With acne scars (hypertrophic or atrophic), overproduction or underproduction of the substance collagen during the healing process of a wound is their primary cause. 

In contrast, acne marks form due to lasting inflammatory acne (cystic nodules and lesions). Naturally, your skin will treat inflammatory acne as an infection, triggering an immune response in the wounded area.

Acne marks mostly occur as PIH spots (post-inflammatory hyperpigmentation marks), which can be present either in dermal or epidermal melanin. They are superficial marks that disappear with time. And, they can appear either as reddish acne spots, or brown acne spots on your skin.

In terms of appearance, acne scars cause textural irregularities, while acne marks display just reddish or brown spots on smooth skin.

Therefore, the aftermath of acne breakout can result in:

• Brown PIH marks
• Red PIE marks
•  Atrophic scars – indented  
•  Hypertrophic scars – raised. 

Treating Scars vs Acne Marks

Now that we know what acne marks and acne scars are, and how they form, how do we treat them? Well, the best way to treat them is to avoid them in the first place. This means that you should treat acne breakouts properly, to prevent the formation of acne scars or marks. Treating the root cause means that you won’t have to deal with frequent recurrence of scars.

But if you already have the marks and scars, several treatment procedures can help eliminate the scarring. These might include the use of silicone products, micro-needling, laser resurfacing, preventive treatment, dermal fillers, etc.

While these treatments are mainly for atrophic and hypertrophic scars, most of them will also be ideal for acne marks, (both PIE and PIH marks)

Acne Scars vs Acne Marks: Preventive Treatment

As the saying “prevention is better than cure,” preventive measures of acne scars and acne marks offer the best solution. Instead of waiting to treat the scars or marks, why not treat the problem during the active acne breakout.

Since research shows that it is the initial inflammatory pathways that lead to acne lesions’ development and subsequently atrophic scars, obstructing these pathways might avoid acne scarring. Topical retinoids, available as creams, gels, ointments, or foams, have proven to be great inhibitors of these inflammatory pathways. 

 Acne Scars vs Acne Marks: Silicone Sheets and Gels

Various research studies show that silicone scar treatments are significantly effective in scars treatment. Some studies even suggest that these treatments can reduce the textural irregularities by up to 86% and the scar color by around 84%. Also, they can reduce the scars’ height by up to 68%, giving you back your smoother skin.

The effectiveness of these silicone treatments lies on the silicone’s action of:

• Hindering bacterial tissue infection, thus inhibiting collagen overproduction
• Keeping the skin hydrated and minimizing collagen production
• Controlling growth factors which in turn normalizes collagen creation in damaged scar tissue

Although earlier research in silicone treatments focused on keloids and hypertrophic scars, new improvements like the AWMed products, have seen great effectiveness in atrophic scars and acne marks.

 Acne Scars vs Acne Marks: Microneeding

This is the use of tiny needles to puncture your skin, creating micro-channels into your skin’s dermis layer. The whole purpose of this process is to cause controlled trauma to your skin, which in return, initiates wound healing response and the release of growth factors.

Subsequently, it leads to the manufacture and deposition of collagen, which in turn leads to a new and smooth skin formation. It is estimated that micro-needling can improve acne scarring by up to 70%. Other studies also suggest that the treatment can be as effective in treating acne scars’ appearance, as the “non-ablative fractional laser treatments.”

However, micro-needling is not commonly used to treat acne marks.

Acne Scars and Acne Marks: Chemical Peels

Chemical peels involve the use of special acids like salicylic acid, glycolic acid, and lactic acid, to peel off the top layer of your skin. After this, a new skin that is smoother grows back, removing any signs of wrinkles, scarring, or skin discoloration.

This means that chemical peels can easily get rid of both acne scars and acne marks. However, always make sure that you follow your dermatologist’s instructions to avoid any damage to your skin. This is especially important, with so many counterfeits in the market, whose concentrations might not be verified.