Treating Acne Scars – Both Inside and Out
So you’ve cleared your acne, all good – right? Sighhh, not always, unfortunately. Acne leaves behind remnants and scars that are both physical and mental. They can stick around for months, years, or decades. Let’s talk about the difference between commonly confused skin conditions post-inflammatory hyperpigmentation (PIH), post-inflammatory erythema (PIE), and scarring. Also, we give our opinion on how to know if you are letting old acne memories affect the way you treat your skin now.
Post-Inflammatory Hyperpigmentation (PIH) is simply the pigmented discoloration acne leaves behind. When we get pimples, our skin releases melanin which causes dark spots. It can feel like they are permanent because they may be deep under hundreds of layers of dead skin, and since your skin takes a month to turn over… Well, you do the math.
PIH is not scarring and is completely reversible with the right homecare recommendations from your aesthetician. In studio, we’ll sometime refer to it as “temporary scarring” because while it does leave a mark post-acne spot, it’s fortunately not permanent, and in-studio chemical peel and microdermabrasion treatments will help fade it as well. The only thing that can make PIH worse is sun exposure. Whether gradual or just one good burn, the sun will simply “bake” in discoloration and make it darker and peskier to treat.
The most important step in treating PIH is sun protection (Unseen Sunscreen is a great daily option that doesn’t feel like sunscreen). Then, you will need a good professional regimen to stimulate new skin turnover (we recommend Mandelic Acid Wash and Exfol-A serum to start). When you have those key elements down, coming in for facial treatments will give your results a major boost!
Post-Inflammatory Erythema (or PIE) is simply redness (pro tip: call it “erythema” if you want to sound smart) that sticks around after acne lesions are gone and skin is flattened out and no longer inflamed.
Lighter skin tones will usually report more PIE than PIH post-acne spots in their skin. Also, some people tend to feel like that redness sticks around for a very long time. This is not only because of genetics and skin tone, but also because the homecare regimen is lacking in exfoliants, melanin inhibitors (to ensure the PIE doesn’t turn to PIH), and nourishing ingredients.
Sometimes years of acne will just cause overall trauma in the skin which will make people feel red and uneven all over. This can also look like red pinpricks in the skin, most commonly in the cheeks. This will take time to treat, but again the right products, lots of SPF, and facial treatment will all help.
For PIE it will take more ingredients than just exfoliating ingredients because you are treating a couple of conditions simultaneously. We recommend a balance of exfoliating, melanin inhibiting ingredients, and anti-redness or soothing ingredients. Just a few of our favorites are Green Tea Cleanser, 8% Mandelic Acid Serum, Rejuv Rx Serum, Solution Pads, Lavender Mask, Azulene Relief Solution Ampoule.
Scarring:
So, we’ve established that a chunk of what people see as scarring is just discoloration that is easily treatable. But also, there is actual scarring that can look like ice picks, permanently stretched pores, or crater-like effects in the skin. These conditions are permanent if they’re not addressed by deeper treatments and products. They come from very deep inflamed acne, cortisone shots from the dermatologist, picking, chronic recurring breakouts, and sun exposure during breakouts.
Scarring is different from discoloration because the skin cells aren’t discolored but actually gone. Think about a bruise versus a bad burn versus an injury that requires stitches and how that would heal. While scars can look different, they are all textural changes in the skin. We have to first treat discoloration to fully see what scarring remains. Acne scarring is very common and affects mostly everyone that has ever had acne to some extent. Treating it is expensive because it requires procedures that reach the very deepest layers of the skin. Typically lasers are the best bet and your aesthetician will recommend what you may need outside the scope of our practice at Skin MPLS.
Here are three BIG mistakes people make when it comes to treating scarring. First, they go straight to lasers, deep peels, and micro-needling while they still have acne and PIH/PIE. Scarring needs to be the last thing you treat. Treating it while you have acne or discoloration will be a waste of resources and can sometimes lead to more acne and therefore acne scarring. Second, the sun will absolutely make acne scarring worse as it is the number one thing that breaks down collagen production. SPF every day, all the time, and never think the sun will make your skin better. Third, just because no product magically clears scarring doesn't discredit what regimen can do. Homecare will chip away at the loss of collagen while promoting more skin cell growth. This will improve the look of pores and scarring. Also, making your skin more even, healthy and supple will absolutely soften the look of any scarring to the point where you may not even need advanced treatments because you look past acne scarring.
For best results on scarring, focus on pretty skin and collagen building. Some of our favorites here are Rejuv Rx, Derm-A-Renew, 15% Mandelic Acid Serum, TGF Serum, and a NuFACE device.
The Emotional Trauma Post-Acne
Are you afraid of moisturizer? Are you still using over-the-counter acne meds over the age of 35? Do you have the desire to burn or dry out your skin because oily skin strikes fear in you? Does one pimple send you into overdrive? Do you go in the sun to “fix” acne? And finally, is your aesthetician telling you you don’t have acne, but you refuse to listen?
If you answered yes to any or all of these questions, odds are you aren’t really breaking out any longer, but you still operate like you are. We get it – since acne doesn't really ever go away, you are right to always keep an eye out. However, we see clients being too hard on themselves mentally. Physically, that usually translates to picking, overdrying, and stressing themselves into a pimple (or worse, an imaginary pimple)!
We bring this up because it will be impossible to really treat acne's physical scars if you aren’t healing your mental ones. Without regular SPF, hydration, nourishment, and skin love you will not achieve even and glowing skin. Let go of feeling greasy, shiny, or worrying about everything breaking you out. We are all our own harshest critics and few people (other aestheticians sometimes, especially) will go out of their way to compliment your skin. That’s why at Skin MPLS, we treat skin differently. We give honest feedback, positive reinforcement, and realistic approaches to help you face what is really happening on your face!
The best product for “imaginary acne” is letting go of being afraid of products. This doesn't mean trying anything and everything without your aesthetician's advice because pore-cloggers are real and can break you out again! But, we want you to venture outside of your three or four-step regimen to add in hydrating serums, masks, and tools. We don’t believe one line can treat it all, and we definitely don’t think you should only be using any topicals that dry out your skin. If it says acne medication on the label, just say no! We will help you keep your skin clear of pore-cloggers while treating your skin like a mature adult should!