Adult Acne: Scars, Marks, Treatment and Prevention

Following on from the first of this three part Adult Acne series, this article is about what to do about your acne and what your acne can do to you!

Last time, we discussed why adults get acne, what it is, how it forms and what the grades of acne are. So, what is the absolute worst thing you can do in regards to acne? NOTHING!

Acne is a disease and I find that with a lot of clients, it is not treated as such. If you had the flu for a whole year, I like to believe that you would not simply cover up the symptoms with makeup and continue trying to live your life even though it is inconveniencing you!

To find an effective treatment plan for your acne, you need to be in contact (preferably regularly) with a medical and/or skin professional. I would recommend that as your first step for dealing with acne, especially if you are getting large pustules (full whiteheads) in medium to high amounts, you should speak to your GP who can refer you to a dermatologist, if they believe it to be necessary, or prescribe medicated treatments.

What are the most commonly prescribed acne treatments?

  • Hormonal treatments: Some forms of the contraceptive pill are prescribed to treat acne - they work by regulating hormones and thus controlling oil levels, preventing acne from forming. Spironolactone is a blood pressure medication that is used to regulate a hormone called aldosterone in the body and this is sometimes prescribed for acne also.
  • Antibiotics: You may be prescribed an oral antibiotic, a topical antibiotic or both in conjunction with each other. Oral antibiotics such as doxycycline, minocycline or erythromycin kill the bacteria in the pore and topical antibiotics like clyndamycin or erythromycin kill the bacteria on the skin. It's nearly like a weed spray for the skin in that they get to the root rather than just the top like cosmetic products do.
  • Isotretinoin: Isotretinoin is more commonly known as Roaccutane (or Accutane in the US). A synthetic derivative of Vitamin A, it greatly reduces the rate of oil production and the bacteria P. Acnes within the skin and on top of the skin. Roaccutane is a severe treatment for severe acne - it has a long list of side effects such as intense skin dryness and incredibly high photosensitivity. However, whether you're suited towards Roaccutane is up to a medical professional who will go through all of the side effects and explain ways to counteract them should they occur.

Acne and skincare

Outside of medicative treatments, there are plenty of skincare-orientated ways to slow the growth and reduce the amount of papules, pustules, blackheads and other forms of congestion from forming. On the inside, Advanced Nutrition Programme's Accumax supplements (€52.00 for a month's supply of 60 capsules) provide your body with vitamin A, vitamin C and vitamin E to help with skin reparation and their patented DIM, a highly active plant compound.

I have seen the effect that Accumax can have on clients with acne and it is huge and sometimes life changing. On top, I am a believer in the power of salicylic acid and retinol, as both are keratolytic. This is the nerdy bit: keratolytic therapy is when an acidic treatment is applied to a spot which makes the most outward layer shed from the skin.

Salicylic acid is a beta-hydroxy acid and works as a chemical exfoliant that penetrates into the pore and unclogs it, as opposed to an alpha-hydroxy acid that would exfoliate from the top. It is like the power hose of acne spot treatments, in that it cleans out your pores thoroughly and perhaps better than other acids can. It is also anti-inflammatory so it brings down redness and rise in a spot and can reduce sebum production, preventing future breakouts.

Salicylic acid, however, is not quite strong enough to create major changes when it comes to cystic acne.

Retinol is a derivative of vitamin A, or as I would usually say, the only vitamin and one of the few ingredients that can cause an actual physical effect to the skin. Retinol's molecules are absolutely teeny tiny and thus can penetrate into the skin like no other. Like salicylic acid, it gets rid of dead skin cells and unclogs the pore but in that it gets deeply into the pore, it also repairs the elastin and collagen within the skin, lessening the formation of acne scars.

This dual action is what makes retinol a wonder product to myself and to (all) other skincare professionals world wide. When it comes to acne treatment, I believe in the power of a well-performed, in-clinic peel. IMAGE Skincare have the Acne Lift peel, performed by a clinician, which they describe as a "beta and alpha hydroxy-acid cocktail" - that's the type of cocktail I'll get behind!

The Acne Lift peel resurfaces and smooths out the skin whilst treating active acne. The IMAGE Beta Lift peel uses a non-blended beta-hydroxy acid solution to reduce the appearance of pores, control excess oils and treat mild to moderate acne however this treatment is only available in medical skin clinics as, for absolute skin safety, it is performed by nurses.

If you are looking to incorporate a retinol into your skin care routine, as always, I suggest speaking to a qualified skincare professional to help you choose one that will work best for you. We would rate a retinyl palmitate serum, a different form of vitamin A that works lower and slower, such as in Skingredients Skin Protein (€42.00). 

What causes acne scars?

Acne is painful and irritating enough without the fact that some acne can cause scarring to occur. Acne scars are a textural problem rather than simply being pigment, as that would be an acne mark. Cystic and nodular acne (ie. grade 4 and the further end of grade 3) are the types that cause scarring most frequently. This is because the acne has grown deeply into the skin, too far into the epidermis layer. This damages the skin and tissue that lies beneath and the body will try to heal the damage caused.

During this reparation process, the body will produce collagen, the protein that gives the skin its structure. If the wrong amount of collagen is produced, a scar can occur. If it is too little collagen, a pitted or depressed scar can form, and if it is too much collagen, a raised scar can form. Additionally...

  • Scarring is more likely to occur on areas where acne has not had time to completely heal before a new breakout occurs in the same place.
  • If you do not act fast when you have inflamed acne (grade 3 or 4), you may develop scars. This is why it is important to treat acne rather than just plaster it in makeup, even though it is easier and cheaper to do the latter.
  • Acne scars can happen to squeezers, pickers and poppers. You should NOT touch in any way acne that does not have a very obvious, very soft and very white head. Having a set of long nails does not give you a qualification to do your own at-home extraction and you can irreparably damage the skin!!

What causes acne marks?

Acne marks AKA post-inflammatory hyperpigmentation (try saying that five times fast) are different to scars as they are not raised nor pitted, they are flat pigment marks that are either red, purple or brown in colour or all at different points in time. They will fade between three to six months after your breakout has disappeared, unlike acne scars which are much more difficult to tackle.

Prevention and treatment of acne scars and acne marks

Acne scars:
  • Treat your acne, rather than doing nothing except being upset about it. See a doctor and get on a proper, active skincare routine (AKA retinol/salicylic acid based).
  • Don't pick at it, pop it or do anything that could damage the tissue.
  • Work quickly to bring inflammation down using an acidic spot treatment as soon as possible.
  • I truly believe it is better to prevent through medical treatment but if you already have acne scars, micro-needling could help. Tiny needle tips pierce the skin, penetrating the dermis and stimulating the growth of collagen and elastin. It is through this that micro-needling evens out the texture and tone of acne scars.
  • Laser resurfacing (for example, with the Lumenis machine) tricks the skin into thinking it is being harmed, triggering the uppermost layer to shed off and allowing a new layer of skin to form. This can be effective when it comes to acne scarring, dependent on the depth or rise of the scar itself.
Acne marks:
  • Acne marks are caused by melanocytes AKA the same pigment cells that create the tan effect on the skin. So wearing an SPF everyday can prevent the marks from becoming darker and can shorten their stay on the skin.
  • Not picking can also prevent acne marks!
  • As well as micro-needling and laser resurfacing, brighteners (especially those that use kojic acid) can lighten pigment and improve the appearance of acne marks. I'd be most inclined to suggest IMAGE Skincare's Iluma Intense Lightening Serum (€52.00) or the Neostrata ENLIGHTEN Pigment Lightening Gel (€19.00)
As a recap on my general nerdy advice, prevent rather than firefight! Get professional advice as soon as you notice your acne developing or worsening as there is no guarantee that micro-needling or laser resurfacing will work on your acne scarring and they are a lot pricier as treatments in the long run."