What are acne scars? 

Acne scars are marks left on the skin after an acne lesion has healed. They are formed when the skin’s repair process malfunctions, resulting in an overproduction or loss of collagen. There are different types of acne scars, including:

• Atrophic scars: indented scars that form when the skin does not produce enough collagen during the healing process. They include:
  • Ice pick scars: deep, narrow, pitted scars.
  • Boxcar scars: broad, box-like depressions on the skin with sharply defined edges.
  • Rolling scars: wide depressions with a rolling or wave-like appearance on the skin.
• Keloid scars: a type of hypertrophic scar that is larger and can grow beyond the original wound site. They are more common in people with darker skin tones.
• Hypertrophic scars: raised scars that occur when the skin produces too much collagen during healing, leading to a lump of scar tissue on the skin's surface.

Acne scars can vary in severity and may be influenced by factors such as the type of acne, the individual’s skin type, and the extent of the inflammation. Additionally, an individual may be affected by a combination of different scar types, requiring more than a single treatment module to achieve an even skin texture. 

What causes acne scars? 

Acne scars are primarily caused by the skin’s inflammatory response to acne lesions, such as pimples, cysts, or nodules. When the skin experiences an acne breakout, the body's immune system responds to the inflammation by sending white blood cells to the affected area to repair the damage. This repair process involves the production of collagen, a protein that is essential for skin healing. However, if the inflammation is severe or prolonged, it can disrupt the process. 

Overproduction of collagen can lead to hypertrophic or keloid scars, which are raised and lumpy in texture—meanwhile, insufficient production of collagen results in atrophic scars, which are indented. Moreover, the breakdown of skin tissue during an intense inflammatory response can lead to the formation of pitted scars, as the skin loses its structural support. Additionally, factors such as the depth and severity of the acne lesion, the individual’s skin type, and genetic predisposition can all influence the extent and type of scarring.

What are the symptoms of acne scars? 

Acne scars can impact the skin’s appearance and texture, causing cosmetic concerns. In some cases, they may also affect an individual’s self-esteem and confidence.

Symptoms of acne scars include:

• Textural changes: the skin may feel uneven or rough to the touch due to indented (atrophic) or raised (hypertrophic or keloid) scars.
• Indentations: these are depressions in the skin where there is a loss of tissue. They can take the form of ice pick scars (deep and narrow), boxcar scars (broad with sharply defined edges), or rolling scars (wide with a wavy appearance).
• Raised areas: raised scars, including hypertrophic and keloid scars, appear as lumps or elevated areas on the skin. Hypertrophic scars are confined to the area of the original acne lesion, while keloid scars can extend beyond the original wound site.
• Discolouration: acne scars can be accompanied by changes in skin colour, such as hyperpigmentation (dark spots) or hypopigmentation (light spots), particularly in individuals with darker skin tones. This discolouration can make scars more noticeable.
• Redness: some acne scars may appear red or inflamed, especially in the early stages of healing.
• Sensitivity: the scarred areas may be more sensitive to touch or temperature changes than the surrounding skin.

Who is at risk of acne scars in Singapore?

Anyone who experiences acne can potentially develop acne scars. But certain factors increase the risk, such as:

• Severe acne: individuals with severe forms of acne, such as cystic or nodular acne, are more likely to develop scars due to the deeper inflammation and tissue damage.
• Delayed treatment: early and effective treatment can reduce the severity and duration of acne, thereby minimising the risk of acne scarring.
• Genetics: a family history of acne scarring can increase the likelihood of developing scars as some people are genetically predisposed to more severe inflammatory responses, leading to scarring.
• Skin type: people with darker skin tones may be more prone to certain types of scars, such as keloid scars and post-inflammatory hyperpigmentation. Those with lighter skin may notice redness and post-inflammatory erythema more prominently.
• Picking or squeezing pimples: picking or squeezing acne lesions can worsen inflammation and increase the risk of scars by further damaging the skin.
• Inadequate skin care: poor skincare routines, such as not properly cleansing the skin or using harsh products, can exacerbate acne and increase scarring.
• Hormonal changes: hormone fluctuations, particularly during puberty, pregnancy, or menstrual cycles, can lead to more severe acne, which may increase the risk of scars.
• Environmental factors: exposure to pollution and other environmental stressors can worsen acne and increase the likelihood of scarring.

How are acne scars diagnosed? 

Acne scars are typically diagnosed through a physical examination. Dr. Hoe will visually inspect the skin to accurately determine the type of scar and its severity. The assessment will include the patient’s acne history, any previous treatments, and family history of acne scarring. She may also conduct a comprehensive skin assessment to identify issues associated with acne scarring, such as skin dullness. 

Dr Hoe’s in-depth skin analysis prioritises finding the root cause of acne scarring rather than superficially treating it. No two patients are the same in terms of their acne scar type, skin condition, and ability to take downtime, so a customised approach needs to be taken to personalise a treatment plan. Her bespoke solutions have provided sustainable and long-lasting results for her patients, overcoming even the most complex and stubborn cases of acne scarring.