Acne and Acne Scarring

What is acne?

Acne is a disorder of the hair follicles and sebaceous glands. Acne involves blocked pores which progress to pimples, cysts, and possible scarring. Acne is very common. 90% of the population are affected by acne at some time. It most often begins in puberty.

What causes acne?

During puberty, the male sex hormones, called androgens, increase in both boys and girls, causing the sebaceous glands to become more active and, thereby, increasing the production of oil (also called sebum). Dried oil, dead skin cells, and bacteria can cover the hair follicles, blocking the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation. Other factors playing a role in acne include the following:

  • hormone level changes during the menstrual cycle in women
  • certain medications (such as corticosteroids)
  • oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
  • friction or pressure from helmets, backpacks, or tight collars
  • environmental conditions (such as humidity)
  • Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.

What are the symptoms of acne?

Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands: face, chest, upper back, shoulders, neck

The following are the most common symptoms of acne. However, each person may experience symptoms differently:

  • blackheads (open comedones)
  • whiteheads (closed comedones)
  • pus-filled lesions that may be painful
  • nodules (solid, raised bumps)

Treatment of Active Acne

The goal of acne treatment is to prevent or minimize scarring and relieve symptoms. Specific treatment will be determined by your dermatologist based on:

  • the severity of the acne
  • your overall health and medical history
  • your tolerance for specific medications, procedures, or therapies
  • your opinion or preference

Topical medications to treat acne:

  • Benzoyl peroxide: kills the bacteria (P.acnes) and reduces oil production
  • Topical antibiotics: helps stop or slow down the growth of P. acnes and reduces inflammation
  • Tretinoin and adapalene: stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples
  • Azelaic acid: helps stop or slow down the growth of P. acnes and reduces inflammation

Systemic medications to treat acne:

  • Oral antibiotics. These are often used to treat acne and many patients stay on these medications for some months. They have an excellent safety record in acne patients.
  • Hormonal medications. For females, certain contraceptive pills and similar hormones can be useful in controlling acne in selected patients
  • Oral retinoids (vitamin A analogues)
    This is the most effective treatment for acne available and is a saviour for many patients with significant acne.  It will virtually always control acne, even in cases where other treatments have failed.  It can only be prescribed by dermatologists, as it requires their knowledge and expertise to be used correctly.  It reduces the size of the sebaceous glands that produce the skin oil, and makes the pores less easily blocked, thereby reducing the development of acne lesions. Like all medications, it has some potential rare side-effects, but has been used for over 25 years in millions of patients world-wide and has an excellent safety record.

Acne Scarring Treatments

Acne scarring can cause an enormous amount of distress for those affected. Treatment of acne scarring is a specialized area of medicine and dermatology. It is not possible to re-move all scarring but with persistence, significant improvements can be achieved. Usually a combination of treatments that is suited to an individual’s pattern of acne scarring is recommended. There are multiple types of acne scars including ‘ice-pick’, depressed, raised or hypertrophic, and red or white scars, and each requires a different approach to treatment. Treatment of acne scarring almost always requires repeated treatments over a number of months for best results. Your specialist will recommend a treatment plan that is best suited to your skin. This may include the following:

Fraxel Laser

Fraxel laser is a major break-through in the treatment of acne scarring. Its results have been scientifically shown to be better than any other laser system for treating acne scarring. It uses a simple but ingenious principle of making hundreds of thousands of microscopic laser pin-pricks in the skin. This causes remodeling of the skin and regeneration of new collagen in a very even distribution, smoothing out the clumps of collagen that exist in acne-scarred skin. Typically a series of 5 of more Fraxel laser treatments are recommended at monthly intervals.


Subcision is an excellent procedure for helping improve indented scars, especially acne scars. It involves making the area to be treated numb with the use of local anesthetic (creams and injections). A needle is then inserted into the skin and swept backwards and forwards and side to side under the skin to break up the scar tissue that is pulling the skin inwards at sites of scars. Once the scar tissue is separated, the skin is free to lift up to its correct position. This procedure usually results in some mild to moderate bruising and swelling in the proceeding days. It is often repeated at approximately three-monthly intervals for further improvement. It is typical for us to combine this treatment with Fraxel laser and scar excisions.

Acne scar excisions

Certain small and deep acne scars may be best treated with careful excision and suturing. If the scar is small enough then we may use a punch biopsy instrument of size as small as 1.5 mm to excised the scar and use a single suture to close the wound. Sutures are often removed at around day five. Using Fraxel laser soon after scar excision to optimise the result is a common technique used at this practice.


Acne scarring often involves some loss of volume from beneath the surface of the skin, leading to depressed scars and hollow-appearing areas. Fillers can help reverse this change. We use non-permanent fillers because of their excellent safety profile. We find that we achieve some permanent improvement with them, however. The longer skin is held in a good position, the more likely it is to stay in that position when the temporary filler has dissolved. We also use fillers to hold the skin in a good position while the skin is healing and remodelling itself after subcision and during or after a series of Fraxel laser treatments.

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