Acne & Acne Scars

Most acne scars are depressed scars that form when collagen underproduces as the original blemish heals. There are three main types: boxcar scars, which are round with steep, well-defined borders; ice pick scars, which are narrow but deep, sometimes resembling an oversized pore; and rolling scars, which are shallow depressions without clearly defined edges. Hypertrophic and keloid scars can also develop from acne, appearing as raised, firm scarring that may grow larger than the original blemish. Scarring often becomes more noticeable with age, as we naturally lose facial volume and collagen.

The best approach to acne scarring starts with prevention, through topical treatments and sometimes oral medication, since scarring is more difficult to address once it’s already formed.

Whiteheads develop when an overproduction of oil mixes with keratin and clogs the pore. That mixture can combine with a bacterium called Propionibacterium, which leads to redness and inflammation, and in some cases, larger cysts or nodules. Prevention is the most effective first step. It’s important not to pick at active acne, since doing so increases inflammation and raises the risk of permanent scarring.

Blackheads form when excess sebum combines with keratin in an enlarged pore. When that mixture is exposed to air, it oxidizes and darkens. Melanin naturally present in the keratin contributes to the dark color as well. Improper extraction technique can lead to scarring, so professional extraction is generally the safer route.

Milia are small, pearl-like white cysts beneath the skin’s surface, most commonly found on the cheeks or around the eyes. They’re distinct from typical acne and don’t respond to acne treatment. Popping milia doesn’t work and can cause damage to surrounding skin; professional extraction by a trained aesthetician is the appropriate treatment.

This condition involves the enlargement of an oil gland due to trapped oils, and it becomes more common in middle age. Sun exposure appears to play a role in its development. The lesions typically appear as small yellow or flesh-colored bumps. They can sometimes resemble basal cell carcinoma, which makes an accurate diagnosis important. Once you develop one lesion, you’re likely to develop more over time, so prevention with at-home retinoids is worthwhile.

Often mistaken for acne, pseudofolliculitis is more accurately known as razor bumps. It’s seen most often in African American men, typically in the beard area but sometimes elsewhere hair is trimmed close to the skin, like the back of the neck. It develops when tightly curled hair curves back into the skin, causing a foreign body reaction and inflammation that can lead to hypertrophic or keloid scarring over time.