Scars are a part of the body’s natural healing process. There are a few different types of acne scars, including soft, ice-pick, depressed fibrotic, atrophic macules, and follicular macular atrophy. Soft acne scars are small, circular, and soft to the touch. Ice-pick scars are usually found on the cheek, and are small, deep, and have jagged edges. The depressed fibrotic scars are ice-pick scars that have evolved to be larger and firmer. Atrophic macules are soft, wrinkled, and sometimes have a purple tint. Follicular macular atrophy scars are more common to appear on the back and chest. They are small and resemble white heads.
The most common cause of acne scarring is squeezing, poking, and popping pimples. If a pimple is left alone, it is more likely to go away completely. If a pimple is squeezed and poked, it can stick around forever.
There are a few other factors that can diminish the chance of acne scars to appear. Eating a balanced diet, getting enough sleep, and drinking an adequate amount of water can help with acne scarring because a healthy body heals faster than an unhealthy one. Wearing SPF 30 sunscreen can also help because the sun can darken acne, causing it to heal slower. Clients should limit their time in the sun, especially from 10 a.m. to 2 p.m.
There is also a genetic link between acne scarring. The genes that clients inherit can make them more susceptible to severe acne, acne scarring, differently types of acne scars, and just scarring in general.

Case Study:

One of your VIP clients makes an appointment for her teenage daughter, who is very self-conscious of the acne scars on her cheeks. She has tried various treatments at home, but the acne and scars only seem to worsen. The teenager hates going out in public because of her acne, but is just as embarrassed by the acne scars. She has tried various over-the-counter creams and scar-treatment kits, but this is her first appointment with a professional and she is hoping to rid the scars completely. During her consultation, you find out her father still has some acne scars that came about during his twenties.
The client is 18 years old, lives in Orange Beach, Alabama, and is a lifeguard at her neighborhood pool. She tells you she is pretty sure that she wears enough sunscreen during her shifts.

As a skin care professional, what solution would you propose to treat
this case study on acne scarring?

Jessica Heron, Sothys National Trainer

“Prevention is the key when it comes to dealing with acne scarring because it is an effect of the skin disease acne vulgaris that leaves temporary and permanent scarring on the skin. The acne needs to be under control before scars can be treated. Acne treatments in the spa are recommended for mild to moderate forms of acne, but if the acne is severe then the client must be referred to a dermatologist or medical doctor. Topical vitamin A creams and gels can prevent and clear blemishes before they lead to scar formation, which helps clear out debris from clogged pores. Genetics plays a definite role in the chance that acne severity may cause scar formation. Severity of preteen acne lesions is linked to more severe forms of scarring later in adolescence or adulthood and delaying acne treatments by three or more years may increase the risk of more scarring. All acne and scarring are not alike. The first step is to determine what kind of acne (mild, moderate, or severe) and what kind of scarring (temporary or permanent) she is experiencing. Most serious scarring is caused by the more severe form of acne with painful, pus-filled cysts or lumps. In most cases it is post-inflammatory hyperpigmentation (PIH), which is not scarring at all and is often mistaken for scarring. It is the normal remnant of the skin’s inflammatory process. PIH can fade unassisted, usually within six to 12 months. The darker the PIH, the longer it may take to resolve. Sun avoidance is important as ultraviolet light will darken the skin; Sun protection prevents this and will not interfere with bleaching treatments commonly used for dark spots. The other kind of scarring is a result of a forceful inflammatory response that can have two results. Most commonly there is a loss of skin tissue and collapse, forming a pock mark/ice pick scar.A chemical peel in the spa is recommended for PIH that causes skin color changes for mild scarring. A peel involves the application of alpha hydroxy acids and or beta hydroxy acids such as glycolic acid and salicylic acid to penetrate the deep layers of the skin to assist in resurfacing the skin.”

Ben Johnson, M.D., founder of Osmosis Skincare

“First, I would diagnose her with ‘candida acne’ since it appears on the cheeks. I have isolated the three main causes of acne based on the location that the acne appears. Candida acne is common in teenagers. I would then address the source of her acne internally so that the candida will no longer emit the toxins that are causing the inflammatory reaction in her skin. The scar situation is complicated by the fact that the acne is still appearing. I would prefer to treat the acne and clear her before addressing the scarring. Acne scarring can occasionally respond to laser or chemical peels but the same small percent that can see improvement is similar to the number of people that see a worsening of their acne scars. Zinc Finger Technology™ is great in these situations because it reactivates scar remodeling which often results in a permanent improvement of 30 to 50 percent.”

H. Adhami, M.D., dermatologist and founder of Vivoderm Natural Skincare

“You can think of acne as an infection of the skin that can cause the destruction of collagen of the skin, causing acne scars. Because the sun causes further breakdown of collagen, I recommend for the client to try and stay out of the sun between the hours of 10 a.m. to 4 p.m. I recommend the use of products with zinc oxide (a healing mineral which is an essential part of our cellular building blocks), which is a natural sun block that promotes health, instead of the chemical alternative, SPF. I do not recommend her to use any topical products with acids. Acids will gradually destroy the top layer of the skin, in turn making the skin thinner, destroying the collagen, and worsening the scarring. I recommend natural products, such as masks, containing powerful healing, anti-bacterial and anti-inflammatory herbs such as oregano, cumin, and marshmallow. These herbs help increase the circulation of the skin, so that the capillaries can bring the healing and necessary nourishment to the collagen forming cells (fibroblasts). Fibroblasts produce new collagen, helping to heal the scars and the skin. Just as we eat healthy, natural herbs and ingredients to bring energy and vitality to our bodies, I believe in applying nature's own potent and powerful ingredients to heal and bring life and vibrancy to the skin.”

Anne C. Willis, L.E., C.M.E., founder of De La Terre Skincare®

“Any change to the appearance of the skin can have a huge impact on how one feels about their looks. Though aestheticians should be supportive, it is important to move forward by defining your role and what you can realistically provide for the young client, without getting emotionally involved. Your role is to care for skin!
The best course of action is to demonstrate that your skin care program, which addresses acne and physical changes due to the condition, can improve skin health. Be positive and optimistic! It will take cooperation from the young client to be compliant with self-care recommendations, including changes to lifestyle habits.
Clinical holistic therapies would recommend addressing the inflammatory issues first. The treatment protocol should include reducing swelling, activating lymphatic movement to absorb internal cellular debris, and skin nutrition to aid in skin regeneration. Skin peels are not recommended due to the fact that the skin is still in a developmental stage. Too activating of a treatment will interfere with formation of blood and lymph vessels, cellular communication, and so on.
Someone in their teenage years has probably not been shown how to care for their skin, so self-care instructions where the client can apply the self-care products in front of the aesthetician, insures they feel confident about touching and caring for their skin. This approach will also make them become engaged in achieving results.”