Acne & Scarring

Acne is a condition that involves the oil glands of the skin, located at the base of hair follicles. Acne lesions occur most commonly on the face, however also occur on the neck, shoulders, chest, and back.

Spots that occur are commonly referred to as pimples or zits. There are different types of lesions seen in acne, ranging from blackheads, white heads, pustules (‘pimples’), and painful deep and hard lesions called cysts and nodules.

Most people develop acne in their teenage years. It can affect people of all ages and all races. There are several reasons contributing to acne, especially in this age group:

  • Higher levels of sex hormones, in particular testosterone, at puberty
  • These hormones are further converted in the skin which stimulate the oil glands at the base of hair follicles, and produce excess sebum
  • Hair follicles are tiny canals that open onto the skin, from which a hair exits. The opening of the hair follicles can become blocked with shed skin cells. If this occurs, sebum from the oil glands and dead skin cells build up and collect within the hair follicle.
  • A blockage at the opening of the hair follicle results in blackheads.
  • Normal skin bacteria can accumulate and feed on the excess sebum. If this occurs, pimples or pustules occur. If the buildup is large, the walls of the hair follicle can rupture, and this is when the painful large cystic lesions develop.

Other factors contributing to acne include genetic factors, hormonal factors, environmental factors and certain medications. Given there are multiple triggers and possible contributing factors to acne, further investigations may be required, and treatment often requires a multifaceted approach.

Acne scarring is the unfortunate long term consequence of acne. Scarring is a result of the body healing inflammatory lesions during active acne. 30% of those with moderate-severe acne will have significant scarring. It is more common in the severe forms of acne. To reduce the chance of scarring or progression of scarring, it is important to treat acne early. Unfortunately true acne scars never completely disappear without treatment, but do improve with time. Recent inflammatory acne lesions can be associated with increased pink/purple colour, brown marks or white marks, before gradually fading over many months. There are several types of scarring that can occur – pitted (‘icepick’) scars, thin, flat (atrophic) scars, and thick lumpy scars (keloid).

There are several methods in which acne scars can be treated. Refer to the treatment section for further information.