How Are Acne Scars Developed?

Acne scars develop as a result of the body's response to acne lesions, involving several biological processes that contribute to the formation and types of scars. The pathogenesis of acne scarring, although not fully understood, is believed to involve the following key mechanisms:

1. Inflammation: The inflammatory response to acne lesions plays a critical role in scar development. Inflammatory mediators and immune cells are involved in the process, leading to tissue damage and scarring (Holland & Jeremy, 2004).

2. Abnormal Wound Healing: Acne scars, particularly hypertrophic scars, are a result of abnormal wound healing processes. Myofibroblasts, B cells, and mast cells have been observed in varying densities in different types of these scars, suggesting their role in scar pathogenesis (Chancheewa et al., 2022).

3. Fibrogenetic and Inflammatory Markers: The formation of hypertrophic acne scars has been linked to the roles of fibrogenetic and inflammatory markers, such as TGF-β, SMAD proteins, and cytokines like TNF-α and IL-4. These factors contribute to the fibrotic process leading to scar formation (Yang et al., 2018).

4. Genetic Factors: Genetic predispositions may also play a role in the development of acne and its progression to scarring. Specific genes have been implicated in regulating inflammation, apoptosis, and scar formation (Zúñiga- Gazcón, 2022).

5. Oxidative Stress: Oxidative stress has been suggested to contribute to acne pathogenesis, with a correlation between acne severity and oxidative biomarkers. Reactive oxygen species (ROS) may play a role in inflammation and scarring by altering the generation of proinflammatory cytokines (Kardeh et al., 2019).

Simply put, it isn't one thing.  While, it can develop from Inflammation, and abnormal wound healing, which were mentioned above, new studies have discovered that fibrogenetic and inflammatory markers, oxidative stress, and specific genes regulating inflammation, apoptosis can create those undesirable scars. By understanding these mechanisms is crucial for developing targeted treatments to prevent and manage acne scarring effectively.

How Long Does it Take for Acne Scars to Fade?

The natural fading of acne scars can vary significantly depending on the type of scars and individual skin healing processes. The research literature does not provide a precise timeline for the natural fading of acne scars. However, several studies discuss treatment methods and their effectiveness in reducing acne scarring over time.

For instance, treatments like chemabrasion, laser therapy, dermabrasion, and non-ablative fractional laser are often used to improve the appearance of acne scars, but these studies focus on the outcomes post-treatment rather than the natural fading process (Picosse et al., 2012); (Saluja et al., 2017); (Aronsson et al., 1997).

In general, the natural healing process of the skin and the reduction of acne scars can take several months to years, and the degree of improvement without treatment can be minimal. Factors such as the depth and severity of the scars, skin type, and overall health can influence the healing process. Some scars may fade slightly over time, but many people seek dermatological treatments for more significant improvement due to the typically slow and limited nature of natural scar fading.

For personalized advice and a more accurate estimation of the healing time for acne scars, consulting a dermatologist is recommended. They can provide insights based on individual skin types and scar characteristics.

What's the Best Treatment for Acne Scars?

There are no direct solution for removing acne scars, but there are treatments that make it less noticeable. This depends on the type and severity of the scars, as well as individual patient factors. Current research suggests several effective treatments:

1. Nonablative Radiofrequency (RF): Microneedle bipolar RF and fractional bipolar RF treatments have shown promising results for acne scarring, offering an improvement of 25%–75% after three to four treatment sessions (Simmons et al., 2014).

2. Laser Therapy: Laser treatments, including infrared wavelengths, pulsed dye lasers, and fractional laser resurfacing, have been effective in the treatment of acne vulgaris and acne scarring. Combination treatments with medical therapy often yield optimal outcomes (Alexiades, 2017).

3. Platelet-Rich Plasma (PRP) and Laser Therapy: Combining PRP with laser therapy has been used for acne scars, though larger studies are needed to better evaluate this treatment and determine the best modality (Schoenberg et al., 2019).

4. Dermabrasion: Dermabrasion works best for superficial scars, with less predictable results for more severe forms of scarring (Aronsson et al., 1997).

5. Microneedling: Microneedling (different from microneedle patches for pimples) has been shown to be more effective than 35% glycolic acid peels for treating acne scars, especially in patients with darker skin tones (Ishfaq et al., 2022). 

6. Combination Therapy: Combining various modalities such as fractional radiofrequency, chemical peels, laser treatments, and dermal fillers may be required for optimal results, as individual patients commonly display more than one scar type (Roh & Chung, 2019).

The choice of treatment should be tailored to the individual's scar type, extent of scarring, and skin type. Consulting with a dermatologist for a personalized treatment plan is recommended.

Why Do My Acne Scars Look Worse Some Days?

In Summary

There are many types of acne scars and solutions such as nonablative radiofrequency, laser therapy, and microneedling, but, these will not fully reduce the scars from your skin.  While, combining these with other ingredients such as Vitamin C, which is already well known in the skincare industry, for it's skin benefits can be even better.  But, always, go to your dermatologist or skin professional for medical advice before attempting anything.