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Acne health centre

Complications of acne

NHS ChoicesMedical Reference

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Acne scarring

Acne scarring can sometimes develop as a complication of acne. This happens when the most serious types of spots - nodules and cysts - burst and damage nearby skin.

Scarring can also occur if you pick or squeeze your spots, so it is important not to do this.

There are three main types of acne scars:

  • ice pick scars - small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object
  • rolling scars - caused by bands of scar tissue that form under the skin giving the surface of the skin a rolling and uneven appearance
  • boxcar scars - round or oval depressions, or craters, in the skin

Treating scarring

Treatments for acne scarring are regarded as a type of cosmetic surgery, which is not usually available on the NHS. However, in the past, exceptions have been made when it has been shown that acne scarring has caused serious psychological distress.

See your GP if you are considering having cosmetic surgery. They will be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS.

Many private clinics offer treatment for acne scarring. Prices can vary widely (from £500 to over £10,000) depending on the type of treatment that is required.

The website of the British Association of Aesthetic Plastic Surgeons provides more information about private treatment that is available in your area.

It is important to have realistic expectations about what cosmetic treatment can achieve.

While treatment can certainly improve the appearance of your scars, it will not be able to get rid of them completely. After treatment for acne scarring, most people notice a 50% to 75% improvement in appearance.

Some of the available treatments for acne scarring are explained below.

Dermabrasion

Dermabrasion involves removing the top layer of skin using either lasers or a specially made wire brush.

After the procedure, your skin will look red and sore for several months, but as it heals, you should notice an improvement in the appearance of your scars.

Laser treatment

Laser treatment can be used to treat mild to moderate acne scarring. There are two types of laser treatment:

  • ablative laser treatment - where lasers are used to remove a small patch of skin around the scar to produce a new smooth-looking area of skin
  • non-ablative laser treatment - where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps repair some of the damage caused by scarring and improves appearance

Punch techniques

Punch techniques are used to treat ice pick scars and boxcar scars. There are three types of punch technique:

  • Punch excision is used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it will leave a smoother and more even area of skin.
  • Punch elevation is used to treat boxcar scars. The base of the scar is surgically removed leaving the sides of the scar in place. The base is then reattached to the sides but lifted up so that it is level with the surface of the skin. This makes the scar much less noticeable.
  • Punch grafting is used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is then "plugged" with a sample of skin that is taken from elsewhere on the body (usually from the back of the ear).

Subcision

Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue that pushes up the rolling scar so that it is level with the rest of the surface of the skin.

Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar.

Depression

Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to people with acne becoming depressed.

You may be depressed if during the last month you have often felt down, depressed or hopeless and have little interest or pleasure in doing things.

If you think that you or your child may have depression, it is important to speak to your GP.

Treatments for depression include talking therapies such as  cognitive behavioural therapy and a type of antidepressant called  selective serotonin reuptake inhibitors (SSRIs).

Read more about treatment for depression.

There is currently no main charity or support group for people affected by acne in England.

However, there is a range of informally run message boards and blogs about acne on the web. You may find it supportive to read about other people's experience of living with acne.

The charity Get Connected has a website and helpline for teenagers and young people with emotional and other difficulties. 

Anxiety
Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.
Depression
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Medical Review: February 14, 2012

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