Differences Between Acne and Acne Scars
Skin health is more than just an aesthetic concern; it’s a reflection of a person’s overall health and quality of life. Among dermatological problems, “Acne Vulgaris” (Pimples) is one of the most common, affecting a wide age range from adolescence to adulthood. However, in clinical practice, the two concepts most frequently confused by patients are “Acne,” an active infection process, and “Acne Scars,” which are permanent tissue damage resulting from faulty healing of this process. Many patients continue with drying treatments, mistaking the redness on their face for active acne, or conversely, try to treat scars while they still have active acne. However, the pathology, formation mechanisms, and most importantly, treatment protocols of these two conditions are diametrically opposed.
Especially in a region like Izmir, where humidity is high and the sun is intense for a large part of the year, acne and acne scar management requires extra sensitivity. High humidity increases sebum (oil) secretion in the skin, triggering active acne formation; while intense sunlight (UV) increases the risk of healing pimples leaving marks (post-inflammatory hyperpigmentation). Therefore, it is vital for individuals living in Izmir to clearly understand the difference between acne and acne scars, to consult the right specialist at the right time, and to take appropriate care of their skin.
What is Acne (Pimple)? Active Inflammation Process
Acne is a chronic and inflammatory disease of the sebaceous glands and hair follicles in our skin. This process usually begins with the sebaceous glands producing excessive sebum (oil) under the influence of hormonal changes.
Normally, sebum, which moisturizes the skin, combines with dead skin cells and clogs pores. An oxygen-deprived environment is created in these clogged pores. This environment provides a perfect breeding ground for the “Cutibacterium acnes” (formerly P. acnes) bacteria, which are naturally present on our skin. As the bacteria multiply, the body’s defense system kicks in and sends white blood cells to the area. The result of this battle is redness, swelling, increased heat, and the formation of a pus-filled structure (pustule). In short, acne is a living, active, microbial, and inflammatory process. The main goal of its treatment is to balance oil production, control bacteria, and extinguish inflammation.
What are Acne Scars? A Result of Faulty Healing
Acne scars are the result of the skin’s attempt to repair itself after the active acne process ends. Severe and deep-seated acne (cystic or nodular) damages the lower layers of the skin (dermis).
The body begins to produce “collagen” to repair this damage. However, this repair process doesn’t always work perfectly. If the body produces too little collagen while repairing the damaged tissue, depressions and pits form on the skin; this is called “Atrophic Scar.” If the body produces too much collagen, raised bumps form on the skin’s surface; this is called “Hypertrophic Scar” or “Keloid.” In short, acne scars are not an active infection or inflammation, but a permanent deterioration of the skin’s architecture and texture.
Key Differences: Active Disease vs. Tissue Damage
To choose the right treatment, it’s necessary to clarify the differences between these two conditions. The following table summarizes the key distinctions:
| Feature | Active Acne | Acne Scar |
|---|---|---|
| Nature of Condition | Active infection and inflammation. | Complete healing process, tissue loss/excess. |
| Appearance | Red, swollen, white/yellow tip, painful. | Pitted, wavy or raised, skin-colored or dark. |
| Touch Numbness | Painful, warm, soft. | Painless, hard, or hollow. |
| Treatment Goal | To stop inflammation, balance oil. | To restructure tissue by stimulating collagen. |
| Timing | Usually adolescence and young adulthood. | May be permanent after acne. |
Types and Definitions of Acne Scars
Acne scars are not uniform. The shape and depth of the scar are the most important factors in determining the treatment to be applied (Laser, Gold Needle, Subcision, etc.).
1. Ice Pick Scars
These are scars that look as if an ice pick or needle has been inserted into the skin; they are narrow in diameter (less than 2 mm) but deep. They are usually “V” shaped and are one of the most difficult types of scars to treat. They penetrate deep into the dermis.
2. Boxcar Scars
These are box-shaped depressions with sharp, steep edges and a flat base. They can be round or oval. They are usually seen on the cheeks and temples. They can be superficial or deep.
3. Rolling Scars
These scars appear as undulations on the skin surface.These are marks seen in the clinic, with softer, transitional edges. They are formed as a result of fibrous bands (fibrotic bands) under the skin pulling the skin downwards. Their appearance may lighten when the skin is stretched.
The Difference Between a Spot (PIH/PIE) and a Scar
One of the most common mistakes patients make is mistaking red or brown spots left after acne for “scars”.
- Post-Inflammatory Hyperpigmentation (PIH): These are brown spots left after acne heals. This is due to an increase in melanin pigment in the skin, and there is no depression in the tissue. In sunny regions like Izmir, UV rays darken these spots.
Post-Inflammatory Erythema (PIE): These are red/pink spots left after acne. This situation is due to the capillaries expanding during the healing process.
Blemishes are discoloration on the skin’s surface and can disappear over time or with the right products (blemish treatments). However, “scars” are a physical deterioration (pitting) in the skin’s texture and cannot be completely eliminated with creams; tissue regeneration devices are needed.
Key Differences in Treatment Approaches
Active acne and acne scar treatment proceed through completely different mechanisms. In fact, sometimes contradictory procedures may be required.
Active Acne Treatment
The goal here is to “calm” and “dry”.
Medical skin care treatments, salicylic acid peels, topical retinoids, or systemic treatments (under physician supervision) are used. Aggressive procedures (Dermapen, Laser, Gold Needle) are never performed on skin with active acne; because these procedures can spread the infection throughout the face and worsen the condition.
Acne Scar Treatment
The goal here is to “cause damage” and “reconstruct”.
The aim is to break down the damaged collagen under the skin and replace it with new, smooth collagen. Fractional lasers, radiofrequency gold needles, subcision (breaking bonds with a needle), or chemical peels are used for this. These procedures work on the principle of “controlled damage”.
Climate Factors and Skin Management in Izmir
For patients receiving acne and scar treatment in Izmir, environmental factors directly affect the success of the treatment.
Izmir’s humid climate can cause pores to clog more quickly, which increases the importance of cleansing in acne-prone skin. On the other hand, acne scar treatments (laser, peeling) make the skin more sensitive to the sun. Izmir’s strong sun increases the risk of leaving marks in the treated area. Therefore, in dermatology and medical aesthetic clinics in Izmir, scar treatments are usually planned during the winter months when the sun’s effect is reduced, or very strict sun protection protocols are applied.
Conclusion: Correct Diagnosis, Correct Roadmap
In short; “The Differences Between Acne and Acne Scars” are not just a terminological detail, but a fundamental factor determining treatment success. Active acne is a disease, while acne scars are a legacy of this disease. One requires medical treatment and sebum balance, while the other requires technological devices and tissue regeneration.
In Izmir, correctly identifying the problem you are experiencing with your skin is the first step on the road to smooth skin. If you have active acne, you should first focus on extinguishing the inflammation; if you have scars, you should focus on restructuring the skin. Remember, every skin is unique like a fingerprint, and the most accurate treatment plan should be created by a specialist physician who closely analyzes your skin.
