Acne Blog Part II

Acne – Complications and Consequences

Before reading this blog, if you’ve not done so yet, it may be helpful to read my previous blog: Acne – how and why do we get it?

Why is acne treatment important?

Acne is a chronic condition and even with the best treatment, may persist for many weeks or even months. During this time, repeated pockets of inflammation and infection in the skin can result in a variety of unwanted changes in the skin’s appearance, some of them permanent.

Most of us will have experienced congestion, black & white heads and red pimples. Whilst annoying, these are usually short lived and if we’re lucky, will pass without leaving a trace. However, for certain groups, even a small pimple can leave a long-lasting blemish.

As acne can leave permanent and disfiguring scars, it’s important for sufferers to seek help as quickly as possible. Acne scarring lasts for ever and is difficult to treat - as a clinician that sees those still affected by scars years down the line, I feel strongly that we should take this disease (yes, that’s what it is) seriously and treat it as quickly and aggressively as possible.

Acne complications

Post Inflammatory Pigmentation (PIH)

Melanocytes are the cells in the skin that create pigment. They are extremely sensitive to light, hormones and inflammation and when are exposed to these stimuli, create more pigment. PIH is the term given to an increased production of pigment after melanocytes are stimulated by inflammation. A simple example of this is when a spot leaves behind a brown or black mark. The greater the inflammation, the great the darker or larger the mark.

Groups more like to suffer with PIH are those who already have active melanocytes (e.g. those with brown or black skin). I myself get PIH after any spots, ingrowing hairs or shaving cuts - these appear after just a day or two and can last many weeks. For some, these marks can last for months.

PIH doesn’t affect the texture of skin, just the colour and so can be minimised with good makeup. Despite this it can be significant, unsightly and extremely distressing and so prevention is always better than cure. 


Atrophic Acne scarring

Whilst some people refer to PIH as acne scarring, when clinicians use the term, we are usually referring to atrophic scarring. A simple way to describe these is as a dent in the skin where there has been a loss of tissue.

Atrophic scarring occurs when there is deeper and greater inflammation that damages the lower layers of skin with permanent consequences. Scratching and picking at spots increases the chance of permanent scarring – tempting as it is, do whatever you can to keep your fingers away!

Whilst PIH can be minimised with makeup, despite many sufferer’s best attempts, atrophic scars can rarely be covered and last a lifetime. Even with the best treatment (which can be costly and involve significant down time) there may not be 100% improvement. This is why it is important to avoid squeezing your spots and get proper treatment as quickly as possible.

There are three main types of atrophic acne scars:

Rolling acne scars

These are gentle undulations in the skin like shallow craters and respond the most favourably to treatment

Boxcar acne scars

Usually smaller than rolling scars and with sharper borders – a cliff edge rather than a gentle hill.

Icepick acne scars

Narrow, deep pits extending deep into the skin, the most difficult to treat.


Because of these unsightly complications, preventing acne is always the main goal and better than treating once occurred. Treatment should target the main causes of acne: excess oil production and the build-up of tough keratin in the skin which can block pores. Bacteria does play a part - the P. acnes bacteria live deep within pores (not on the surface of the skin) and can trigger inflammation leading to acne. However, healthy pores can also harbour P. acnes showing that the link is not the whole story.

I’ll discuss treatment options in my next blog post.


Dr Askari Townshend is a GMC registered doctor, qualified in 2002, and Member of the Royal College of Surgeons, England. He is founder and Medical Director of ASKINOLOGY in the City of London and has been practising aesthetic medicine full time since 2008.


Read about the treatments we offer for acne and acne scarring:

Peels >

LED light treatment >

ZO Skin Health Skin Care >

Dermaroller >

Fractional Laser >

I’ll discuss treatment options and the consequences of acne, especially acne scarring in my next blog post.

Dr Askari Townshend is a GMC registered doctor, qualified in 2002, and Member of the Royal College of Surgeons, England. He is founder and Medical Director of ASKINOLOGY in the City of London and has been practicing aesthetic medicine full time since 2008.

Posted 13/3/17