Acne scars and milia are two common skin conditions that can significantly affect texture and tone, often causing confusion when it comes to identification and treatment. While acne scars result from inflamed blemishes damaging the skin's deeper layers, milia are small, benign cysts formed by trapped keratin beneath the surface. Dr. Nirupama Parwanda, Dermatologist & Founder of Zolie Skin Clinic explains each condition is crucial for choosing effective, targeted skincare solutions and preventing further damage.

What Are The Tiny Little Bumps On Your Face? 

The little white or skin-coloured spots on the face don't necessarily indicate acne. They can be milia, hard-filled little cysts of keratin that are often seen around the eyes and eyelids and on the cheeks. 

How Does Milia Develop? 

Milia may develop on their own (primary milia) or it may occur after some type of injury to the skin, inflammation or certain skin disorders (secondary milia). They're typically located on the eyelids and cheeks, but can also be seen on other parts of the face and body. The small, dome-shaped pimples are usually pinkish-white or skin coloured; known as milia. They are, in general, difficult to spot, and do not produce redness, tenderness or inflammation, as do inflammatory acne. 

Different Kinds Of Acne On Your Face

Acne can manifest itself in many ways, including open and closed comedones, inflammatory papules or bumps, pustules and even, in extreme cases, nodules and cysts. A milium is not like a whitehead, and should NOT be attempted to squeeze/pop at home. This may result in inflammation and infection, post inflammatory pigmentation and even scar. If removal is desired, a dermatologist will be able to diagnose the lesion and determine the proper means of its removal or alternate therapy. 

Difference Between Acne Mark And Acne Scar

Before operating on your face, you must keep in mind the actual difference between an acne mark and an acne scar. The scars usually look red, pink or brown, but no actual scars. Only if it alters the structure and texture of the skin (not when it changes in appearance) will the acne scarring be permanent. 

Only true scars (those which change the structure or the texture of the skin) make acne scars permanent. Post-inflammatory hyperpigmentation (PIH) is when spots are brown or dark and flat, probably due to an increase or change in melanin that occurred as a result of inflammation. Post-inflammatory erythema or erythema acne is often called erythema (red skin) or pink flat spots and is believed to be due to alterations in the blood vessels. These colour changes are NOT structural acne scars, and will gradually disappear over time (6 months to 5 years) depending on each individual, and may fade away over time. In dark skin phototypes, PIE is sometimes frequent and long-lasting.

Different Kinds of Acne Scars 

Real acne scars involve alterations of skin contour and/or texture. Acne scars can be classified into two different types: atrophic scars (which are sunken) and raised scars. 

Atrophic Scars

Raised Scars 

There are three kinds of atrophic scars: Ice-pick scars, Boxcar scars and Rolling scars.

Raised acne scars are of two types: Hypertrophic or Keloids

  • Ice-pick scars are long narrow deep depressions through which there is a small surface opening. Boxcar scars are wide, sharply delineated, shallow or deep and have distinct margins. 

  • The rolling scars are shallow, wide, slightly irregular and are located mostly where skin is attached to the underlying tissues. 

  • A hypertrophic scar remains within the limits of the wound and doesn't expand any further. 

  • A keloid scar extends beyond the wound and will keep growing.

    • Treatments For Different Kinds Of Acne Scars 

    Treatment will be determined based on the type of scar, depth of scar, skin type, presence of pigments/erythema and any acne concerns. This can be done using microneedling, energy based treatments (fractional laser), chemical re-construction, subcision and punch or fillers. Combination therapy might be necessary in different types of scar. A dermatologist can differentiate between active acne, milia, pigmentation, erythema and real acne scarring and decide on the treatment based on this individual. 

    Remember: Proper treatment when the acne first appears and refraining from picking and squeezing the pimples can also help prevent all the acne marks and scars.

    Conclusion

    Accurately identifying skin bumps, marks, and true structural scars is essential for selecting appropriate treatments and avoiding unnecessary skin damage. Consulting a qualified dermatologist ensures an accurate diagnosis and a customised treatment plan for clear, healthy skin.

    (Image Credits: Magnific)

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