Acne Scars: Acne is an extremely common skin condition that affects people of all ages. It occurs when hair follicles become clogged with oil and dead skin cells, leading to whiteheads, blackheads, pimples, and even cysts or nodules in more severe cases. One of the most frustrating aspects of dealing with acne breakouts is that they often leave behind acne scars after the blemishes have healed.
Acne scars form for a variety of reasons. In some cases, the damaged skin does not regenerate properly after an inflamed blemish. Other times, skin cells produce too much collagen as they heal, resulting in a raised scar. With severe acne, lesions can damage the deeper layers of the skin and leave pitted scars.
The good news is that there are many effective acne scar treatments available today. However, to find the right treatment, you first need to identify the type of acne scar you have. Here are the three main types of acne scars and how to treat them.
Types of Acne Scars
Atrophic scars, commonly referred to as depressed scars, are sunken indentations in the skin. They form when there is a loss of collagen and elastin, the fibers that provide structural support in the skin. Atrophic scars come in three main subtypes:
- Ice pick scars– Narrow, deep pits in the surface of the skin that look like a hole has been punctured in the skin.
- Rolling scars– Broader depressions with sloping edges, giving the skin a wavy appearance.
- Boxcar scars– Angular scars with sharp edges and a rectangular, U-shaped cross-section.
Hypertrophic scars are raised, thick clusters of scar tissue that form above the skin’s surface. They develop when excess collagen is produced as the skin heals, causing the scar to become red, firm, and elevated. Over time, hypertrophic scars may flatten and become paler but will remain visibly raised.
Keloids are a more severe form of hypertrophic scarring. They extend beyond the original wound site and do not regress over time like hypertrophic scars. Keloids grow larger over time and often have an irregular shape with a shiny, smooth surface. They tend to be firmer than hypertrophic scars. Keloids are more common on the chest, shoulders, earlobes, and cheeks.
Treatments for Acne Scars
The type of treatment recommended will depend on the type of acne scar you have. Here are some of the most effective treatments for each kind of acne scar.
Treatments for Atrophic Scars
Laser Resurfacing – Laser resurfacing uses concentrated beams of light to remove outer layers of skin. Ablative lasers (such as CO2 and Erbium) remove thin layers of skin to stimulate collagen production, while non-ablative lasers (such as pulsed dye or fractional) penetrate deeper without removing layers. Laser resurfacing is effective for improving rolling, boxcar, and shallow ice pick scars.
Dermabrasion – This procedure uses a rapidly rotating device to remove the top layers of skin. New skin grows back in its place over 2-3 weeks. Dermabrasion reaches deeper layers than chemical peels and improves texture, but does not stimulate collagen. It can treat rolling scars and some shallow boxcar scars.
Microneedling – Also called collagen induction therapy, microneedling creates tiny punctures in the skin using fine needles. This stimulates collagen production and new skin growth to smooth out depressions. It is mainly used for shallow atrophic scars and improves scar appearance over time with multiple treatments.
Fillers – Dermal fillers like hyaluronic acid can be injected under atrophic scars to raise sunken areas level to the skin. Results are temporary, lasting 6-12 months, but fillers can help improve the appearance of rolling and boxcar scars.
Subcision – This treatment uses a needle or blade to disconnect tethered scars from deeper structures below the skin. This allows the scar to rise to the level of normal skin. Subcision is primarily used to elevate depressed scars before filler injection.
Treatments for Hypertrophic Scars
Intralesional Corticosteroid Injections – Corticosteroids like triamcinolone or hydrocortisone are injected directly into thickened scars to reduce inflammation and collagen production. This helps flatten and soften hypertrophic scars. Multiple treatments are usually needed.
5-Fluorouracil Injections – 5-FU is a chemotherapy drug that inhibits collagen synthesis when injected into hypertrophic scars. It may be used alone or with steroids to reduce scar thickness. Improvement is gradual over several months.
Laser Treatment – Vascular lasers and pulsed dye lasers help reduce the redness and thickness of scars by shrinking excess blood vessels. CO2 or Erbium ablative lasers can also resurface and flatten scar tissue. Several treatments are required.
Cryotherapy – Controlled freezing of the scar tissue with liquid nitrogen helps reduce collagen production and renew normal skin. Cryotherapy works best on hypertrophic scars that are less than 2 years old.
Compression Therapy – Using silicone sheets, bandages, or gel to apply gentle pressure to a hypertrophic scar helps flatten and smoothen it. Compression therapy is often used in conjunction with other treatments.
Treatments for Keloid Scars
Steroid Injections – Intralesional steroid injections are the first-line treatment for keloids. The injections help shrink the scar by suppressing inflammation and excess collagen. Multiple injections every 4-6 weeks are usually needed to see results.
Cryotherapy – Freezing keloids with liquid nitrogen after a steroid injection helps enhance the effects of the steroid. The freezing causes localized injury, initiating wound healing that helps reduce the scar.
Laser Treatment – Laser and light therapies such as pulsed-dye laser, Nd: YAG laser, and photodynamic therapy can all disrupt the cellular processes that cause keloids to grow. Lasers are often used along with steroid injections.
Radiation Therapy – High doses of radiation are used to prevent keloid recurrence after surgical removal. Radiation aims to damage fibroblasts to prevent overgrowth of collagen during healing. Potential side effects include skin discoloration.
Compression Therapy – Using silicone sheets and other compression techniques post-surgery helps flatten and reduce keloids. Compression garments are often worn for 12-24 hours per day for at least 6 months.
Surgery – Surgical removal of the scar may be done for severe, painful, or highly visible keloids. Combining excision with steroid injections, lasers, compression, and radiation therapy helps prevent recurrence.
While it’s not always possible to prevent acne scars from forming, taking proper care of your skin can help reduce their severity:
- Avoid picking or popping pimples to limit skin injury
- Treat acne early to prevent lesions from becoming inflamed and rupturing
- Use over-the-counter creams with vitamin C, retinoids, or vitamin E to help fade post-inflammatory marks
- Always use sun protection to prevent marks from darkening
- Work with a dermatologist to create an acne treatment plan if you have severe or cystic acne
With time and consistency, the right acne scar treatment can dramatically improve your skin’s texture and tone. Speak to your dermatologist about the best options tailored to your scar type and concerns. While acne scars can be frustrating to deal with, the wide range of available treatments makes it possible to significantly minimize and smooth out unsightly scarring.
FAQs About Acne Scars
What is the difference between acne marks and acne scars?
Acne marks, also called post-inflammatory erythema, are reddish or brownish flat spots left behind after a pimple clears up. These are not scars and will fade over several weeks to months. Acne scars occur when there is damage to the deeper layers of the skin, causing textural changes and indentations that do not fade on their own.
How long do acne scars take to form?
Most acne scars begin forming after an inflamed pimple ruptures or is picked. Within the first month after a breakout, collagen formation starts which can lead to scarring. However, scars often don’t fully develop for 3-6 months after healing.
What is the best treatment for getting rid of acne scars?
There is no single best treatment since there are different types of acne scars. Depressed scars respond best to resurfacing treatments like laser, microneedling, or dermabrasion. Hypertrophic scars benefit most from steroid injections or cryotherapy. Keloids may require surgery. It’s best to consult a dermatologist about your scarring.
How can I prevent my acne from scarring?
To help prevent permanent acne scarring, stop touching and picking active breakouts, treat acne early with medications, use sun protection diligently, and talk to your dermatologist about long-term acne scar prevention options. Never try to pop deep cysts or nodules.
How long do acne scar treatments take to work?
Most acne scar treatments take 3-6 months to start seeing results. Treatments like microneedling require several sessions spaced 1-2 months apart. Steroid injections require multiple rounds 4-6 weeks apart. Lasers and resurfacing also require several treatments over months. Results continue improving for up to a year.
Dealing with acne scarring can be disheartening, but there are more treatment options available now than ever before. The key is accurately diagnosing your scar type, whether atrophic, hypertrophic, or keloidal. From there, your dermatologist can recommend the most suitable treatment plan based on the depth, size, and number of scars.
With consistent treatments over time, even severe scarring can be minimized. While atrophic scars may never fully disappear, the overall texture and appearance of your skin can be significantly improved. Some of the most effective therapies include lasers, dermabrasion, microneedling, cryotherapy, steroid injections, and surgical excision.
The best approach is to start treatment as soon as scars begin to develop rather than waiting years down the road. Early intervention and diligent follow-up treatment will provide you with the best possible outcome. Although having acne scars can affect your self-esteem, there are solutions. By exploring the available options, you can discover a treatment that works for your scar type and start reclaiming your confidence.