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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Having acne is bad enough, but having to live with the scars it can leave behind can feel even worse. Thankfully, there are plenty of ways to deal with those scars—even the severe ones.
What causes acne scars?
Acne happens when bacteria, sebum (your body’s natural oils), and dead skin clog pores, causing inflammation. It’s the inflammation that causes the scarring. When the pore swells, the walls of the pore are damaged and break down, destroying collagen—your skin’s building blocks—and creating a hole in the skin (Connolly, 2017).
If the hole is shallow, it can heal quickly and leave no permanent scar. But sometimes the inflamed contents of the pore spill into surrounding tissue, creating more damage. The loss of tissue creates a scar. Your skin repairs itself by producing collagen, but if it makes too much, you get a raised, or hypertrophic, scar (Connolly, 2017).
What are the different types of acne scars?
Acne scars are classified by their shapes (Connolly, 2017):
- Ice pick scars: These are deeper than they are wide, with jagged edges. They sometimes resemble a large, scooped-out pore.
- Boxcar scars: These are broad, rectangular depressions with steep, defined edges.
- Rolling scars: These are broad depressions that have rounded, sloping edges.
Scars raised off of the skin and about the same size as the original pimple are called hypertrophic. Raised scars that grow bigger than the original blemishes are called keloids. They’re less common than recessed scars and are treated differently (Connolly, 2017).
Adult acne: symptoms, causes, and treatments
How can you prevent acne scars and dark marks?
Use sunscreen to help prevent acne scars and dark marks, as well as fine lines, wrinkles, and skin cancer.
Suppose you feel a deep, under-the-skin pimple coming on. In that case, you can call your dermatologist or another medical professional for a steroid shot—the same day if possible, as these types of pimples can grow very quickly.
How can you get rid of acne scars and dark spots?
If the scars aren’t too deep, you might be able to get good results using over-the-counter (OTC) and at-home treatments, like alpha hydroxy acid peels, retinol, and skin needling. If those don’t produce the results you want, you may need to consult a professional. Be aware that professional therapy can be expensive, especially since many treatments need to be repeated over time (Hession, 2015; Gozali, 2015).
At-home or professional treatments
The following treatments are available for at-home use or with a professional (Gozali, 2015):
- Temporary fillers: The least invasive and easiest way to reduce the visibility of acne scars is to use a temporary filler. Fillers are applied like makeup and wash off easily.
- Natural oils: For raised scars, natural oils like castor oil can be massaged into the scars to soften their appearance.
- Vitamin C: For dark spots, topical serums containing vitamin C can help to fade dark spots left by acne.
- Chemical peels: Superficial peels are available without a prescription and may provide mild improvement. Alpha hydroxy acids, such as glycolic acid, are popular choices.
- Microneedling: Also called collagen induction therapy, skin microneedling involves puncturing the skin with rows of needles, usually in a handheld barrel roller. In one study of professionally performed microneedling, after three months of treatment, there was good to very good improvement in rolling and boxcar scars, moderate improvement in icepick scars, and little improvement in deep scars (El-Domyati, 2015). Microneedling can be done at home, but you must sterilize the device carefully each time you use it to prevent infection.
- Retinols and retinoids: Both OTC retinols and prescription-strength retinoids can help stimulate new skin growth, relieve hyperpigmentation, and smooth the appearance of the skin. The higher concentrations (over 2%) found in prescription retinoids work faster but can cause skin irritation and redness until your skin gets used to them.
Hormonal acne: causes, types, treatment
You can only get the following treatments with a professional (Gozali, 2015):
- Chemical peels: Medical professionals can perform medium-depth and deep peels, also called chemabrasion. Medium-depth peels (for instance, with trichloroacetic acid) can help, but the depth of penetration into the skin is unpredictable. These peels can create hyperpigmentation (skin discoloration) for up to three months. Deeper peels (for instance using phenol) can achieve good results. However, they may cause new scars to form, or remove pigment, creating light spots in the skin.
- Dermabrasion and microdermabrasion: These treatments can help smooth out sharp-edged scars by essentially sanding down the skin. Dermabrasion and microdermabrasion have been around since the 1950s but are less popular now. Dermabrasion is used for deep scars, while microdermabrasion removes only the outer layer of epidermis, so it isn’t effective on deep scars. One problem with these procedures is that their success depends on the skill of the person performing them. An error can result in more scarring (Tullington, 2021). In addition, recovery times can be long, and there is often post-procedure pain.
- Subcision: Subcision can be used for rolling scars. In this procedure, a professional inserts a needle into the scar and manipulates it to create a wound. The body responds by depositing collagen, filling in the scar. For rolling scars, subcision may work better than dermal fillers. However, some individuals may develop hypertrophic scarring from subcision.
- Punch excision: This procedure is used for icepick scars. A dermatologist or skin professional uses a punch biopsy tool to cut the scar out of the skin. They then sew the site closed with a tiny stitch or leave it open and allow it to heal. This technique isn’t good for people who have dark skin tones or who are prone to hyperpigmentation. For best results, laser resurfacing may be done after the site has healed.
- Punch replacement grafting: This technique is best for sharp-walled or deep ice pick scars. With this procedure, your provider will take punches of tissue from an inconspicuous place, like behind the ears, and graft that tissue in place to fill in the scarred area.
- Stem cell therapy (autologous fibroblast transfer): This is a newer technique. Cells are taken from an inconspicuous site, cultured for several weeks, and then injected into the scar. Some studies have shown promising results with few side effects, but more studies are needed.
- Steroid injections: Steroid injections can help thick, raised scars appear softer and flatter.
- Dermal fillers (tissue augmentation): Dermal fillers are injected into the scar area to replace lost tissue and stimulate collagen formation. Collagen was once the main dermal filler used, but now hyaluronic acid, calcium hydroxyapatite, poly-L-lactic acid, and polymethylmethacrylate are preferred. The individual’s own fat tissue may also be taken from another part of the body and used as a filler. Fat is impermanent, however, and requires additional treatments. A combination of microscopic balls of polymethylmethacrylate and collagen provides permanent results.
- Laser resurfacing: Lasers target water in the skin, creating controlled injury so that the skin produces collagen to heal the damaged area. Different types of lasers may be used, most recently, ablative fractionated CO2 and erbium lasers. Hyperpigmentation can occur after laser treatment in darker-skinned individuals.
- Combined treatments: If types of scars vary, treatments may vary accordingly.
As you can see, many different treatments are available for treating acne scars. If you have deep or severe scarring, a skilled and experienced medical professional can work out the best course of treatment for you. Keep in mind, though, that although you can expect to see a lot of improvement, no treatment—even professional treatments—can erase acne scars 100%.
- Connolly, D., Vu, H. L., Mariwalla, K., & Saedi, N. (2017). Acne scarring—pathogenesis, evaluation, and treatment options. The Journal of Clinical and Aesthetic Dermatology, 10(9), 12–23. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/
- El-Domyati, M., Barakat, M., Awad, S., Medhat, W., El-Fakahany, H., & Farag, H. (2015). Microneedling therapy for atrophic acne scars: An objective evaluation. The Journal of Clinical and Aesthetic Dermatology, 8(7), 36–42. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509584/
- Gozali, M. V., & Zhou, B. (2015). Effective treatments of atrophic acne scars. The Journal of Clinical and Aesthetic Dermatology, 8(5), 33–40. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445894/
- Hession, M. T., & Graber, E. M. (2015). Atrophic acne scarring: a review of treatment options. The Journal of Clinical and Aesthetic Dermatology, 8(1), 50–58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295858/
- Tullington, J.E., Gemma, R. (2021). Scar revision. [Updated 2021 Jul 1]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK542318/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.