- Acne scars are caused by deep, inflammatory acne.
- They can be higher or lower than the surrounding skin’s surface.
- Post-inflammatory hyperpigmentation is not a scar, but a common post-acne issue.
- Effective treatments include professional skin resurfacing procedures, over the counter treatments and at-home remedies.
Acne scars are a common problem among individuals who have experienced acne. They are most associated with moderate to severe acne but can develop as a result of any singular inflamed pimple or blemish. Acne scars are addressed with over the counter products, procedures performed by a dermatologist or DIY remedies.
Causes of Acne Scarring
Acne scars occur when inflammation damages the tissue around the site of a breakout. They are typically caused by deeper, inflammatory types of acne and by picking at, squeezing and popping blemishes. Individuals who scar easily and who smoke have an increased likelihood of experiencing them.
Types of Acne Scars
Different types of acne scars develop according to the severity of the acne that caused them and skin type.
This type of scar takes the form of a depression in the skin, developing most often on the face. They occur when insufficient collagen is available while a blemish heals. There are three types of atrophic or depressed scars.
Ice-pick scars appear as small, round or oval holes in the skin. They occur as a result of a deep infection.
Boxcar scars are wider depressions with sharp edges. They can be deep or shallow. These scars are caused by moderate to severe acne and occur most often on areas of the face where the skin is thicker, such as the lower cheeks and jawline.
Rolling scars have sloping edges and a waving, irregular appearance. They occur on the lower cheeks and jaw as a result of widespread, moderate to severe acne.
These scars result from the excess production of collagen during the healing process. They are raised above the surrounding skin and red or pink in color. Raised scars occur most often on the chest and back and in people with darker skin tones.
Although not technically a type of scar, this form of hyperpigmentation is a common post-acne concern. They occur in all skin types and are caused by any type of acne. Post-inflammatory hyperpigmentation (PIH) appears as patches of red, brown or purple discoloration.
Can You Get Rid of Acne Scars?
Acne scars can be effectively treated with certain in-office procedures, skin care products and home remedies. The type of acne scarring you have and your skin type determine the best solution for you.
Some forms are more difficult than others to treat. Atrophic and hypertrophic scars rarely fade on their own, while PIH often disappears after several months.
Over the Counter Treatments
Several solutions for treating acne scars are available without a prescription. These over the counter (OTC) products address scarring by reducing hyperpigmentation, exfoliating and increasing collagen production.
This skin bleaching agent treats PIH by inhibiting the production of tyrosinase. Tyrosinase is an enzyme that triggers the production of melanin, the pigment that gives skin its color.
Hydroquinone is available OTC at a concentration of 2% and by prescription at 4%, typically in the form of a gel, cream or lotion. Choose a product in an opaque container that minimizes air exposure, which degrades the active ingredient. Results start to appear after 8-12 weeks of consistent use; it is safe to use for up to six months.
Hydroquinone is effective for PIH but cannot address atrophic or hypertrophic scarring.
This dicarboxylic acid is a tyrosinase inhibitor and antioxidant, meaning it protects the skin from free radicals that can exacerbate dark spots. It is less irritating to the skin than hydroquinone and is recommended for individuals with dry, sensitive skin. However, it is linked to hypopigmentation (undesired skin lightening) and discoloration in people with dark skin.
Azelaic acid is available in a range of formulations, including foams, creams and gels. Lower concentrations (10–15%) can be purchased OTC, while concentrations above 15% require a prescription.
Azelaic acid treats PIH and will not affect hypertrophic or atrophic scarring.
Retinol is a multipurpose skin care ingredient belonging to a class of vitamin A-derived topical treatments called retinoids. Retinol, along with other retinoids such as adapalene, treats acne scars by increasing skin cell regeneration to improve skin texture and reduce discoloration. Retinol is most effective on atrophic scars and PIH.
This anti-inflammatory beta-hydroxy acid smooths the skin’s surface by gently exfoliating the uppermost layer of dead cells. It is an ingredient in many products, including cleansers, moisturizers, wipes and makeup. These products usually contain 2% of the active ingredient.
Salicylic acid treats all forms of acne scarring. It is safe to use on dark skin but may be drying for dry, sensitive skin types.
How Dermatologists Treat Acne Scars
A variety of in-office procedures can treat acne scars. The most effective solution is determined by the type of scarring you have and your skin tone, as not all treatments are recommended for all skin colors.
These procedures treat acne scars by exfoliating or resurfacing the skin and encouraging new skin cell growth.
These treatments focus a laser beam on the top layers of skin to break up scar tissue and encourage the growth of healthy new cells.
Ablative resurfacing removes the top layer of skin, smoothing the scar’s appearance. Non-ablative treatments use the heat of infrared lasers to stimulate collagen production and reduce inflammation.
Laser treatments are effective on all types of acne scars; however, they are not recommended for darker skin tones due to the risk of causing hyperpigmentation.
This treatment chemically exfoliates the topmost layer of dead skin cells to smooth out the skin’s texture and lighten hyperpigmentation. Chemical peels work best for PIH and atrophic scarring, though in the latter case, multiple peels may be necessary. Peels can treat very mild hypertrophic scarring.
The most effective peels for acne scars use 30% salicylic acid or alpha-hydroxy acids such as glycolic acid, lactic acid or mandelic acid.
Microneedling uses a small handheld device that pierces the skin with tiny needles. The process encourages the production of collagen and new, healthy skin cells. It is most effective on atrophic scars and PIH and is safe for all skin colors and types; however, it is not recommended for people who scar easily as the procedure can cause further scarring.
This scar treatment involves buffing away the uppermost layer of skin with a diamond-tipped handpiece or a spray of fine crystals. The procedure triggers the body’s wound healing response and encourages collagen production.
After a microdermabrasion session, the edges of acne scars are less visible, and scars appear shallower. Microdermabrasion treats PIH and mild to moderate atrophic scars. It is safe for all skin colors and skin types.
Home Remedies for Acne Scars
These at-home remedies treat PIH and do not affect other types of acne scars. They are less effective than OTC products and in-office procedures, usually requiring long periods of use to produce any results.
Using lemon juice is a common DIY remedy to lighten hyperpigmentation. The fruit’s citric acid is a tyrosinase inhibitor.
Lemon juice requires several months of frequent use to obtain results and is not as effective as other skin-lightening products and procedures. It must be diluted with water before being applied topically to prevent irritating the skin. Apply diluted lemon juice to dark spots for 15–20 minutes every day until the PIH improves.
Vitamin E capsules
This antioxidant vitamin smooths the surface of the skin. Puncture a vitamin E gel capsule and massage the contents onto your acne scars, repeating once or twice a day until you obtain the desired result. Vitamin E is safe for all skin types but requires several months of use to lighten scars.
Home Remedies to Avoid
Not all natural ingredients are safe for the skin. Avoid the use of undiluted lemon juice or apple cider vinegar, both of which can cause damage and irritation.
Baking soda, commonly recommended as an exfoliant, can disrupt the skin’s naturally acidic pH levels, and its rough granules are irritating; it should therefore be avoided.
Acne scars are a common consequence of deep, inflammatory acne and picking at or popping pimples. They can be hypertrophic (raised) or atrophic (lowered). Atrophic scars occur as icepick, boxcar or rolling scars. Post-inflammatory hyperpigmentation is another common post-acne issue, though it is not technically a type of scar and often fades on its own.
The appropriate acne scar treatment is determined by the type of scar being addressed and the individual’s skin color and type. OTC products used for this purpose include salicylic acid, azelaic acid, hydroquinone or retinol. In-office procedures such as laser treatments, chemical peels, microdermabrasion and microneedling are another option. It is possible to lighten PIH with at-home remedies such as lemon juice, vitamin E capsules or apple cider vinegar, but these DIY options are less effective than OTC or professional treatments.
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