- Acne scars are a result of healed blemishes and are associated with all forms of acne, especially severe
- They can be raised or depressed compared to the surrounding skin’s surface
- Effective treatments include professional skin resurfacing procedures and over-the-counter treatments
- At-home remedies can treat postinflammatory hyperpigmentation, another common acne-related issue
Acne scars are a common outcome among individuals who have experienced acne breakouts. They are most associated with moderate to severe acne but can also develop as a result of any inflamed pimple or blemish. Acne scars are addressed with over-the-counter (OTC) products and dermatological procedures.
While not effective for scars, at-home remedies can help reduce the appearance of postinflammatory hyperpigmentation, the dark spots that appear once lesions heal.
Causes of Acne Scarring
Acne scars occur when inflammation damages the dermis, the thick lower layer of skin beneath the epidermis. Individuals who scar easily or who smoke are particularly vulnerable to scar formation.
Scars are typically caused by deep, inflammatory types of acne or by picking at, squeezing or popping blemishes, which can introduce more bacteria and increase inflammation. As the skin heals, it repairs itself by producing new collagen fibers. These fibers are noticeably different in texture, color or height compared to the surrounding skin.
Types of Acne Scars
Different types of acne scars develop according to the severity of acne and skin type.
Atrophic scars take the form of a depression in the skin and occur when the skin is unable to generate sufficient tissue while the blemishes heal. There are three types of atrophic or depressed scars.
- Ice pick scars appear as small, round or oval craters in the skin. They occur as a result of a deep acne infection
- Boxcar scars are wider depressions with sharp edges and 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 varying depths which result in an uneven appearance on skin. They occur on the lower cheeks and jaw due to widespread, moderate to severe acne
These scars form due to excessive production of collagen during the healing process. This results in raised scars that are red or pink in color. Raised scars occur most often on the chest and back, and in people with darker skin tones.
Postinflammatory hyperpigmentation appears as patches of red, brown or purple discoloration.
Can You Get Rid of Acne Scars?
While you may not be able to completely erase deep scars, you can significantly improve their appearance with certain in-office procedures and over-the-counter (OTC) skin care products. The type of acne scarring you have and your skin type determine the best solution for you.
Generally, the more severe a scar is, the more difficult it is to treat. Additionally, other factors such as genetics, sun exposure and smoking will influence the outcome.
Several effective solutions for treating acne scars are available without a prescription. These products address scarring by exfoliating the skin and increasing collagen production.
This anti-inflammatory beta-hydroxy acid smooths the skin’s surface by gently exfoliating the uppermost layer of dead cells. It is a popular ingredient found 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 darker skin tones but may be too harsh for dry, sensitive skin types.
Glycolic acid is an alpha-hydroxy acid found in many skin care products including face washes, toners, peels, serums and creams. Its ultra-small molecules can deeply penetrate the skin to provide intense exfoliation and smooth out scars. Most leave-on products contain 5–10% glycolic acid; at-home peel kits may contain up to 50% and should be used with caution.
Glycolic acid treats all forms of acne scars. The frequency at which you can safely use it depends on the percentage of acid within your products and your skin’s sensitivity.
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 postinflammatory hyperpigmentation.
Hydroquinone is effective for lightening acne-related hyperpigmentation but cannot address atrophic or hypertrophic scarring. This skin bleaching agent inhibits the production of tyrosinase, 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. Results start to appear after 8–12 weeks of consistent use; it is safe to use for up to six months.
How Dermatologists Treat Acne Scars
There are several in-office procedures that can effectively treat acne scars. The best 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.
Laser 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 to smooth and reduce the look of scars. Nonablative treatment uses an alternative approach by stimulating collagen production and reducing inflammation. This is achieved through the use of heat emitted by infrared lasers.
Laser treatments are effective for 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 skin to remove dead skin cells, smooth skin’s texture and lighten hyperpigmentation. Chemical peels work best for dark spots left by acne and atrophic scarring, although 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, lactic or mandelic acid.
Microneedling involves piercing the skin with a small handheld device to create microwounds, encouraging the production of collagen and new, healthy skin cells. It is most effective on atrophic scars and postinflammatory hyperpigmentation. Microneedling is safe for all skin colors and types; however, it is not recommended for people who scar easily as the procedure can worsen scarring.
This scar treatment involves buffing away the top layers of skin with a diamond-tipped handpiece or a spray of fine crystals. This 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 more shallow. Microdermabrasion treats postinflammatory hyperpigmentation and mild to moderate atrophic scars. It is safe for all skin tones and types.
Home Remedies for Postinflammatory Hyperpigmentation
These at-home remedies can effectively treat hyperpigmentation but have no effect on acne scars. They are less effective than OTC skin-lightening products and in-office procedures, and usually require long periods of use to produce any results.
Lemon juice is a common DIY remedy to lighten hyperpigmentation as it is an antioxidant and a rich source of citric acid, a tyrosinase inhibitor to inhibit melanin formation.
Lemon juice requires several months of consistent use to achieve results. Dilute with water first to prevent irritation and apply to dark spots for 15–20 minutes every day until you see improvements.
Vitamin E capsules
This antioxidant vitamin is rich in antioxidants and can help fade dark spots. Puncture a vitamin E gel capsule and apply, repeating once or twice a day. Vitamin E is safe for all skin types but requires several months of use to see results.
Home remedies to avoid
Not all natural ingredients are safe for the skin. Avoid using any undiluted substance such as lemon juice or apple cider vinegar, both of which can irritate and damage skin.
Baking soda, commonly used as an exfoliant, can wreak havoc on the skin’s naturally acidic pH levels, and its rough granules are irritating.
Acne scars are a common consequence of deep, inflammatory acne and picking at or popping pimples. They can be hypertrophic (raised) or atrophic (depressed). Atrophic scars include icepick, boxcar or rolling scars.
The appropriate acne scar treatment is determined by the type of scar, skin tone and type. OTC products that are effective treatments include salicylic and azelaic acid, hydroquinone and retinol.
In-office procedures such as laser treatments, chemical peels, microdermabrasion and microneedling are other effective options. While possible to lighten hyperpigmentation with at-home remedies such as vitamin E capsules or diluted lemon juice, these options are far less effective than OTC or professional treatments.
- Chandra, M., Levitt, J., & Pensabene, C. (2012). Hydroquinone Therapy for Post-inflammatory Hyperpigmentation Secondary to Acne: Not Just Prescribable by Dermatologists. Acta Dermato Venereologica, 92(3), 232–235. https://doi.org/10.2340/00015555-1225
- Dinarello C. A. (2010). Anti-inflammatory Agents: Present and Future. Cell, 140(6), 935–950. https://doi.org/10.1016/j.cell.2010.02.043
- Fabbrocini, G., Annunziata, M. C., D’Arco, V., De Vita, V., Lodi, G., Mauriello, M. C., … Monfrecola, G. (2010). Acne Scars: Pathogenesis, Classification and Treatment. Dermatology Research and Practice, 2010, 1–13. https://doi.org/10.1155/2010/893080
- Hession MT, Graber EM. Atrophic acne scarring: a review of treatment options. J Clin Aesthet Dermatol. 2015;8(1):50-58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295858/
- Iriarte, C., Awosika, O., Rengifo-Pardo, M., & Ehrlich, A. (2017). Review of applications of microneedling in dermatology. Clinical, cosmetic and investigational dermatology, 10, 289–298. https://doi.org/10.2147/CCID.S142450
- Matsuura, R., Ukeda, H., & Sawamura, M. (2006). Tyrosinase Inhibitory Activity of Citrus Essential Oils. Journal of Agricultural and Food Chemistry, 54(6), 2309–2313. https://doi.org/10.1021/jf051682i
- Tan, J., Tanghetti, E., Baldwin, H., Stein Gold, L., & Lain, E. (2019). The Role of Topical Retinoids in Prevention and Treatment of Atrophic Acne Scarring: Understanding the Importance of Early Effective Treatment. Journal of drugs in dermatology : JDD, 18(3), 255–260. https://pubmed.ncbi.nlm.nih.gov/30909329