- Acne scars form when the dermis is damaged by inflammation from acne blemishes, particularly cysts and nodules
- Treatments range from over-the-counter topical products to professional procedures
- While scars can not be eliminated completely, the right treatment can greatly reduce their appearance
How to get rid of acne scars is a common question, as they can be very challenging to treat. Scars are a frequent outcome of acne, a skin disease that can be mild to severe and can cause several types of scars to form.
No one person will respond in the same way to medications, therefore treatment often involves trying different medications or a combination of therapies to achieve the most effective outcomes. As it is not possible to completely eliminate scars, the focus is on reducing their appearance.
What Causes Scars?
Acne scars result from damage to the dermis, the layer of skin beneath the epidermis, the outermost layer of skin. While they are most associated with severe cystic or nodular acne, they can also develop when milder acne lesions become inflamed.
Picking at or squeezing pimples can also cause acne scars to form and postinflammatory hyperpigmentation contributes to making acne scars more noticeable. Dark spots remain on the skin after acne lesions have healed and are the result of the skin producing excess melanin in response to acne inflammation.
Types of Acne Scars
There are three types of scars that are associated with acne and are categorized based on severity; it is possible to have more than one type.
Atrophic acne scars
Atrophic acne scars are the least severe of acne scars and the most common, affecting approximately 40% of those with acne. These scars present as depressions in the skin and result from a loss of collagen coupled with inflammation deep in the dermis. There are three types within this category and they most often appear on the face.
- Boxcar scars are round or oval depressions
- Ice pick scars are deep and narrow
- Rolling scars vary in depth and have sloped slides
Hypertrophic acne scars
Contrary to atrophic scars, hypertrophic scars are pink, thick and raised. They result when an abnormal amount of connective tissue forms in response to wound healing. They most commonly form on the chest, back and shoulders in the areas that have the most skin tension.
Keloid acne scars
Like hypertrophic acne scars, keloids are raised but larger in size and tend to be reddish-purple in color. They can extend beyond the original point of the acne blemish. They most often appear on areas where the skin is thick, such as the back, shoulders and chest. Keloids are regarded as the most severe type of acne scar.
Medical Treatments for Acne Scars
There are a number of professional acne scar treatments available to reduce the appearance of scars. These are typically used for hypertrophic and keloid scars that originate deep within the dermis and for any scars that fail to respond to topical treatments.
Chemical peels remove the uppermost layers of skin to exfoliate dead cells, encourage cell turnover and fill depressed areas to blend in with surrounding healthy tissue. Peels typically are performed with alpha hydroxy acids (AHAs) such as glycolic acid and beta hydroxy acids (BHAs) such as salicylic acid or a combination of the two.
Also called microdermabrasion, this procedure involves removing the upper layers of skin with a wire brush or a device that uses microscopic diamond particles to gently scrape off damaged cells. It is only effective for atrophic acne scars.
Fluorouracil (5-FU) injection
5-FU is a chemotherapy drug that is FDA-approved for treating hypertrophic scars and keloids. When injected into scar tissue, 5-FU stops cells called fibroblasts from proliferating. Fibroblasts are found primarily in connective tissue and secrete collagen, which is why they’re a primary factor in raised acne scars.
Dermal fillers are natural or synthetic substances that are injected into the skin to plump it up; some fillers also encourage collagen growth. Both actions help to fill in atrophic scars.
Although a variety of dermal fillers are used for acne scars, the only one approved by the FDA for this purpose is polymethyl methacrylate (PMMA) with bovine collagen (known commercially as Bellafil). In one study, PMMA was found to be both safe and very effective in treating atrophic scars.
Dermatologists use three types of lasers to treat acne scars:
- Ablative lasers direct energy at the surface of affected skin to vaporize scar tissue, revealing the healthy skin beneath
- Nonablative lasers work beneath the skin’s surface, using energy to stimulate the growth of new collagen
- Fractionated lasers emit microscopic columns of laser light that more precisely target scar tissue and avoid healthy tissue. There are fractionated versions of both ablative and nonablative lasers
In this procedure, a dermatologist uses a device embedded with slender needles to create tiny wounds in the skin. As these heal, new collagen is formed and fills in depressed areas with healthy tissue. Microneedling combined with a topical retinoid, tazarotene gel, has been found to be especially effective for moderate to severe atrophic acne scars.
Once the scar is removed, the wound is sutured, leaving a far less noticeable scar. Punch techniques, which include punch excision, punch elevation and punch replacement grafting, are most effective for ice pick and boxcar scars that are smaller than 3 mm.
A relatively new approach to treating all types of atrophic acne scars, radio frequency therapy sends an electric current through the dermis causing heat-induced wounds. As part of the healing process, new collagen is produced, filling out indentations and smoothing skin.
Subcision is a minor surgical procedure. The depressions that characterize atrophic acne scars are caused by scars pulling on healthy tissue. To counteract this, a needle is inserted beneath the surface of the skin to break up the scar tissue and detach it. It’s used most often for rolling scars.
Topical Treatments for Acne Scars
Some acne scars can be minimized with certain topical medications that are available in over-the-counter (OTC) and prescription strengths.
Alpha hydroxy acids
Alpha hydroxy acids (AHAs) treat acne scars by exfoliating the top layer of skin. They are found in OTC cleansers, toners, serums and at-home peels. Glycolic and lactic acid in concentrations of 10% or less are the AHAs used most often for treating acne scars and other skin conditions.
Retinoids, a class of medication derived from vitamin A, speed up the exfoliation of dead skin cells and encourage the growth of new ones, making them an effective treatment for atrophic acne scars.
Topical retinoids are often prescribed to treat atrophic acne scars. Additionally, vitamin A medications called retinols are available OTC in creams, lotions, serums and other formulations that work to improve mild scarring.
Adapalene is a retinoid-like medication available in prescription and nonprescription strengths under the brand name Differin. It is also effective for treating acne scars, particularly when combined with benzoyl peroxide in a prescription gel called Epiduo.
Salicylic acid is a beta-hydroxy acid (BHA) that reduces the appearance of acne scars by exfoliating and smoothing the skin. It also has anti-inflammatory properties, an important quality for scar prevention.
Salicylic acid is available OTC in a variety of skin care products, typically in concentrations of 2%, and is gentler on skin than AHAs.
DIY treatments for Acne Scars
Natural treatments for acne scars are unlikely to be effective for moderate to severe scarring but they can be beneficial for minor or fresh scars and to boost your current treatment regimen. To avoid any unwanted effects it’s best to check with your dermatologist before incorporating them into your routine.
As a rich source of vitamins A (retinol) and C, rose hip oil is best known for its anti-aging properties. However, there’s evidence it may also speed up wound healing and improve the appearance of scars, likely due to the abundance of fatty acids.
Rosehip oil is available in cosmetic and drug stores. Look for 100% cold-pressed oil. Apply one or two drops to scarred areas morning (before using sunscreen) and night (after moisturizing).
The gel inside the fleshy leaves of the aloe vera plant has anti-inflammatory and antimicrobial properties that makes it ideally suited to treat acne scars. Studies support aloe vera’s efficacy in accelerating wound healing, which can in turn result in less scarring, and may minimize existing scars.
Aloe vera is inexpensive and easily found in grocery stores, markets and nurseries. To use, snip off a leaf, squeeze out the gel-like liquid inside, and apply it directly to skin.
Black seed oil
Oil distilled from the tiny black seeds of the Nigella sativa plant contains a wealth of ingredients that may help treat acne and reduce or prevent scarring. One valuable ingredient is a compound called thymoquinone that has been found to stimulate the production of collagen and reduce tissue damage during wound healing.
Black seed oil is inexpensive and easy to find in health food stores and online. Look for organic 100% oil and test it on a small patch of skin before applying to larger areas of scars.
Vitamin C (ascorbic acid), a primary component of lemon juice, is a proven and effective treatment for hyperpigmentation. It can fade dark spots and skin discoloration that are associated with acne scars.
As pure lemon juice can be irritating to skin, it must first be diluted for safe use. Start with equal parts water and fresh lemon juice. Dampen a cotton ball with the mixture and apply to scars; allow to rest for 20 minutes, then rinse with water.
Acne Scar Treatment Myths
There is an abundance of misinformation about acne scars and dealing with them, including:
Myth: Acne scars only form on the face
Acne can leave behind scars and discoloration anywhere on the body, such as the back, especially if you pop or squeeze pimples.
Myth: Tanning will make acne scars less noticeable
Exposure to ultraviolet rays can deepen discoloration and increase the risk of skin cancer.
Myth: Adult acne doesn’t leave behind scars
Acne can occur at any age and cause scarring; they can be more prominent on older skin which naturally has less collagen.
Myth: You can’t prevent acne scars
Some degree of scarring may be inevitable, especially if you have severe cystic or nodular acne. However, there are preventative steps you can take. Prompt treatment is key, as is following your dermatologist’s instructions and not popping or squeezing lesions.
Can You Get Rid of Old Acne Scars?
One prevailing myth is that old scars are permanent. While it is difficult to remove scars completely, there are effective solutions available.
Often it requires a combination of treatments, especially for hypertrophic and keloid scars that tend to develop slowly and worsen over time. One treatment approach to effectively flatten and shrink persistent keloids includes laser treatment combined with injection of steroids or 5-FU and steroids.
How to Prevent Acne Scars From Forming
There are a number of steps you can take to prevent or minimize acne scars including:
- Choose gentle skin care products formulated for acne-prone skin and be consistent with your skin care regimen
- Resist the temptation to squeeze, pop or pick at pimples or scabs left behind by healing blemishes
- If your acne worsens with OTC treatments, see a dermatologist as soon as possible to determine the best acne treatment for you
All types of acne can leave behind scars, especially inflammatory and cystic acne. The likelihood of scarring is greater if acne isn’t treated promptly or pimples are squeezed or popped.
The type of scar largely determines how it’s treated. Atrophic scars which are depressed such as ice pick, boxcar and rolling scars may be less challenging to treat than hypertrophic or keloid scars that are raised and form due to an excess of collagen production.
Acne scar treatments range from topical OTC and prescription-strength medications including AHAs and retinoids to in-office procedures performed by a dermatologist such as chemical peels, laser resurfacing and microdermabrasion.
For minor acne scars, home remedies such as diluted lemon juice, aloe vera and specific oils can offer some benefits by diminishing hyperpigmentation and promoting skin healing.
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