Acne Scars

Acne scars are one of the hardest parts of acne to deal with, often lingering long after the spots have gone. Although many people use the word scar for any mark left by acne, true scars are permanent changes in the skin’s texture. There are also several different types of acne scars and they differ in terms of which treatments they respond to and how well. In this guide we explain what causes acne scars, how they differ from other post-acne marks and the different types. We also review the best treatments for acne scars from skincare through to professional procedures.

City Skin Clinic is an online skincare clinic. We provide custom at home prescription skincare treatments but do not offer in-clinic procedures such as chemical peels, laser treatment or energy-based devices. However, we have explained all the options below because we believe the public deserve clear, evidence-led information without commercial bias.

What are Acne Scars?

Acne scars are permanent changes in the skin’s texture left behind by inflamed acne. They form when a spot damages the deeper layers of the skin and it heals imperfectly. Severe or deep spots are the most likely to scar. Tendency to scar also runs in families. When the skin makes too little collagen as it heals, the surface sinks, which gives an atrophic scar. When it makes too much, the scar is raised instead. Treating acne early and never squeezing spots is the single best way to avoid scarring in the first place.

What’s the Difference Between Acne Scars and Marks?

This is the most important thing to get right, because scars and marks need different approaches. True scars change the skin’s texture, leaving it dented or raised, and they do not fade on their own. Post-acne marks are flat patches of colour left after a spot heals, and they can fade with time. Brown or grey marks are post-inflammatory hyperpigmentation, which is more common in deeper skin tones. Pink or red marks are post-inflammatory erythema, which is more common in lighter skin tones.

What are the Different Types of Acne Scars?

Acne scars fall into two groups. Most are atrophic, which means depressed or pitted, and a minority are raised. The three main atrophic types of acne scars are:

• Ice pick scars: Narrow, deep, V-shaped pits, as if made by a sharp point. They reach far into the skin, which makes them the hardest to treat.
• Boxcar scars: Wider, round or oval depressions with sharp, defined edges. They sit on the cheeks and temples and can be shallow or deep.
• Rolling scars: Broad, shallow depressions with sloping edges that give the skin a wavy look. They come from bands of tissue tethering the skin from below.

Raised types of acne scars are less common and occur in people prone to them. These type of scars require different treatment such as surgical excision or immune suppression. We won’t discuss them in this guide as they’re covered in a separate blog post but for completeness they include:

• Hypertrophic scars: Firm, raised scars that stay within the border of the original spot.
• Keloid scars: Raised scars that grow beyond the original spot. They are more common in deeper skin tones and on the chest, back and jaw.

How are Acne Scars Treated?

How acne scars are treated depends on the type and how deep they are. Unfortunately, no single treatment suits every scar. The right plan usually combines settling active acne, daily skincare and, for established scars, an in-clinic procedure. The most effective approaches to treating acne scars include:

• Treating active acne: The first step is always to bring any active acne under control. New spots simply create fresh scars and marks. Settling the acne stops the cycle that drives scarring and lets the skin start to recover.
• Prescription skincare: Retinoids like tretinoin speed up skin renewal and stimulate collagen. This fades post-acne marks and can improve early or shallow atrophic scarring. Actives like azelaic acid and other exfoliants can also support this by smoothing and brightening the skin. Skincare works best on superficial scars and marks, so deeper, established scars usually need more.
• In-clinic procedures: Established atrophic scars are treated with procedures that rebuild collagen and level the skin. Microneedling, laser resurfacing, chemical peels, surgical subcision and dermal fillers can all help often in combination with skincare. They need to be done by an experienced practitioner and extra care should be taken in deeper skin tones which are prone to post-inflammatory hyperpigmentation.
• Matching the treatment to the scar: Different scars respond to different procedures. Rolling scars often improve with subcision, which releases the tethering bands beneath them. Boxcar and ice pick scars may need resurfacing or more focal techniques like TCA cross peel. Check out our blog post on getting rid of acne scars which explains in detail which treatment suits each scar type.

Can You Get Rid of Acne Scars?

It helps to be realistic about acne scars. Unless they’re very superficial, they rarely disappear completely. However, the right treatment can improve them significantly and change how the skin looks and feels. Improvement takes time, and usually requires more than one type of treatment. By far the best approach, though, is prevention. Treating acne early and resisting the urge to pick or squeeze stops most scars forming in the first place.

At City Skin Clinic, our doctors create personalised skincare to clear acne and fade the marks it leaves. This is the first step in dealing with scarring and the best way to prevent new scars. We do not offer in-clinic scar procedures. However, a prescription routine using actives like tretinoin, azelaic acid and hydroquinone can treat active acne, fade post-acne marks and improve scars amenable to topical treatment. Every plan starts with an online consultation built around your skin and your goals. Start your online consultation today. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.