One of the biggest causes of heartache for acne sufferers is the aftermath. Even if you work hard to treat acne and clear it up, it can still leave its mark. This includes hyperpigmentation and acne scars. These can persist even after acne is long gone and usually do not completely go away by themselves. In this article we look at how acne scars form. We also review the broad array of treatments that can help get rid of them.
How Do Acne Scars Form?
Acne scarring is the result of the body’s inflammatory response to acne lesions and the wound healing response this triggers. Acne forms when excess dead skin cells and sebum block a pore. This creates a breeding ground for Cutibacterium acnes (formerly P. acnes) bacteria and sets off an inflammatory response. The result is the formation of lesions such as pustules, papules and, in severe cases, nodules.
Severe acne can damage the skin by breaking down collagen, which gives the skin its elasticity and structure. The body, in an attempt to repair this damage, produces collagen. When the body produces too little, the skin develops depressed (atrophic) scars. These include ice pick, boxcar and rolling scars. When too much collagen forms, the result is raised hypertrophic scars or keloids. Inflammation can also cause discolouration or post-inflammatory hyperpigmentation. This often goes hand in hand with acne scars, especially in skin of colour. Scarring is more common with severe or persistent acne. Genetics and trauma like picking or squeezing spots can also play a part.
The type of scar matters because it dictates the best treatment. We cover each one in detail in our guide to acne scars. Most atrophic scars respond best to the treatments below.
How Do You Treat Acne Scars with Skincare?
No single treatment suits every scar, and the right plan depends on the type and depth. The first and most important step is always to bring any active acne under control. New spots simply create fresh scars and marks. From there, skincare is usually the starting point and works best on early, superficial scars and post-acne marks. The main skincare options include:
- Topical retinoids: The most effective topical treatment for acne scars is a retinoid, in particular a prescription retinoid like tretinoin. Tretinoin increases cell turnover and stimulates collagen and elastin. This smooths the skin and treats ongoing acne and hyperpigmentation at the same time. Research shows that topical retinoids improve the appearance of atrophic acne scars and reduce the progression of scarring. Tretinoin is often combined with hydroquinone to fade the appearance of marks more quickly.
- Vitamin C and exfoliating acids: Vitamin C and exfoliating acids like glycolic acid can also smooth the appearance of scars and promote skin cell renewal. In general, topical treatments suit early-stage, superficial scars and post-acne hyperpigmentation best. They can also improve more severe scarring and increase the effectiveness of in-clinic treatments.
- Oral retinoids: Isotretinoin (known by the brand names Accutane or Roaccutane) is a powerful medication. It is reserved for severe acne that hasn’t responded to other treatments. It works mainly by preventing new acne, which in turn prevents new scars from forming. It does not directly improve scars that are already established. It is a dermatologist-prescribed and closely monitored medication with potentially serious side effects. As such, it is not a primary treatment for deep, well-established scars.
What Professional Treatments Help Acne Scars?
Established atrophic scars usually need an in-clinic procedure that rebuilds collagen and levels the skin. These treatments are not without risks and can involve downtime. They need an experienced practitioner, with extra care in deeper skin tones where they can trigger post-inflammatory hyperpigmentation. The most effective options include:
- Dermabrasion and microdermabrasion: Dermabrasion uses a rapidly rotating device to remove the skin’s top layer, which smooths the skin and minimises the appearance of deeper scars. Its gentler sibling, microdermabrasion, exfoliates the surface layer of dead skin cells to encourage new skin to grow. These can improve shallow boxcar or rolling scars but offer less for deeper scars. They may not suit darker skin tones, because they can trigger hyperpigmentation.
- Laser resurfacing: Laser resurfacing directs concentrated beams of light at the skin’s outer layer and stimulates collagen production underneath. It suits most types of acne scars, including ice pick, boxcar and rolling scars. However, it can trigger hyperpigmentation in more pigmented skin, and recovery can take up to two weeks. You will need a course of treatments for noticeable results.
- Chemical peels: Like laser therapy, chemical peels remove the outer layers of skin to promote regeneration and improve texture. They can help mild to moderate boxcar and rolling scars but may not affect deep ice pick scars. They can also cause pigmentation changes in darker skin tones, and you will need a course of treatments for noticeable results.
- Microneedling and RF microneedling: Microneedling (also called collagen induction therapy) uses fine needles to create micro-punctures. These trigger collagen and elastin production, which helps fill in scars over time. It is particularly effective for rolling and boxcar scars and can help smaller ice pick scars. RF microneedling adds radiofrequency energy deep into the dermis to further enhance skin tightening and scar reduction. Both need multiple sessions for the best results.
- Dermal fillers: Hyaluronic acid dermal fillers add volume to lift and smooth depressed scars. They work especially well for rolling and boxcar scars. They give immediate results, but the body breaks the filler down over time. The procedure therefore needs repeating every few months. They are most useful for isolated scars that have not responded to anything else.
Acne scars are challenging to treat, but a range of treatments can substantially improve their appearance or even clear them. Patience is key, because most treatments need time and consistency to deliver results. You might also need a combination of approaches if your scars are severe or mixed. As always, see a qualified and experienced doctor who can advise you on the best plan for your skin.
At City Skin Clinic, we believe that skincare is personal and should always centre around your needs. Our doctors offer custom topical treatments for acne, acne scars and hyperpigmentation using ingredients like tretinoin and azelaic acid where appropriate. If you are interested in a personalised skincare treatment please use our online skin consultation form or book a video consultation. Start your treatment journey today and take your first step towards great skin.
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.
