Acne Scars 101: Causes, Types, Treatments and Prevention Tips

Acne Scars 101: Causes, Types, Treatments and Prevention Tips

Dealing with whiteheads, blackheads, pimples and other forms of acne can be an embarrassing, frustrating process.

Most of the time, acne comes and goes without any long-term effects. However, some forms of acne can leave behind persistent, obvious scars that can affect both your appearance and your self-confidence. 

Acne scars come in several different types and can affect both your face and your body. While they can be frustrating to deal with, the good news is that both acne breakouts and the scarring they can often leave behind are treatable. 

Below, we’ve explained how and why acne scars develop, as well as the different types of acne scarring that you may notice if you’re prone to acne breakouts. 

We’ve also listed the treatments that are available for both acne and acne scarring, as well as a variety of tips and techniques that you can use to prevent acne scars from affecting your skin in the future.

What Causes Acne Scars?

Acne scars are, obviously, caused by acne. However, the process behind them is a little more complicated than it may seem at first, with certain types of acne more likely to contribute to the development of scars than others. 

All types of acne develop when your skin’s hair follicles, or pores, become clogged with either sebum, dead skin cells, or a combination of these two substances. 

When a pore becomes clogged, it can develop into comedonal acne — a mild form of acne that includes whiteheads and blackheads.

Sometimes, bacteria can become trapped inside a clogged pore. When this happens, the pore can develop into a type of infected, inflamed acne. This type of acne is usually red in color and raised from the skin. 

When infected acne develops deeper under the skin, it’s referred to as cystic acne, or nodular acne. This type of acne can be painful, with large, inflamed, pus-filled cysts or lumps that form under the skin’s surface.

Most of the time, comedonal acne heals smoothly without leaving behind scars. However, the more severe forms of acne — particularly cystic or nodular acne — can often leave behind large, obvious scarring.

For the most part, acne scars form the same way as other scars that can develop after injuries or other damage to your skin. 

When acne occurs deep in your skin, it can damage the skin and surrounding tissue. When the acne clears, your skin begins to heal itself, producing new collagen to serve as a foundation for the new skin tissue.

Your body’s process for repairing skin is incredible. However, it’s not perfect. Sometimes, your body might produce slightly too much or too little collagen, resulting in a scar that doesn’t quite match the surrounding skin.

Scarring is generally more common when your skin is injured deeply. For acne, the deeper the damage caused by the acne is within your skin, the more likely it is to leave a scar.

Types of Acne Scarring

Acne scars come in a range of different forms. Some scars are depressed, or atrophic, meaning they sit below the surface of your skin. Other scars are raised, or hypertrophic, meaning they sit slightly above your surrounding skin. 

There are three different types of depressed acne scarring, as well as one type of hypertrophic scarring. We’ve explained more about each type of scarring below, from how it looks to the way it typically develops on your skin. 

Ice Pick Scars

Ice pick scars are deep and narrow. As their name suggests, they resemble the type of scarring that could be left behind by a long, thin instrument like an ice pick. Most icepick scars measure less than 2mm across and have a V-like shape.

Scars of this type often form after deep acne breakouts on the forehead and cheeks, where the skin is relatively thin. Since they’re quite deep, they’re often more challenging than other acne scars to treat.

Ice pick scars are extremely common, making up about 60 to 70 percent of all depressed acne scarring.

Boxcar Scars

Boxcar scars are wide and typically quite shallow. They can be round or oval in shape, with a sharp edge that sets them apart from the rest of your skin. Most boxcar scars measure 1.5mm to 4mm across.

As their name suggests, boxcar scars look like an open boxcar, with a relatively wide diameter and a shallow depth. 

Boxcar scars are less common than ice pick scars, accounting for around 20 to 30 percent of depressed acne scarring. When shallow, they’re often quite easy to treat with skin resurfacing treatments.

Rolling Scars

Rolling scars are generally wide and shallow, with smooth edges that create the impression of rolling and uneven skin. Scars of this type can measure as much as 5mm across, making them the widest acne scars.

Due to their smooth, sloping edges, rolling scars often appear to be less deep than other acne scars. Rolling scars typically develop on areas of the skin that are thicker, such as the jaw and lower cheeks.

Rolling scars are less common than ice pick and boxcar scars, making up approximately 15 to 25 percent of depressed acne scarring.

Hypertrophic Scars

Hypertrophic scars, or keloid scars, are scars that are caused by growth of the fibrous tissue of the skin. They develop when the skin heals after an injury, such as an acne lesion. Unlike the other types of acne scarring, hypertrophic scars are raised above the surrounding skin.

It’s normal for hypertrophic scarring to affect the chest, back, shoulders and jaw line. Scars of this type are common in people with dark skin and may itch or feel painful. 

Other Marks Left Behind By Acne

Although they’re not a form of scarring, some acne lesions can leave behind small areas of skin that look darker than your normal skin tone. 

This is referred to as post-inflammatory hyperpigmentation. It’s common in people with “skin-of-color.” Although it technically isn’t scarring, the dark color left behind by some types of acne can last for significantly longer than the acne itself.

Treatments for Acne Scarring

Acne scars can be incredibly frustrating, especially when they develop in highly visible areas of your face and body. 

Although treatments can’t always completely get rid of acne scarring, most types of acne scars can be made less visible through the use of medications, cosmetic procedures and changes to your habits. 

If you’re prone to acne, it’s important to treat your current acne breakouts before you focus on scarring. We’ve listed a range of options that you can use to get rid of acne for good in our full guide to science-backed acne treatments.

Over-the-Counter Products

If you only have mild acne scars, using an over-the-counter treatment may help to make them lighter and less visible. Several products available over-the-counter have been shown to treat acne scars, including the following:

  • Salicylic acid. A popular ingredient in over-the-counter acne products, salicylic acid can clear pores and reduce swelling from inflamed acne, as we’ve explained in our full guide to salicylic acid as an acne treatment.

    As a peeling agent, it can also help to treat mild acne scars. However, it may not be an ideal option if you have deep or severe acne scarring.
  • Alpha hydroxy acids. Some alpha-hydroxy acids, which are used in skincare products sold over the counter, may help to treat acne scars by promoting exfoliation. These are mild acids that work by helping to strip away the outermost, oldest layer of the skin.

    Common alpha hydroxy acids used in over-the-counter skincare treatments include glycolic acid, citric acid and lactic acid.
  • Over-the-counter retinoids. Some over-the-counter retinoids, including adapalene, help to stimulate collagen production and may be helpful for treating certain types of acne scarring.

Medications for Acne Scarring

Some prescription medications can help to lighten and get rid of scars left behind by moderate or severe acne. Using a prescription treatment can be a good option if your scars are too deep for milder, over-the-counter products. 

Tretinoin is type of topical retinoid, tretinoin is commonly used to get rid of acne and as a treatment for acne-related scarring and dark spots.

Tretinoin works by speeding up the production of new skin cells, helping to prevent acne breakouts and promote the creation of healthy skin.

In one study, researchers found that regular use of tretinoin delivered using a method known as iontophoresis resulted in flattening of acne scars for 79 percent of people and worked best on younger scars and on ice pick and superficial scars.

Because it’s a prescription medication, you’ll need to speak to a professional before you can use tretinoin. You can also find it in our customizable acne cream, along with several other active ingredients to prevent acne and promote healthy skin. 

Cosmetic Procedures

While over-the-counter products and prescription medications are often enough to get rid of mild acne scarring, moderate to severe scarring can be significantly more difficult to treat.

If you have moderate or severe acne scars, you may benefit from cosmetic treatments designed to improve your skin. These treatments get rid of scarring through a variety of methods, from the use of chemicals to remove damaged skin to injection of dermal fillers.

Cosmetic procedures for acne scarring may vary in cost based on the severity and type of your acne scars. You’ll need to talk to a dermatologist or plastic surgeon if you’re interested in having your acne scars treated by a professional. 

We’ve listed common cosmetic procedures for acne scarring below. Since no two cases of acne scarring are exactly the same, there’s no one-size-fits-all procedure for everyone. Instead, your dermatologist will typically use the best treatment for your specific scars and skin type. 

Cosmetic procedures for acne scarring include:

  • Dermabrasion. This is an exfoliating procedure in which a small, rapidly-rotating device is used to strip away the outer layer of your skin. The skin then regrows, creating a new, smoother external layer that’s smoother and less affected by scarring.

    In addition to acne scars, dermabrasion is used to reduce the visibility of surgical scars, wrinkles and hyperpigmented skin.
  • Laser resurfacing. Often referred to as ablative laser therapy, this procedure involves the use of a laser to strip away the outer layers of your skin and stimulate the growth of new skin cells.

    Like other cosmetic procedures, laser resurfacing is used both for acne scarring and to reverse certain signs of skin aging.
  • Dermal fillers. Some cosmetic fillers, such as Juvederm, Radiesse, and Restylane, are often used to reduce the visibility of depressed acne scarring. These fillers are injected directly into the areas of skin affected by scarring to create smoother, more even skin.

    Several clinical trials have found that fillers can help to significantly reduce the size and severity of some types of acne scarring. Since many fillers aren’t permanent, you may need to have repeated procedures if you rely on fillers to treat acne scarring.
  • Chemical peeling. This procedure involves using a chemical solution to strip away the top layer of skin and stimulate the growth of new skin. The new layer of skin that grows back is smoother, reducing the appearance and severity of acne scarring.

    Like other cosmetic procedures, chemical peels are done to treat acne scarring and to reduce the visibility of wrinkles or discolored skin.
  • Punch excision. This procedure involves physically removing scarred skin with a skin punch. It’s often used for deep scars, such as ice pick scars, which sometimes can’t be removed using conventional acne scar treatments.
  • Punch grafting. This procedure involves removing the scar and replacing it with a new section of skin from elsewhere on the body. It’s typically used for deep acne scars, such as deep ice pick scars.
  • Subcision. Also referred to as subcutaneous incisional surgery, this procedure involves making small cuts below the scar using a needle, breaking the fibres connecting the scar to the tissue in the deeper levels of skin.
  • Microneedling. Also referred to as collagen induction therapy, microneedling involves the use of small needles to puncture the outer layer of skin. Like other procedures, this creates small injuries that help to promote collagen production and skin healing.

  • Steroid injections. Raised scars, or hypertrophic scars, are occasionally treated using corticosteroids. These are injected directly into the scar to break down the bonds linking collagen fibers in the skin, causing the scar to shrink.

Home Remedies & Lifestyle Changes

Once acne scarring forms, getting rid of it typically means using one or several of the treatments listed above. However, you may be able to prevent acne scars from developing by making some small changes to your habits:

  • Treat acne as soon as it develops. More acne usually means more potential for scars to develop. If you’re prone to acne, make sure to treat it as soon as you notice any new acne lesions developing, as each breakout can potentially leave behind scars.

    Our guide to science-backed acne treatments goes into more detail about what you can do to treat and prevent acne.
  • Don’t pop or pick at your acne. As tempting as it might be, popping acne isn’t a good idea. Not only can popping pimples make your acne worse by pushing bacteria deeper beneath your skin — it can also lead to permanent scarring.
  • Avoid picking at scabs. If you do pop a pimple and it turns into a scab, make sure not to pick at the scab. This can stop the skin from healing properly and make it more likely that a scar will develop.

In Conclusion

If you’ve had moderate or severe acne in the past, it’s far from uncommon to have a few scars to show for it. Acne scars can vary hugely in size and severity, from one or two mild scars to a large amount of deep, highly visible scarring.

While over-the-counter products can be enough to treat mild acne scarring, it’s best to talk to a dermatologist if you have severe acne scars. They’ll be able to recommend the best treatment based on the type and severity of your scarring.

If you still get acne, make sure to treat it first before you focus on your scars. This will stop any future breakouts from causing further damage to your skin. 

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.