Dealing with acne can be a frustrating experience. Dealing with the aftermath of severe acne—scarring, roughness and other skin imperfections—can often be even harder. Tretinoin is one of the most common and effective medications to help treat acne and the signs of aging. But did did you know you can use tretinoin cream for acne scars, too?
Acne scarring occurs when severe pimples develop and heal, leaving behind healed skin that isn’t as smooth as the original skin that formed prior to the acne outbreak. If your skin has acne scarring, it may look bumpy, rough and uneven, even when there’s no acne present.
According to statistics, approximately 60 million people in the United States have acne, of which around 20% have acne so severe it may already have or may have the potential to result in scarring.
People with acne scarring rarely view it as a positive. A detailed study into acne scarring shows that the vast majority of people view acne scars as a negative aspect of skin health—a problem that can affect everything from self-perceived attractiveness to overall self confidence.
In short, acne scars are a frustrating but very common side effect of acne. They’re also an effect with lasting consequences—unlike acne, which is usually temporary, acne scarring can last for life if untreated.
Today, a large variety of treatments are available for acne scars, ranging from over-the-counter creams containing ingredients such as salicylic acid, to clinical procedures such as dermal fillers and microneedling.
In this guide, we’ll examine the science behind using tretinoin cream for acne scars, as well as how you can potentially use it to improve your skin.
How Do Acne Scars Develop?
Acne scars form as a result of your body’s response to acne. During an outbreak of acne, small lesions form on your face as a result of oil and dead skin clogging the sebaceous glands inside your pores.
When the gland becomes clogged with oil and dead skin, a pimple can form. During a severe outbreak of cystic acne, bacteria can work its way into the pore, resulting in inflamed, red acne that can be painful and unpleasant.
Over time, your body will heal acne lesions on its own. During the healing process, one of two things can happen:
- If your body produces excess collagen to create new skin over the acne lesions, it can produce a slight elevation in the new skin tissue, creating the bumpy, uneven look that most people associate with acne scarring.
- If your acne is severe, it can cause some degree of tissue loss, which can cause depressions in your skin that are known as “icepick scars” or “boxcar scars.” Luckily, tretinoin for pitted acne scars is a thing, and we'll look into it more below.
All in all, there are actually four different types of acne scars, each with a slightly different look and root cause:
- Icepick scars tend to be deep and narrow, with the appearance of a needle or “icepick” indentation. These scars normally develop as a result of cystic acne.
- Boxcar scars are wide, pitted scars that are caused by tissue loss as a result of acne outbreaks.
- Keloid scars, or “hypertrophic scars,” are elevated acne scars that jut outwards from the facial skin rather than inward. These scars are typically caused by an excessive amount of collagen production during the process of acne lesion healing.
- Rolling scars are acne scars that have a rolling texture. These scars are most common on the cheeks and are caused by the development of fibrous areas of tissue connecting the skin with deeper tissue.
Each form of acne scarring is treated slightly differently. If you have acne scarring, it’s usually a good idea to talk to a dermatologist to learn more about the type of scarring you have and how you can treat it most effectively.
How Does Tretinoin Work for Acne Scars?
Although tretinoin was originally developed as a treatment for acne, several studies suggest that it can also help to heal acne scars.
Tretinoin works by increasing the speed at which your body replaces old skin cells—a process known as skin cell turnover. By removing dead skin cells from the face and replacing them with newer, fresh skin cells, tretinoin can improve acne and reduce some signs of aging.
In a 2004 study, researchers used topical tretinoin on 38 patients—29 women and 9 men—with some level of acne scarring. The patients ranged in age from 16 to 29 and typically had fairly young acne scars that had only been present for several years.
Over the course of 3.5 months, the researchers noted that when the subjects used tretinoin cream for acne scars consistently, they observed flattened acne scarring in 79% of the patients. The treatment was most effective on younger acne scars, as well as with narrow, indented icepick scars.
On the whole, tretinoin was well tolerated by the study participants, with the side effects limited to retinoid dermatitis (scaling and dryness caused by tretinoin) and an exacerbation of acne (a common side effect during the first few weeks of tretinoin usage).
The researchers concluded that treating acne scars using tretinoin could potentially replace more invasive techniques, such as dermabrasion or chemical peels, or be useful as a complementary medication alongside other acne scar treatments.
Another study of tretinoin as a treatment for acne scarring produced similar results. In the 1999 study, 32 volunteers with acne scars were given .025% tretinoin gel and instructed to apply the solution twice weekly to areas with acne scarring.
After three months, 94% of the patients experienced a significant decrease in the depth of their acne scarring. The researchers concluded that tretinoin is an “effective, noninvasive treatment of atrophic acne scars without causing disturbing side-effects.”
A review of treatments for acne scarring also mentions tretinoin, although not as a treatment for scarring. Instead, it mentions that tretinoin is often used as a pre-treatment for other acne scar treatments, such as medium and deep peeling.
Finally, studies of other retinoids (the class of medications to which tretinoin belongs) also show positive results in treating acne scarring. In a 2015 study, people with acne scarring noticed a significant improvement in acne scarring from a mix of retinoic and glycolic acid.
How to Use Tretinoin Cream for Acne Scars
Using tretinoin is a simple process. Tretinoin is sold as a cream, gel or liquid, all of which are designed to be applied directly to your skin. Our Complete Guide to Using Tretinoin for Acne covers the entire process of using tretinoin for acne prevention or acne scar healing.
When you’re using tretinoin for acne scar flattening, removal and healing, keep these key tips in mind:
- Talk to your doctor before using tretinoin. Tretinoin is a prescription medication, meaning you’ll need your doctor’s approval before using it. Your dermatologist can provide expert advice on whether tretinoin is the right option for your acne scars.
- Consider starting with a low to moderate strength of tretinoin. Tretinoin cream, gel and other products come in several concentrations, with the lower strength options the best bet for minimizing side effects during the first few weeks of treatment.
- Avoid excessive sun exposure while using tretinoin. Tretinoin can make your skin more sensitive to sunlight, meaning it’s best to avoid long periods of sun exposure and use an SPF 30+ sunscreen for the first few weeks of using topical tretinoin.
- Consider using a moisturizer with tretinoin. Tretinoin can dry out your skin and even cause peeling, flaking and itchiness. Using a moisturizer with tretinoin is one of the most effective ways to mitigate and manage these side effects.
- Be prepared for the tretinoin “purge.” During the first few weeks of treatment, it’s far from uncommon for your skin to get worse before it gets better.
- Treat your acne scarring as quickly as possible. Studies show that tretinoin is most effective on fresh, recent acne scars. For the best results, take action as quickly as you can once you notice acne scars developing.
- Have realistic expectations. While tretinoin might be able to lighten your acne scars, there’s no guarantee that it will completely remove them. Have realistic expectations of what tretinoin can and can’t do and you’ll likely be more satisfied with your results.
- When using tretinoin for pitted acne scars, understand that the healing process is one that takes time and patience. Don't be deterred if you don't start seeing immediate results.
Used consistently shortly after you notice acne scars developing, tretinoin can be a useful tool to help you smooth out and repair your skin. If you have mild or recent acne scarring, it might even be able to replace more invasive methods of repairing acne scarring.
Learn More About Using Tretinoin for Acne
Tretinoin is one of the most powerful and effective medications on the market for treating and preventing acne. It’s also safe and well tolerated, with significantly fewer potential side effects than oral acne treatments such as Accutane.
You can learn more about how to treat and prevent acne using tretinoin in our Complete Guide to Using Tretinoin for Acne. Our Tretinoin 101 guide also covers the basics of tretinoin, from its development and uses to safety information, scientific studies and more.