The 101 on acne scars

If you’ve ever had acne, you may have been left with acne scarring. If you have acne now, you may be worried you’ll get scars.

Here we’ll let you know the different types of acne scarring, and we’ll give you advice about how you can treat them.

What is acne?

Acne is a skin condition that causes spots, inflammation, and sometimes scarring. People usually get it on their face, but it can appear on the neck, back, chest, and shoulders too. There are also a lot of different types of acne.

What causes acne scarring?

Acne doesn’t always cause scarring, but it can when the more serious types of acne spots form, called nodules and cysts.

These larger spots can cause inflammation in the surface layers of your skin, and this swelling can press into lower layers and damage the structures there. This damage to the deeper levels of your skin is what causes the scars.

Scars can also form if you squeeze your spots to burst them, as it can damage the skin beneath the spots and make the spots themselves worse. We know how tempting it can be to give them a squeeze, particularly when you can see white heads on your spots, but try hard not to, as in addition to giving you scars, it can cause infections in your spots to spread further into your skin too. So it’s best to leave them alone.

Why do I need to know what type of acne scarring I have?

Scars are scars, right? Well, no. Different types of acne scars can respond differently to treatments, so knowing what kind of scar (or scars) you have, can help you pick the best treatments for your skin.

There are two main types of acne scarring, depressed and raised.

Depressed acne scars

Depressed scars, also called atrophic scars, form when there’s not enough collagen in damaged skin tissue when it heals after a spot clears up. Collagen acts as a structural support in skin, think of it like the frame which holds up a house. If your skin loses collagen then it can sag in places, forming depressions on your face. These depressions are visible on the surface of your face as the top layers of skin dip down into them. There are three types of depressed acne scar:

Boxcar scars

These are generally shallow, circular scars, but often with defined, almost sharp edges, giving them the appearance of small boxes (kind of). They often form where a large nodule or cyst has healed. Although they’re usually shallow, they can sometimes be deep, with deeper scars being harder to treat.

Ice pick scars

These scars are narrower than boxcar scars, and usually look like small holes, like an ice pick has been pressed into the skin. They can be harder to treat than boxcar scars, as they often extend deeper into the skin.

Rolling scars

These are roughly circular, like boxcar scars, but are usually wider. They typically have an irregular appearance with less of a defined shape than boxcar scars, often with more curved edges.

Raised acne scars

Raised acne scars, also called hypertrophic scars, are the opposite of depression scars in that they are raised from the skin, rather than indented. And whereas depression scars are caused by not enough collagen in damaged skin, raised scars are caused by the presence of too much collagen. They look like raised bumps and lines on the skin, and although they do form on the face, they’re more common on the back and chest.

How to prevent acne scarring

Unfortunately, there’s no guaranteed way to prevent acne scars. If you have acne, scarring will always be a risk. But you can do the following to help minimize your chances of getting scars and to limit their severity:

• Don’t try and squeeze or pop your spots, as this can make scarring worse
• Use acne treatments to try and limit how bad your acne gets, as generally, the worse the acne, the worse the scarring
• You can also make lifestyle changes to try and limit the severity of your acne, particularly by eating some foods and avoiding others

How to get rid of acne scars

OK, we have to say this. Treating acne scars can be difficult. Most scars are permanent. No matter the treatment, they’ll never completely disappear. Treating acne scars is more about minimizing their appearance, rather than getting rid of them forever. With that said, many treatments are effective though, and they can visibly reduce the prominence of your scars. You’ve got the following options:

At-home treatments for acne scars

You can buy a range of over-the-counter or prescription products which you can use at-home to treat your acne scars, including:

• Salicylic acid. This is a common acid in many acne treatments and face cleansing products and is found in everything from toners to cleansers to wipes and pads. As well as helping to treat acne, it can also reduce the appearance of acne scars
• Alpha hydroxy acids. Alpha hydroxy acids (AHAs) have a mild exfoliant effect, removing discolored and rough skin from the surface of scars, making them less noticeable. AHAs can be used to treat all types of scars and can be found in a range of products, including cleansers, lotions, and creams which can be bought over the counter
• Retinoids. Retinoids are a type of molecule similar to vitamin A which can speed up cell regeneration and improve skin texture. Products containing retinoids can reduce discoloration and make acne scars less visible. You can buy some mild retinoid products over the counter, but you can also be prescribed stronger retinoid products too, such as tretinoin
• Sunscreen. Damage from sunlight can make scars look darker and more prominent. Wearing sunscreen everyday can protect you from this

Professional treatments for acne scars

You can also try a range of treatments offered by dermatologists and other healthcare professionals to reduce the appearance of acne scars, including:

• Dermabrasion. Think of this as deep exfoliation for your skin. Dermabrasion is an effective treatment for reducing the visibility of acne scars, particularly shallower scars, like boxcar and rolling scars
• Chemical peels. These are treatments with a strong acid that removes the top layers of skin from your face. You can use some chemical peels at home, but healthcare professionals can treat you with stronger ones. Chemical peels are used to treat all kinds of acne scars, but can be used particularly for deeper scars, like ice pick scars
• Laser resurfacing. A laser can be used to remove the top layers of skin. Your skin often heals faster after this treatment than with dermabrasion or chemical peels. It’s suitable for all types of acne scar
• Fillers. These are products made of collagen, commercial fillers, or even your own fat. The filler is injected into your skin, and it works by filling in depressions, smoothing your skin and making scars less prominent. Fillers don’t last forever though, they need to be re-done every six to 18 months, but they can work well, particularly for boxcar and rolling scars
• Microneedling. This approach uses a needle to puncture the skin to promote healing and collagen formation. It’s a relatively new approach, but there’s evidence that it can reduce the severity of all types of depression scar

Surgery

Acne scars can be removed surgically, although this is usually an option reserved for more serious and deeper scarring, as well as raised scars. A dermatologist or surgeon can remove a scar, but this will leave a small scar in its place, so surgery is often best suited for larger, more prominent scars.

Knowing what kind of acne scar you have is the first step in treating them. But you need to have realistic expectations as most scars are permanent. However, there are a range of treatments that can make them less visible.

Sources

• Acne – NHS