Acne scars and pimple marks can make some people feel insecure or self-conscious about their skin. It may remind them of their unhappy teenage years, or maybe a horrible breakout that happened only weeks ago.
To some people, those marks may negatively affect their self-esteem and may result in a decline of their self-confidence.
Related: How to Be Confident with Your Body
That is why many acne sufferers live with a medicine cabinet full of oral medications and chemical creams in hopes of being blemish-free. However, not all of those creams may work for your skin type.
So we asked experts to share their knowledge about the effective regimens and treatments that may reduce—and eventually remove—the appearance of acne scars and pimple marks.
Table of Contents
- Acne scarring
- Before you start any acne scar treatment, you must address existing acne
- To avoid further acne scarring, avoid picking at any pimples
- Facial scar revision
- Layered closure
- Topical cream (non-invasive)
Scarring is actually part of normal wound healing. When the skin is damaged through trauma, surgery or an inflammatory skin process (such as acne), it heals by producing new epithelial cells to cover the surface layer and new collagen to repair the deeper dermis.
This process also requires the development of new blood vessels to feed the healing skin and the recruitment of various inflammatory cells and molecules that ultimately help skin healing.
The new vessels and inflammation can lead to redness and tenderness in the new skin/scar and the new collagen is sometimes thicker than the original, undamaged skin, which can lead to thick, raised and indurated (hard) scars.
Healing skin continues to remodel for a year after the ‘trauma’, so sometimes, waiting, together with good wound and skin care is all that is needed, or will let you minimize the required intervention.
How a wound heals or scars will depend on the type of wound, the body site, the genetic healing characteristics of the individual (eg, dark skin may be more prone to keloid formation), the tension on the wound while it is healing, and even the wound care.
It can be difficult to treat scars with any physical intervention because it can actually cause more scarring in some cases (e.g. keloids).
It can be difficult to prevent scarring. Avoiding or minimizing the ‘trauma’ in the first place, is obvious.
If the scarring is due to surgery, the surgeon should try to orient the final wound in the direction of least resistance/least tension.
Good wound care is next. Keeping the site clean and applying grease to the site to let the new cells ‘swim’ over to seal and heal the epithelium is helpful. Once the skin is closed over, there are interventions that may help prevent a scar from becoming thick and/or to treat them if they become thick (or depressed).
If the skin is healed over, the key is to minimize traumatizing the area and let it finish healing. For post-traumatic or surgical scars (e.g., c-section scars), apply a silicone scar sheet to the site to help prevent the scar from becoming thick and raised.
You can wear 23.5 hours a day (remove it to shower and re-apply it when your skin is dry) for weeks-months. Topical silicone gels may be helpful if you cannot tolerate the stick-on sheet. Mederma cream (a.m version) is made of onion extract and may help reduce redness and possibly prevent thickening. It doesn’t smell like onion.
Aka Post-inflammatory erythema, these are due to the neovascularization or new vessel growth that was necessary to sustain the new cells during wound healing. They will fade with time. Irritated lesions can be treated with topical steroids for up to 2 weeks to reduce inflammation-related redness.
To speed up the fading process, red scars can be treated with a laser that targets red vessels. The Pulsed Dye laser (PDL, 585nm) is probably the most effective, followed by the KTP laser. Photofacial treatments that use Intense Pulsed Light (IPL) can be helpful, as well.
All options could require multiple treatment sessions to lighten the scar to your satisfaction. For redness due to acne scarring, prescription creams containing tretinoin or azaleic acid will help to fade the marks over time. Broad-spectrum light can temporarily calm skin and redness.
This refers to scars that are thick and over-grown but remain within the original trauma site. It can happen any time but may be more common in areas that have frequent movement, because of the repetitive breakdown and re-formation of the newly formed tissue.
Silicone scar sheets are helpful and can be purchased over the counter at most pharmacies (I like Scar Away, $19.99 at CVS). For thick, itchy or irritated scars, see your dermatologist for intralesional steroid injections. The steroid helps to reduce inflammation and break down some of the thickened collagen.
They refer to overgrowth of scars beyond the area of the original trauma or surgical site or acne lesion. There is a genetic predisposition to developing this type of scarring and it is more common in African American skin. They tend to develop in areas of high-tension or in the skin that lies over large, strong muscles with increased movements, like shoulders, upper back, and midline chest.
If patients know that they develop keloids, their surgeon might inject steroids into the site at the time of surgery, in an attempt to prevent them from developing. Monthly intralesional steroid injections by your dermatologist will help to flatten the keloids. The Pulsed dye laser (PDL) has been shown to reduce redness and thickness of some keloids after multiple treatments. Home treatment should include silicone scar sheets.
They refer to thin scars that are due to broken collagen and elastin (e.g., stretch marks). They can be difficult to treat because it is hard to sufficiently re-grow collagen in the dermis. Topical retinoids may help promote the growth of collagen.
Microneedling with or without PRP (plasma rich platelets) and fraxel lasers can also create micro-trauma in the dermis, which stimulates the development of new collagen. Multiple treatments are necessary to notice a clinical improvement.
Aka pitting, these scars are usually a result of inflamed acne lesions and sometimes due to picking. The skin is bound down, creating a pit in the skin. They are difficult to clear completely. Your dermatologist has a number of things that she can try, including:
- Subcision (involves cutting underneath the bound down skin to help it pop back up);
- TCA-cross (spot-treating the pitted scars with a very strong trichloracetic acid, which scars the skin closed to minimize the appearance of the pit;
- Microdroplet injections of filler to help raise the skin and make the pit appear less deep;
- Non-ablative fraxel laser to stimulate collagen growth;
- Ablative lasers to destroy/peel the skin, so that it may heal back in without the pits;
- Cutting out the scar with a punch biopsy and sewing the skin together.
Box-car Scars or Pock Marks
These are indented scars that are larger than ice pick/pitted scars. They can develop from inflammatory lesions or picking. They are classically associated with chicken pocks (hence the term Pockmarks).
Their appearance can be minimized with subcision to help pop up the bound-down skin, and with microdroplet injection of fillers into the scar to lift the epidermis and make the scars appear less deep. They can also be cut out with a punch biopsy and the skin can be sewn back together.
This refers to the bumpy, raised edges on the sides of a flat or depressed scar. They are usually associated with inflammatory and poorly-healed cystic acne lesions. They can be revised by:
- Ablative lasers (CO2 or Erbium: YAG laser);
- Electrocautery to the edges;
- TCA acid spot treatments;
- They can be excised.
Khalil A. Khatri, MD.
Dermatologist & Cosmetic Surgeon, SkinLaserOnline
Acne may come and go, but the scarring left behind will not. Acne scarring can appear in the form of discoloration or actual dermal depressions on the skin. These typically form as a result of acne that develops deep within the skin. Pus and bacteria form in a pore, causing inflammation. The inflammation affects collagen production and healthy fats, resulting in a depression in the skin.
There are different types of acne scars that will result from the loss of collagen. The most common are icepick scars, rolling scars, and boxcar scars.
Icepick scars are narrow and deep, whereas Rolling scars are wider and have smooth edges. Boxcar scars are wider, have sharp vertical edges and a defined area of depression, similar to chickenpox scars. In some extreme cases, Hypertrophic and Keloid scars may occur. These types of scars are raised and pigmented.
Before you start any acne scar treatment, you must address existing acne
The treatments below may further irritate and further worsen existing acne. Your dermatologist can prescribe a treatment plan that may include oral or topical medications and/or laser treatments.
There are several solutions available to minimize the appearance of acne scars. For years, the main treatment options have included surgical techniques such as punch removal, excision, and subcision. During this procedure, a physician uses different instruments to puncture the top layer of the skin in order to physically extract or breakdown the scar, cyst or pore. Some non-surgical solutions include fat transfer and dermal fillers.
Fortunately, there are less invasive solutions available. Dermabrasion and chemical peels have proven to be effective and generally well tolerated. Results can be typically seen after a series of treatments.
In addition to these techniques, laser skin resurfacing is an effective tool for the improvement of acne scars. Ablative lasers (which remove the top layer of skin) and non-ablative lasers are well tolerated and have been shown to be effective in the improvement of facial acne scarring.
For pink, hypertrophic and keloid scars, pulse dye lasers (PDL) have been clinically proven to significantly improve the texture and color of these type of scars.
To avoid further acne scarring, avoid picking at any pimples
As soon as you start to see acne, you should see a dermatologist. You need to start the right treatment at the right time. If you wait longer, the acne gets worse, which leads to scarring.
Always consult with your dermatologist on the best options to treat both your acne and acne scars.
Dr. Minas Chrysopoulo, MD FACS
Plastic Surgeon | Creator, InviCible Scars Advanced Scar Treatment
Facial scar revision
There are a few different ways to tackle the issue of acne scars, from non-invasive to minimally invasive to surgery. For example, facial scar revision redefines the appearance of scars, combining topical treatments, which expedite the healing process and improve pigmentation, with surgery.
The procedure, which must be conducted by a certified plastic surgeon, is also known as layered closure, involves cutting out the old scar and reclosing it, repositioning the edges of the scar so it heals better.
Dermabrasion can also help to reduce the appearance of acne scars through the removal of scarred skin. It utilizes a series of sharp-edged brushes, rotating them quickly across tissue to “sand away” uneven areas and promote more even texture as the skin heals.
This bolsters the body’s ability to heal (as exposing unaffected dermal layers restores balance to collagen production) and helps to improve the appearance of scars. Dermabrasion can be done by a dermatologist.
Topical cream (non-invasive)
A non-invasive approach would be applying a topical cream. Look for one that combines natural ingredients, like aloe, with a stable form of Vitamin C and silicone (the gold standard in scar healing) to heal, soften and fade scars.
Sarah Nicole Payne
Co-Founder & President, Sarah Nicole Skin Care
When it comes to getting rid of dark marks left over from breakouts, the first step begins when you first see a pimple forming.
Be diligent with wearing a broad-spectrum SPF, UV rays have the ability to worsen how badly our acne scars are, and of course, no picking!
While your breakout is active and healing, do your best to keep it well lubricated so your skin doesn’t become dried out and flaky, a bit of vaseline can help protect your wound as it heals if your acne products really did a number on your skin.
Afterward, use a serum with niacinamide and skin brighteners to fade the mark away. Air on the side of being kind and gentle to your breakouts as much as you want to get back at them for arriving, that way they leave much more peacefully than they arrived.
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