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A Dermatologist's Tips for Acne Scars

acne scars
Laurel Naversen Geraghty, MD - Blogs
By Laurel Naversen Geraghty, MDBoard-certified dermatologistSeptember 9, 2019
From the WebMD Archives

You’ve battled breakouts – and you have the scars to prove it. Blemishes can be distressing enough, but the marks left behind can serve as a lasting reminder of the emotional trauma and confidence hit that acne can cause. Your dermatologist has seen it many times, completely understands, and probably has even been there themselves. They are standing by, ready to help clear your skin, minimize scars, and restore your hope and confidence.

But before we talk about scars, let me clarify that there’s a difference between a true scar and a temporary mark after acne. The marks you’re concerned about – are they indented, or they just discolored?

Regardless of your skin type, a true post-acne scar is characterized by an irregularity in the surface texture of the skin. Derms often call these ice pick scars, rolling scars or boxcar scars - all are indented and appear a bit like pock marks. If the skin is smooth with no textural change, it's probably not a scar – it’s just the pink or dark mark that acne has left behind, called post-inflammatory hyperpigmentation (PIH). These spots are temporary and reversible, and will gradually fade with time (though this can sometimes take weeks to months, especially in olive or darker skin tones). For every skin tone, it’s important to wear sunscreen consistently, as everyday exposure to UV light can keep marks discolored for much longer (look for a broad-spectrum SPF 30+ product labelled “noncomedogenic” to help ensure that it won’t clog pores).

If your scars are true scars, however, I’m sorry to say they may never go away on their own, and they typically cannot be removed entirely. But the good news is, whether you’re dealing with marks or scars, there are many things you can do to improve your skin after you’ve suffered from acne. 

Creams and Gels (effective for both scars and marks)

As any dermatologist will tell you, over-the-counter creams marketed as scar treatments are typically not helpful. This is mainly because most “scar” creams are are not backed by significant research. Also, acne scars tend to be indented - a type of scar that can be tricky to treat. What works better, according to decades of scientific study: A retinoid cream or gel (derived from vitamin A), which gradually alleviates scars by evening out skin tone, improving the turnover of skin cells, and building new collagen and elastin (they can help prevent and treat small blemishes, too). Look for adapalene (sold as over-the-counter Differin gel) or tretinoin or tazorac (which a doctor could prescribe). These medicines have the potential to cause dryness, peeling, and irritation, which is why only a thin layer is recommended at bedtime, often with a plain moisturizer on top to soothe the skin. (It’s important to use these only at night due to increased sun sensitivity and because the product can be deactivated by sunlight.)

Combining benzoyl peroxide (a topical antibiotic) to adapalene (a mild retinoid) can significantly reduce scars and blemishes, according to a recent study of 67 patients followed for 6 months, published in the American Journal of Clinical Dermatology. This combination of medicines is available as prescription gels, called Epiduo or Epiduo Forte. A milder version could be created at home using OTC adapalene (Differin gel) applied with an OTC benzoyl peroxide cream. Dermatologists recommend these products applied sparingly in the evening, and taking caution with benzoyl peroxide, since it bleaches fabric and can cause irritation.

Procedures for Scars (often not necessary for marks)

Since there are several procedures that can help to minimize acne scars, it makes sense to seek the care of a dermatologist to guide you through the options. A series of treatments is almost always necessary, and be warned – it’s unlikely that your insurance will cover them.

  • Lasers. Depending on your skin type and the appearance of any scars, your dermatologist may suggest laser therapy to reduce redness, resurface the skin, or promote new collagen and elastin production. Options include pulsed dye laser, picosecond laser, fractionated lasers, or the aggressive but highly-effective carbon dioxide laser.
  • Injections. Tiny injections of steroid medicine can thin and flatten thick, itchy, or ropy scars. Gels called filler can be injected directly into indented scars to plump them temporarily, evening out the skin’s surface. Your dermatologist may suggest polymethyl methacrylate (Bellafill), or hyaluronic acid filler (such as Juvederm or Restylane, though these are not FDA-approved for this purpose).
  • Surgical Methods. Physicians can perform punch biopsies (surgical removal of certain scars using a small tool), dermabrasion (careful removal of the upper layer of skin using a rotating, mechanical tool), or subcision (when a needle or blunt object is directed within the skin to break up fibrotic scars).
  • Microneedling. By creating tiny pinprick wounds to promote skin healing, microneedling may gradually lessen acne scars over a series of treatments. (Note: It’s a good idea to have this procedure performed in a physician’s office, since infection and other adverse events are possible.) The light microneedling and dermaroller treatments done at home can exfoliate skin and leave it feeling nice, but are unlikely to (and should not) penetrate deep enough to improve scars.

And, whether you’re dealing with marks or scars, prevention is important, because it can be hard to see improvement if new blemishes keep forming. A dermatologist can help design a treatment regimen if over-the-counter therapies aren’t enough. And when acne does pop up, avoid picking or popping pimples, since manipulating the skin can increase the risk of scarring.

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About the Author
Laurel Naversen Geraghty, MD

Laurel Naversen Geraghty, MD, is a Stanford-trained dermatologist, former Glamour beauty editor, and journalist who has written for The New York Times, Glamour, Allure, Real Simple, Women’s Health, and other publications. She has made many television appearances and co-hosted The Dermatology Show on Sirius-XM throughout medical school. Her personal skincare blog can be found on Instagram and Facebook.

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