Acne Scars: Causes, Treatment & Prevention

Acne scarring is a complication of acne that can negatively affect your self-esteem. Scars can be caused by any type of spot, but the most serious types like nodules and cysts are most likely to damage the skin around them if they burst.

Acne scars can also happen if you pick or squeeze spots. So, it is important to understand how to look after your skin to prevent scarring. In this guide, we will explore the different types of acne scars, what causes them, and how you can best treat them.

Scarring can sometimes be a complication of acne, especially if you have the most severe types like cystic acne or you’re prone to picking or popping your spots.

Acne scars form from inflammation of acne lesions. The pore which has been affected by acne swells and the wall of the pore breaks down. In some cases, the scars are shallow and heal quickly, but in others the contents of the lesion can burst into the surrounding tissues, forming a deeper scar.

Your skin tone can also affect the appearance of acne scars. For example, darker skin tones are at a higher risk of developing post-inflammatory hyperpigmentation or dark spots.

These form after an acne outbreak because of an increased production of melanin, the natural pigment in the skin, in the affected area. This can also affect which type of acne treatment is most appropriate for acne scarring, as methods such as laser treatments may increase the risk of scarring and hyperpigmentation in darker skin tones.

Types of acne scars

There are 2 main types of acne scar, depressed or raised.

Depressed scars

Depressed or atrophic acne scars are the most common type. They are formed when not enough collagen is made during the wound healing process, resulting in an indentation on the skin. The 3 main types of depressed acne scars are:

1. Boxcar – wide, U-shaped scars that can have sharp edges and be shallow or deep.
2. Ice pick – narrow, V-shaped scars that can form deep in the skin and have a round or oval appearance, similar to a chickenpox scar.
3. Rolling – wide, depressed, and shallow scars that can make the skin look uneven with rounded and irregular edges.

Raised scars

Raised or hypertrophic acne scars are most common with chest and back acne. These types of scars are raised above the skin’s surface and are caused by too much collagen being produced during the healing process. The main types of raised acne scars are:

1. Hypertrophic – raised, firm scars that are the same size as the original acne lesion.
2. Keloid – raised bumps on the skin that are larger than the original acne lesion.
3. Papular – raised, skin-coloured or lighter bumps on the skin and can mimic closed comedones (whiteheads).

Other types of acne scars

Post-inflammatory hyperpigmentation (PIH) is a condition that’s more common in people with darker skin tones.

PIH occurs following skin inflammation or injury, such as acne, and is caused by an overproduction of the skin’s natural pigment, melanin, leaving behind dark spots or patches on the skin.

Acne scars are caused by inflammation or severe forms of acne, such as cystic acne. Acne is caused by sebum (oil), bacteria, and dead cells clogging pores or hair follicles. Scarring happens when the skin produces too much or too little collagen when it is repairing itself. If you squeeze, pick, or pop your spots, this can also cause scars to form.

Several factors can increase the risk of acne scars, including:

• picking or squeezing spots
• delayed treatment
• severe inflammatory acne
• over or underproduction of collagen during healing
• skin tone
• hormonal changes

Treating acne scars can range from topical treatments, like creams and gels, to medical procedures, such as laser therapy and chemical peels.

Which type of treatment is best for you will depend on several factors.

Topical treatments

Topical treatments include creams and usually contain chemicals to treat the appearance of scars. Some available over-the-counter while others may require a prescription.

Retinoids

Topical retinoids, like tretinoin and adapalene, are a type of acne treatment that can also be used to treat acne scars. They work by increasing cell turnover to improve skin texture, reduce discolouration, and make scars less prominent.

Research shows that when combined with glycolic acid, retinoic acid improved the appearance of acne scars in 91% of people after 12 weeks.

Topical retinoids can improve atrophic acne scars and reduce post-inflammatory hyperpigmentation.

Salicylic acid

Salicylic acid is a common acne treatment that has anti-inflammatory properties and reduces acne by exfoliating the skin to clear your pores. It’s included in many treatments, including face washes, lotions, and spot treatments.

Salicylic acid is also considered to be one of the best treatments for acne scars as it works by breaking down the fats within cells which can reduce the appearance of scars. It is also a safe treatment option for darker skin tones.

Lactic acid

Lactic acid can act as a chemical exfoliant to remove dead skin cells. Some research reports that lactic acid can improve texture, pigmentation, and the appearance of treated skin, with 1 person experiencing at least a 75% clearance of lesions after 3 months of lactic acid peels.

A combination of dermatologist performed topical poly-lactic acid and microneedle fractional radiofrequency resulted in better clinical outcomes for acne scars, including improved smoothness and reduced size.

Medical procedures

Several medical procedures are available to treat acne scarring but these are a type of cosmetic surgery. So, you will often need to pay privately for these treatments. Their cost can range from around £400 to more than £10,000 depending on the type of procedure you have.

Acne scarring medical treatments include:

Chemical peels

A procedure that involves applying a strong acid to your face to remove the top layer of skin. It is often used for deep acne scars. There are at-home versions as well as dermatologist-applied chemical peels that include stronger ingredients.

Laser resurfacing

Similar to chemical peels, laser resurfacing or dermabrasion removes the top layers of damaged skin to reduce the appearance of acne scars.

It is suitable for all types of acne scars and lighter skin tones.

Microneedling

Microneedling is a relatively new treatment that involves a needle-studded roller or pen puncturing the numbed surface of acne scars. As the skin heals, it encourages the production of collagen. Microneedling can improve the appearance of scars but the side effects can include post-inflammatory hyperpigmentation and acne.

Dermal fillers

Dermal fillers are best used for depressed scars. The procedure involves a substance being injected under the scar to lift the skin upwards and make the scar less noticeable.

Research shows that injecting hyaluronic acid gel into atrophic or depressed scars improved the scar severity in 67% of people.

Cryotherapy

Cryotherapy involves a dermatologist applying liquid nitrogen to the scar to freeze it. The freezing process damages the abnormal skin cells, killing them off, and encouraging new, healthier skin cells to grow in their place.

Cryotherapy is often used for hypertrophic or raised scars, particularly on the back, chest, or face. However, younger and smaller scars are most responsive to this type of treatment.

Is it possible to undertake scar treatment alongside acne treatments?

No, it’s usually not recommended to start treatment for acne scars while you still have active acne.

Most doctors and dermatologists recommend treating acne first before starting scar treatment because treating scars may worsen your acne or lead to further scarring.

One of the best ways to avoid acne scars developing is by getting early and effective acne treatment.

There are several different types of acne, including:

Cystic acne is a severe type of acne that causes painful pus-filled spots. Several treatments are available for this type of acne including topical retinoids, like:

• Differin cream – a type of topical retinoid cream that contains the active ingredient adapalene
• Treclin gel – combines a topical retinoid called tretinoin with the antibiotic clindamycin
• Epiduo gel and Epiduo Forte gel – a gel that contains benzoyl peroxide and adapalene

Comedonal acne is characterised by small bumps that appear on the skin called comedones which can be open (blackheads) or closed (whiteheads). Topical retinoids are the most effective treatment for comedonal acne. For example, adapalene gel can reduce non-inflammatory lesions by 46%. At Superdrug Online Doctor we offer Differin gel or Differin cream.

Forehead acne causes breakouts on the forehead usually because of hormone changes, stress, or irritation. The type of acne lesions you have will determine which type of acne treatment you will need. At Superdrug Online Doctor, we offer a wide range of acne treatments, including:

• Acnecide 5% gel – topical benzoyl peroxide that’s applied once or twice daily to kill or stop the growth of acne causing bacteria
• Differin cream – a retinoid cream that contains the active ingredient adapalene which increases skin cell turnover to prevent acne outbreaks
• Finacea gel – contains the active ingredient azaleic acid that works by reducing the growth of acne causing bacteria and prevents pores becoming clogged – also available under the brand name Skinoren cream
• Treclin gel – combination of the antibiotic clindamycin and a retinoid, tretinoin, that’s used to treat facial acne
• clindamycin 1% + benzoyl peroxide 5% Gel – combination topical treatment that contains an antibiotic and benzoyl peroxide to kill the bacteria that causes acne and unclog pores
• doxycycline + Skinoren 20% cream – a combination of doxycycline oral capsules, a type of antibiotic, and Skinoren cream

Hormonal acne is caused by hormonal changes that can lead to excessive oil production in the skin leading to breakouts, including pimples, comedones, and cysts.

You can further reduce the risk of developing acne scars by:

• avoiding picking or squeezing spots – this will cause further damage and inflammation to your skin increasing the risk of scarring
• wearing sunscreen – too much sunlight can darken scars making them more noticeable, wearing sunscreen on your face will help prevent further damage
• avoiding smoking – tobacco smoking increases the risk of acne scars, so quitting smoking can help

Acne scars are a complication of acne that are most common with severe acne types or if you are prone to picking or popping spots. There are 2 main types of acne scars:

• depressed scars caused by not enough collagen being made during the healing process
• raised scars caused by too much collagen being made

If you are not sure if you have acne or your scars are caused by acne, you can use our skin condition diagnosis service for a fast and accurate diagnosis from one of our doctors, enabling you to access the right treatment.

We offer a range of acne treatments at Superdrug Online Doctor, to help you effectively treat acne lesions and prepare your skin before treating acne scarring.