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Acne Scars: Causes, Types and Treatments

Acne scars are permanent changes to skin texture caused by severe or poorly treated acne. Learn about types, causes, and the most effective treatment options available.

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Things worth knowing about "Acne scar"

Acne scars are permanent changes to skin texture caused by severe or poorly treated acne. Learn about types, causes, and the most effective treatment options available.

What Is an Acne Scar?

An acne scar is a lasting change in the structure of the skin that forms after inflamed acne lesions heal. When deep pimples, cysts, or nodules damage the collagen framework within the skin, the body's repair process can lead to permanent scarring. Acne scars affect millions of people worldwide and can significantly impact self-esteem and quality of life.

Causes and Formation

Acne scars develop when inflammation from an acne lesion penetrates deep enough to damage the surrounding skin tissue. The body responds by producing collagen to repair the damage. If too much collagen is produced, raised scars form; if too little collagen is produced, depressed scars result.

Severe, inflammatory acne (nodular or cystic acne)
Squeezing or picking at pimples
Genetic predisposition to scarring
Delayed or inadequate acne treatment

Types of Acne Scars

Depressed Scars (Atrophic Scars)

This is the most common type of acne scar, caused by a loss of skin tissue. There are three main subtypes:

Ice pick scars: Deep, narrow, pitted scars that extend into the skin
Boxcar scars: Broad, flat depressions with sharply defined edges
Rolling scars: Shallow, wave-like depressions with soft, sloping edges

Raised Scars (Hypertrophic and Keloid Scars)

Hypertrophic scars are raised, firm scars that stay within the boundary of the original wound. Keloid scars grow beyond the original wound area and can become larger than the original acne lesion.

Post-Inflammatory Hyperpigmentation

After acne heals, reddish or brownish discoloration can remain on the skin. This is called post-inflammatory hyperpigmentation (PIH). It is not a true scar but a temporary pigment change that may fade over time, especially with proper treatment and sun protection.

Diagnosis

Acne scars are typically diagnosed through a clinical examination by a dermatologist. The doctor evaluates the scar type, depth, extent, and skin tone to recommend the most suitable treatment. In some cases, dermatoscopy may be used to assess the skin structure in greater detail.

Treatment Options

A wide range of treatments are available for acne scars. The choice of therapy depends on the scar type, skin tone, and severity of scarring.

Laser Treatments

Laser procedures such as fractional CO2 laser or erbium laser stimulate collagen production and improve skin texture. They are considered among the most effective treatments for atrophic scars.

Microneedling

Microneedling uses fine needles to create controlled micro-injuries in the skin, triggering the natural collagen production process. It can visibly improve the appearance of various scar types, particularly rolling and boxcar scars.

Chemical Peels

A chemical peel involves applying an acid solution (e.g., glycolic acid, trichloroacetic acid) to the skin to remove the outer layers and promote skin renewal. It is particularly effective for superficial scars and pigmentation changes.

Dermabrasion and Microdermabrasion

Dermabrasion mechanically resurfaces the skin to smooth out uneven scar tissue. The gentler microdermabrasion is better suited for mild pigmentation issues and superficial surface irregularities.

Dermal Fillers

Dermal fillers such as hyaluronic acid can temporarily fill depressed scars and smooth the skin surface. Results are immediate but require periodic repeat treatments.

Corticosteroid Injections

For hypertrophic scars and keloids, corticosteroid injections are commonly used to flatten and soften the excess scar tissue over time.

Topical Treatments

Products containing retinol, vitamin C, niacinamide, or azelaic acid can support skin renewal and help fade pigmentation changes. However, they are less effective for deep or structural scars.

Prevention

The most effective strategy against acne scarring is early and consistent treatment of active acne. The following measures can help minimize the risk of scarring:

Avoid squeezing or picking at pimples
Seek dermatological treatment for acne early
Apply sunscreen consistently, as UV exposure can worsen scars and pigmentation
Treat inflammatory acne with appropriate medications as prescribed

References

Fabbrocini, G. et al. - Acne Scars: Pathogenesis, Classification and Treatment. In: Dermatology Research and Practice, 2010.
Tan, J. et al. - Acne scarring: A review of current treatment options. In: Journal of the American Academy of Dermatology, 2017.
American Academy of Dermatology (AAD) - Acne Scarring: Diagnosis and Treatment Guidelines, 2022.

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