There are two main types of acne scars. Physical scars that can be felt with the hand and pigmented flat spots are color changes. The most common physical scars will look like depressions in your skin or deep holes, also called ice-pick scars.
What are the best treatments for flat hyperpigmented acne "scars"?
The treatment of hyperpigmentation should always start with good sunscreen. The best sunscreen for people with acne-prone skin would be an invisible broad-spectrum (UVB/UVA) sunscreen that is also oil-free and water-resistant. SPF 30 is optimal. Higher SPFs contain more chemicals and have an increased risk of allergies.
The second step would be using a dark spot remover. The best ingredients to look for in skin brightening cream are hydroquinone in the USA and arbutin outside of the USA.
What is the best dark spot remover in the united states?
Hydroquinone is the gold standard for treating dark spots and is highly effective. It can be bought in the USA without a doctor's prescription but will require a doctor's prescription in most countries out of the USA. Hydroquinone works best with retinoids and an anti-inflammatory agent (Kligman's formula). One of the best Hydroquinone-free Kligman formula-inspired dark spot removers is MDacne's Dark Spot Remover which can be found here.
What is the best dark spot remover outside the united states?
The best choice of a dark spot remover out of the USA will be products based on Arbutin. Arbutin is a natural substance that transforms into hydroquinone in the skin. In combination with other ingredients, it can help fade hyperpigmentation.
What are the best surgical treatments for physical acne scars?
Surgical procedures performed in a dermatologist's office are the most effective treatments for this type of scars. Cutting the collagen fibers under the scars (undermining) is the most common surgical treatment for depressed acne scars. A less invasive procedure is microneedle radiofrequency, which can significantly improve physical acne scars and make the skin smoother and less bumpy.
What are the best non-surgical treatments for physical acne scars?
Some improvements can also be achieved with non-surgical methods.
Retinol is the most effective anti-scar topical treatment. If used correctly for at least six months, it produces a gradual skin exfoliation and the production of new collagen fibers in the dermis. These effects can decrease the depths and the appearance of depressed acne scars and provide a healthier, brighter look for the skin. Combined with niacinamide and dimethicone, high-quality retinol will cause less redness and irritation than the simple "one size fits all" prescription retinoids.
How to use exfoliation for the treatment of depressed acne scars?
Using particle scrubs or electric spin brushes is not good for people with physical scars. It can cause more dark spots and more acne breakouts if it damages the skin's protective barrier layer. The correct way to exfoliate the skin is with several well-researched topical agents; retinol and alpha and beta hydroxy acids. (AHA/BHA).
The most effective of those would be retinol. Used in the adequate percentage of 0.25%-0.5%, it causes a mild, invisible exfoliation of the skin's upper layer. With time it renews the epidermis and makes the skin smoother and brighter. More importantly, retinol penetrates deeper into the dermis and triggers the production of new collagen. If used for at least six months, these effects will reduce the appearance of physical scars and provide a smoother, glowing look to the skin. Combining niacinamide with retinol will enhance the beneficial effects of retinol while reducing skin redness and irritation.
Alpha and beta hydroxy acids are also effective peeling agents for the epidermis. Having said that, AHAs and BHAs will not have the same effect as retinol for the dermis and will not help with collagen production and depressed scars or fine wrinkles.
What is the effect of silicone gel on scars?
There are multiple silicon gels on the market claiming to help with scars. Silicone gel or silicone sheets can sometimes help with hypertrophic, raised scars. Unfortunately, silicon gels do not affect the skin's deeper layer and will not help depressed acne scars. A better choice for depressed scars is dimethicone, a type of silicon used in a high-end moisturizing cream. Dimethicone will not be as effective as retinol or niacinamide but would help make the skin smoothers and reduce the appearance of depressed scars.
Anti-scar clay masks
Clay masks can be beneficial to people with acne and post-acne scars. The best masks for acne or acne scars will be based on pink clay that absorbs skin oil and reduces skin redness and irritation. When those masks are boosted with retinol and AHA/BHA, they can help provide mild exfoliation and help reduce the appearance of flat and depressed scars. Using those masks 1-2 times per week would be optimal for most people.
- Goodman GJ, Baron JA. Post acne scarring: a qualitative global scarring grading system. Dermatol Surg. 2006;32(12):1458-1466.
- Layton AM. Optimal management of acne to prevent scarring and psychological sequelae. Am J Clin Dermatol. 2011;12(5):283-294.
- Fabbrocini G, Annunziata MC, D'Arco V, et al. Acne scars: pathogenesis, classification, and treatment. Dermatol Res Pract. 2010;2010:893080.
To find the right acne treatments for your unique skin, take the free skin assessment by clicking here.