About 15% of people are left with post-acne scars after their active acne is reduced. Wondering what kind of scars you have and how you should treat them?
You're in the right place!
There are two main categories of post-acne marks. The first category includes flat, smooth brown or pink spots that DO NOT change the skin's texture. Then, there are "real acne scars," which alter the skin's texture. These real acne scars look like pits (icepick scars), valley-like depressions in the skin (rolling or boxed scars), or elevated hard-to-the-touch bumps. (hypertrophic and keloid scars).
Why do you get acne scars?
While a pimple is healing, your skin produces new collagen fibers to replace the damaged tissue. If this process is defective, these new collagen fibers will pull down. A scar may appear as a little bit on the skin's surface or a shiny, slightly raised surface. If you pick at a pimple too much, or if an acne pimple is so inflamed that your skin's collagen is destroyed, and not enough collagen is produced to rebuild the skin, you end up depressed (aka atrophic) scar. On the other hand, if the healing response gets a little too enthusiastic, it may result in a raised (aka hypertrophic) scar.
How to treat flat brown acne marks?
Treatment of post-acne brown flat spots is usually pretty straightforward. Your first step should be to control your active acne with an effective anti-acne treatment protocol. Do not pick or pop your pimples! This commonly contributes to acne scars. The second step - use an oil-free sunscreen. Excessive sun exposure and visits and avoiding the sun or tanning salons will make your post-acne dark spots darker. The third step – look for a high-quality dark spot corrector for acne-prone skin. Dark spot correctors are not alike. The best Dark spot corrector will contain Hydroquinone. The newest ones add Arbutine, a natural, non-medicated hydroquinone alternative, retinoids, and plant-based complexes that help fade the post-acne spots faster, with less skin irritation.
For more resistant brown spots, it's possible to add superficial peels or intense pulse light treatments — for any of those, you'll need to visit your dermatologist.
How to treat flat pink and red acne marks?
The enlargement of microscopic capillaries causes pink or red post-acne spots. They usually fade two to three months after your acne is controlled. If you want to fade them faster, a couple of IPL (Intense pulsed light) or laser treatments will do the job.
What are the five main types of real acne scars?
There are five distinct types of real acne scars. Icepick scars, rolling scars, boxed scars, hypertrophic acne scars, and keloid acne scars.
What are icepick acne scars?
Another kind of "real acne scar" is called an icepick scar. These are smaller in diameter (1-2 mm) deep, with possible tracks to the dermis or subcutaneous tissue. Although the surface opening is smaller and steep-sided, a broad base may evolve into depressed or boxcar scars. Icepick scars are commonly seen on the cheeks.
What are boxcar (boxed) acne scars?
"Boxcar Scars" are shallow (0.5 mm) or deep (0.5 mm) and often 1.5 to 4 mm in diameter. They have sharply defined edges with steep, almost vertical walls. Shallow scar treatment can happen with resurfacing or possibly punch elevation, whereas deep scar treatment is often done by punch excision, elevation, or another modality.
What are rolling acne scars?
Last, there are soft "rolling acne scars." These can be circular or linear, are often greater than 4 mm in diameter, and have gently sloped edges that merge with normal-appearing skin. Treatment is commonly by subcision.
What are hypertrophic acne scars and keloid acne scars?
Hypertrophic acne scars (Elevated scars confined within the margins of an original pimple) and keloid acne scars (Elevated scars larger than the actual pimple and commonly found on the chest, back, shoulders, and ears. Both hypertrophic scars and keloids have thicker, more abundant collagen stretched and aligned in the same plane as the epidermis. Both have 5-to-15 times higher in African Americans and 3-to-5 times higher in Asians (Compared with Caucasians). It's estimated they affect both the African American and Hispanic populations between 4.5% and 16%.
What is the best cream for acne scars?
Topical creams can not eliminate real depressed (atrophic) acne scars. That said, using topical retinoids for long periods can help smooth the skin. Retinol, a derivative of vitamin A, is one of the best options available over the counter and does not require a dermatologist's prescription. Acting as topical vitamin A, retinol was shown to promote skin cell turnover and renewal and increase new collagen fiber production in the dermis. High-quality retinol will also cause mild exfoliating to the skin's upper surface, providing a fresher natural glow. If your concern is mainly post-acne dark spots, you may also want to check out the Dark Spot Remover, which can be used alongside your acne treatment (alternating nights) to help treat dark spots more quickly.
What are the best supplements to treat and prevent acne scars?
Taking acne supplements can help the wound healing process and reduce the risk of scarring. The most important vitamins and minerals that play a role in wound healing and treatment of existing scars are the vitamins from the B family, Vitamins A, the minerals zinc and selenium, and to a lesser extent, vitamins C and D.
Regular "one size fits all" skin and hair multivitamins are not the best choice for people with acne scars. They usually contain a large amount s of biotin and vitamin E, which can counteract the beneficial effect of vitamins A and B5 on active acne and acne scars. A better choice is that vitamin and mineral supplements are specially formulated for acne and acne scars. This vitamins and mineral formulation contains the correct amount of vitamins (especially A and B5) and the correct amount of Zinc, with less Biotin and Vitamin E.
What are the best office treatments for real acne scars?
Real acne scars are the hardest to treat. But there's hope — a few new in-office technologies show promise. Dermatologists use the most popular technologies to treat acne scars: microneedle radio-frequency, fractional lasers, subcision (cutting under the scar with a scalpel), and injectable fillers (temporary solution).
This technology is regarded today as the gold standard for treating acne scars. It uses extra-sharp gold-plated micro-needles to heat the deep part of the skin. These minute needles (300 microns wide) penetrate the skin gently to a depth of up to 3.5 mm with minimal pain or discomfort. Once they reach the death of the skin (dermis), they produce heat. This heat promotes a natural healing process of the skin that builds new collagen and decreases the depth of the scars. In addition to its efficacy in treating acne scars, microneedle radiofrequency causes minimal downtime. The skin is red for a few hours, and the patient can return to school or work the next day.
Ablative and non-ablative fractional lasers
Laser treatments come in two forms: ablative and non-ablative. Ablative lasers resurface the skin by removing outer layers. Non-ablative lasers create changes in the dermis without causing damage to the skin's surface. The carbon dioxide laser is the most common ablative laser used to treat acne scars. Ablative fractional lasers create micro burns in the skin that trigger the buildup of new collagen. The results are usually similar to microneedle radiofrequency but with more pain, downtime, and risk for post-treatment hypo and hyperpigmentation. The usual result of fractional ablative laser treatment is that "new" skin is smoother, atrophic scars are reduced in-depth, and the overall scarring is softened. After ablative laser treatment, the skin generally heals within two weeks but can remain red for some time after healing. The redness fades over several weeks to several months.
Non-ablative lasers tighten the skin and stimulate new collagen formation. These lasers are less effective than microneedle radiofrequency or ablative lasers and have minimal effects on deep, pitted scars. Pulsed dye lasers are another kind of non-ablative laser that is used to improve raised scars and keloids.
Subcision (cutting under the scar with a scalpel)
One of the causes of depressed scars is collagen fiber that pulls down the skin's surface. In a Subcutaneous incision, also known as subcision, a needle or small scalpel is inserted to run parallel to the skin's surface. Once these bands have been released, the surface of the skin lifts, smoothing the skin surface's appearance. This procedure is invasive, requires local anesthesia, and is more costly than the microneedle or laser treatment.
Injectable dermal fillers
Similar to wrinkles, Depressed scars can be filled with injectables. These are called dermal fillers. Substances used as dermal fillers can be made of include human and bovine collagen, hyaluronic acid, or fat transferred from the patient's own body. A filler substance is injected into the acne scar, elevating the scar base, even with the skin's surface. Unfortunately, these fillers degrade with time, and procedures should be repeated every few months.
The best way to get rid of acne scars is to prevent them. Treat your active acne effectively - and you will not struggle with acne scars. If you already have acne scars, there are ways to treat them. If these "scars" are flat, a good Dark Spot Corrector cream will do the job. If the scars are deeper, pitted, or depressed, you will need more than just topical creams.
Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45(1):109-117. doi:10.1067/mjd.2001.114011. PMID: 11423818.
To find the right acne treatments for your unique skin, take the free skin assessment by clicking here.