Acne scars can be a source of frustration and insecurity, but there’s good news: with dedication, the right products, and consistent treatment, you can significantly reduce their visibility. We consulted with dermatologists to provide a comprehensive guide to treating acne scars and keloids, covering prevention, effective home remedies, and the latest medical treatments available.
Understanding Acne Scars
First, it’s important to understand what acne scars are. They are the marks left on the skin after moderate to severe acne, referring to indentations or pits. “They are what remain after acne heals,” explains Marisa Garshick, MD, a dermatologist at MDCS Dermatology. “They may appear as red or brown discoloration, blemishes, or changes in texture.”
Types of Acne Scars
There are three main types of acne scars, according to Garshick: icepick, boxcar, and rolling. Icepick scars are narrow, deep, and resemble holes in the skin. Boxcar scars are shallow and indented with a sharp, almost 90-degree angle. Rolling scars are also shallow and indented, but the depression is smoother. The type of scar you have will determine the appropriate treatment approach.
It’s crucial to differentiate between acne scars and marks. “Many patients use the words ‘scar’ and ‘mark’ interchangeably, but I define them as totally different things,” explains Andrew Alexis, MD, PhD (MPH), a professor of dermatology at the Icahn School of Medicine at Mount Sinai. “Acne scarring is permanent if not treated and leaves the skin with indents or depressions. Acne marks, on the other hand, eventually fade, but are characterized by flat or smooth black spots (hyperpigmentation) or long-lasting red spots (erythema) in the area where the acne lesion was.” How can you tell the difference between a scar and a mark? “Close your eyes and feel your face or the area where you had acne with your fingers,” advises New York City dermatologist Sheelah Idriss. “If the texture feels different, it’s likely a scar.”
What Causes Acne Scars and Keloids
Generally, “scarring” refers to what happens to skin after an injury; any time the skin is wounded or damaged, it tries to repair itself, often leaving a scar. Acne scars follow this same principle. “Depending on the severity, pimples can affect not just the top layer of the skin, but the deeper layers as well,” says Idriss. “As inflammation resolves and the skin tries to heal, scar tissue is formed. Severe acne, picking, and delayed treatment can all contribute to scar formation.”
Garshick adds that excess oil production, inflammation, and bacteria are also involved. Most pimples heal without leaving marks, but some blemishes are more stubborn and tend to scar. Some individuals are also genetically predisposed to scarring.
Preventing Acne Scars and Keloids
The first step to preventing acne scars is treating the underlying cause. “Start by controlling and treating your acne, otherwise, you’ll be in a constant battle with new scars forming,” says dermatologist Naissan O. Wesley, MD, FAAD. Some acne treatments can even improve the appearance of existing scars, she adds. “Once you have your acne under control and are breaking out less frequently, then consider getting additional acne scar treatment. It’s a good time to address the scars you still have.”
Alexis recommends following your dermatologist’s prescribed acne therapy if you’re dealing with moderate to severe acne, such as red bumps, pus, or cystic lesions. Wesley also suggests using over-the-counter soothing acne treatments. “Try a treatment containing salicylic acid and willow bark extract, which you can apply with a cotton ball. This will help soothe inflamed acne and gently exfoliate the surface of the skin, which can speed up healing of acne and acne scars,” she explains. “Prebiotics, polysaccharides, calendula, and sage are also known to help promote healing and maintain the skin’s moisture barrier.”
Treating Discoloration First
“When considering a treatment plan for acne scars, I recommend treating discoloration first,” says Idriss. “Evenizing the color of the scar can make the texture changes less noticeable than you might think.” It’s also important to be aware of how acne impacts different skin tones. “Lighter skin tones or people who tan easily tend to have more red acne marks, while darker skin tones or people who tan easily are more likely to have brown acne marks,” explains Wesley.
Skincare for Acne Scars
One of the most powerful topical treatments for fading marks is vitamin C serum. Vitamin C is packed with antioxidants, protecting the skin from damaging free radicals caused by the sun, while also brightening the skin and making marks less noticeable. Incorporate retinol into your skincare routine as well. A derivative of vitamin A, retinol is an essential nutrient that boosts cell turnover and stimulates collagen production, which can help treat discoloration. You can also use retinol alternatives. Garshick also notes that for sensitive skin, niacinamide can help calm redness and improve pigmentation.
Add gentle exfoliation with acids into your regular skincare routine. Chemical exfoliants, like alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs), work to soften the skin and remove dead skin cells, resulting in a smoother appearance, says Garshick. For oily skin or those with active breakouts, incorporating a BHA, such as salicylic acid, can help reduce not only acne but also redness and fading marks. On the other hand, AHAs like glycolic acid, mandelic acid, and lactic acid are ideal for treating discoloration.
Always Wear Sunscreen
Wearing sunscreen is always important but is one of the most effective ways to address acne scars, particularly pigmentation, says Garshick. “Sun exposure can cause scars to darken and become more noticeable,” she explains. If you’re worried that sunscreen will exacerbate breakouts, choose a non-comedogenic type that won’t clog your pores.
Medical Treatments
While unfortunately, once a scar forms, it doesn’t fully disappear. However, you can improve its appearance with professional treatments in combination with topical medications. You have many options, including fillers and steroid injections, but the three most common medical treatments to consider are:
1.
Laser Treatment
“Lasers are incredibly effective at improving acne, acne scars, and keloids,” says Wesley. Garshick agrees and adds that they can be used to target skin tone and texture. Some lasers and light devices, like IPL (intense pulsed light) or pico lasers, are particularly effective for dark marks, while others, like pulsed dye laser (PDL), work well for red spots.
Non-ablative and ablative surface resurfacing lasers are excellent for treating acne scars, especially indented types. For hypertrophic scars or keloid scars from acne, Wesley says that combining vascular lasers or surface resurfacing lasers with topical or intralesional (injected directly into the scar) corticosteroids can improve the scar’s appearance, and photodynamic therapy (light therapy) can be used to reduce inflammation from active acne.
2.
Microneedling
Microneedling is a process that involves creating tiny punctures in the skin to stimulate new collagen production. According to Garshick, it can help improve the appearance of indented or atrophic scars and can be done in conjunction with platelet-rich plasma (PRP) therapy or radiofrequency treatment. It’s considered safe for all skin tones, but she emphasizes that it’s important to have it done by a qualified, licensed professional.
3.
Chemical Peels
Garshick says that chemical peels use exfoliating acids, such as AHAs and BHAs, to remove the top layer of dead skin cells, improving skin tone and texture and helping to fade dark marks and discoloration. They can also help even skin tone and smooth the overall appearance of the skin, treating textural changes like indentations or atrophic scars.
No matter what type of acne scars you have, the most important factor is to be patient with treatment. The nature of the scar and the type of treatment used can impact the timeline and outcome. Still, with a variety of approaches available, from at-home skincare to medical procedures, there are solutions for every individual. “It can be discouraging, but there are definitely more options for treating acne scars than ever before,” says Wesley. Find the approach that works best for you.
Text: Lauren Valenti & Audrey Noble
Translation: Moe Ideishi
From VOGUE.COM
