Acne scarring is a risk from any type of acne lesion, however, the likelihood of scarring usually increases for larger and more inflamed lesions.
Lawrence Green, M.D.
Board-Certified Dermatologist, Aesthetic and Dermatology Center (Maryland)
Lawrence Green, M.D., is a past member of the American Society for Dermatologic Surgery (ASDS) Board of Directors. Dr. Green also serves as a Clinical Professor of Dermatology at George Washington University School of Medicine and shares his medical expertise as an ASDS Social Media Ambassador and Advocacy Ambassador.
What causes acne scarring?
An acne spot starts with a clog in a pore on the skin. Cellular material gets trapped in the clog and our immune systems respond to that, recognizing that the clogged material shouldn’t be there. It sends immune system cells to try to destroy the material that is trapped in the clog. Immune system responses are seen as redness on the skin — the larger the immune response, the larger the red bump becomes.
When this large immune response resolves, sometimes the skin heals with a scarring response. First, your skin can heal with a darker or lighter discoloration, or redness that is flat on the skin. This response is not considered scarring because the flat discoloration doesn’t contain scar material. The discoloration may stay for a while and often will fade over time (but not always).
On the other hand, an acne scar response is almost always permanent, just like any scar on the body. The body heals from the large inflammatory immune response by creating scar tissue at the site.
Types of acne scars
Acne scars can look a little bit different for everyone. The most common types include:
- “Atrophic scars” that are wide with very little depth, appearing more superficial as a result of tissue loss. Examples are “icepick scars” (small, depressed narrow scars that look like holes in the skin), “rolling depressed scars” (wide and wavy in texture like an upside-down hill), and “boxcar scars” (small sunken squares).
- “Hypertrophic” or “keloid” scars are caused when the body produces too much collagen as acne wounds heal, resulting in a mass of raised tissue on the skin’s surface.
Regardless of the type, all acne scars are usually permanent to some degree, but they also tend to fade somewhat as months and years pass. Some retinoid creams, such as tretinoin, trifarotene, or tazarotene, all prescribed by your dermatologist, have been clinically proven to help scars heal after the inflammation in them has subsided.
Prevention and treatment
The best way to prevent acne scars is to see your board-certified dermatologist to treat your acne so that little to no scarring occurs. If you already have some acne scars, your dermatologist can evaluate your skin for a customized treatment plan. After scars form, I recommend that my patients continue their prescription retinoid cream for at least six months before starting any cosmetic procedure to help lessen and improve the scar’s appearance.
Dermatologists commonly use laser therapy, such as the “pulsed dye laser” to take redness out of scars. “Microdermabrasion” is another effective non-invasive treatment that applies tiny rough particles to remove the uppermost layer of skin.
If you only have a few deep scars, dermatologists usually recommend a cost-effective treatment called “subcision” to help improve them. This is performed with a sterile needle (after numbing your skin) to break apart the fibrous bands of tissue that prevent the skin from laying in its natural position. It can also be done with a chemical peeling agent. Usually, several treatments are recommended to obtain the best results.
If you have many scars, your dermatologist may perform a series of “chemical peels” to remove the outer layer of old skin. “Microneedling,” or microneedling with radiofrequency, can be used to improve scars that cover much of the face. These minimally invasive procedures involve a topical anesthetic and superficial controlled skin puncturing at a set depth with fine needles to stimulate the body’s collagen production and smooth acne scarring. Expertly trained dermatologic surgeons can perform these procedures on patients of any skin color.
Know your provider’s credentials
There are additional procedures that can treat acne scarring, and many times a customized treatment plan will use a combination approach. It’s important that you seek guidance and care from a physician with extensive training and patient care hours who can evaluate your particular case. Visit asds.net/Find to locate a board-certified dermatologist near you.