Unlike a raised scar that can emerge from a cut, acne scars are often pitted and require connective tissue called collagen to be rebuilt. Acne scarring can worsen as people age and their collagen level decreases. Thankfully, dermatologists can examine the acne scars — which are most commonly found on the face and back — to determine the best acne scar treatment and removal options.
Dr. Lindsey Bordone, a board-certified dermatologist in the Department of Dermatology at Columbia University Medical Center, says acne scars are important to treat with the assistance of a dermatologist because there are not over-the-counter solutions to acne-specific scars.
What Causes Acne Scars?
The good news: Whiteheads and blackheads rarely cause scarring unless a picked pimple traumatized deeper layers of the skin. Not all acne scars are caused by picking at zits, though. Cysts or inflamed acne can cause injury to the skin's surface, even if they are never touched. For that reason, dermatologists urge patients to work with a professional to treat the acne early rather than waiting for it to scar, because it's harder to fix.
Cystic acne on the face often leads to pitted scars, which can be addressed with a collagen-increasing treatment from a dermatologist. If you notice a red mark or discoloration on your skin following a zit, it's likely hyperpigmentation rather than an acne scar. In time, those spots will fade. For long-lasting hyperpigmentation or acne marks on other parts of the body, dermatologists can prescribe creams that speed up the healing process.
Bordone says it's rare for back acne to cause indented scars, but it is common to see dark marks and scars that take years to fade because the skin is thicker. Most of the time, it's just increased pigment following inflammation.
Can Acne Scars Be Prevented?
The first step to preventing acne scarring on the face and back is careful sunscreen application, Bordone says. Apply a noncomedogenic Neutrogena or CeraVe sunscreen that won't clog pores (even during breakouts) to help prevent dark marks from forming after the acne inflammation heals.
Despite popular belief, it is a dangerous myth that soaking up the sun's rays can improve acne. In reality, people who perceive skin improvements are often just seeing reduced redness as the sun's UV rays damage the skin. In other cases, the sun is temporarily drying out the skin and causing a short-term effect of reducing oil production, which the body will later overcompensate for with more breakouts. As the skin is damaged from the sun, it loses its protective barrier, and people grow more at risk for skin cancer. "Sunscreen prevents the sun's UV rays from causing what we call solar elastosis, which is thinning of the skin," Bordone says. "The thinning of the skin can make an atrophic scar worse."
Over-the-Counter Acne Scar Treatments
According to Bordone, over-the-counter scar treatments do not actually work for treating acne scars. To treat acne scars, you have to rebuild collagen, which is a protein that binds together the skin's connective tissue. Dermatologists can help formulate a plan to do that, but certain over-the-counter methods are often a waste of money.
"Something that you just put on the skin won't do anything for deeper indented scars. You really do have to treat the underlying acne," Bordone says. "When the scars are thin and indented, creams do not make much of a difference."
Professional Acne Scar Treatment Options
Before addressing acne scars, it's important to manage the acne to ensure the patient does not face cyclical problems, says Bordone. She prescribes Accutane as a treatment for severe acne, which can seem extreme for some patients who hope over-the-counter methods will solve all their problems. "A lot of people fear Accutane," Bordone says. "But, it's a really wonderful medication because it leads to a permanent cure in most of these severe cases of cystic acne."
Outside of Accutane, dermatologist-administered chemical peels or microdermabrasion can be used to help resurface the skin's cells. Some patients also respond well to laser treatments for hyper-pigmentation, though it does not work for everyone.
If you are affected by acne scarring, a licensed dermatologist can help create a treatment plan that best addresses scars, hyper-pigmentation, and the acne at the root of it.