How to get rid of acne scars

About 85% of people between ages 12 and 24 will get acne.

In some cases, acne scars can form after breakouts. While acne scars are more of a cosmetic concern than a health issue, many people are self-conscious about the way scars affect their appearance. The good news is that several types of effective acne scar treatments are available.

There are essentially three types of acne marks. The first kind is the depressed scar. Also known as face craters, depressed or atrophic scars sit below the surrounding skin. They're common on the face, although craters can also appear elsewhere. These scars form when the body doesn’t produce enough collagen—a substance that supports the skin—during healing.

The second type of scar is the raised or hypertrophic scar, which sits above the skin. These scars form when the body produces too much collagen as the skin heals. They are more common among people of color.

The third type of acne scar is the hyperpigmented scar. These acne dark spots on the skin are usually flat. As the skin heals, hyperpigmented scars can develop when the body produces too much melanin—the pigment that gives skin its color. Hyperpigmentation from acne is more common in people of color.

The most effective results are often seen when using two or more treatments combined. Depressed scars, sometimes referred to as "holes in the skin," can be treated with:

• Resurfacing. For widespread acne scar removal, resurfacing techniques may be the best option. These include laser treatment, chemical peels and dermabrasion, all of which remove the superficial (outermost) layers of skin. While widespread depressed scars can appear anywhere on the body, resurfacing is often used to treat scarring on the face, or what some people call a "pockmark face."
• Micro-needling. In this procedure, also known as collagen induction, a dermatologist uses a roller with very fine needles to create little holes in the skin. This will induce your skin to produce collagen, which can fill in defects.
• Fillers. A variety of substances, including collagen and fat from another part of the body, are used to fill up the depressed scar.
• Botox. A dermatologist injects onabotulinumtoxinA (Botox) to relax the surrounding skin and raise a puckered mark.
• Surgery. The goal of surgery is to convert a prominent acne scar into a less noticeable scar that should fade with time. This is usually accomplished with a procedure called punch excision, in which the scar is removed and replaced with a tiny, unscarred skin graft. Surgery is a good option when there are only a few scars that are very deep.
• Skin tightening. A dermatologist uses radiofrequency to tighten the skin, which may help make depressed scars less noticeable.

Dermatologists may use one of the following techniques to treat raised scars. Raised scars can sometimes be painful, so treatment may focus on relieving pain in addition to addressing cosmetic appearance.

• Injections. A dermatologist injects different medicines into the scars to flatten them. These medications may include corticosteroids, fluorouracil (F-FU, a chemotherapy agent used in cancer treatment) or interferon (a chemical we make in our bodies that is also used to treat cancer).
• Laser therapy. A pulsed dye laser transforms light into intense heat, destroying blood vessels in the skin. This works gently to increase circulation and lymphatic drainage, which helps to decrease inflammation. This technique is better for those with lighter skin, as one side effect of laser therapy is post-inflammatory hyperpigmentation, especially in darker-skinned people.
• Surgery. Like depressed scars, raised scars can be treated with surgery. Follow-up treatments, such as radiation or injections, are often required after surgery.
• Cryosurgery. The raised lesion is frozen, causing the skin to die and fall off.
• Products for acne scars. Many products with active ingredients such as retinol and silicone are available. They're most helpful for relieving the pain or itching that accompanies a raised scar. These products alone will not remove raised scars, but they may help improve their appearance.

Treatments for hyperpigmented scars include:

• Sun protection. This is a critical component of treatment, as sun exposure can make acne dark spots worse. Avoiding the sun, covering the skin and applying plenty of sunscreen regularly are your best bets for keeping the lesions from becoming more pronounced.
• Depigmenting agents. Hydroquinone is typically your first line of defense against hyperpigmentation. This medication is often combined in a topical formulation with other agents, such as retinoids or corticosteroids. It can also be used in conjunction with azelaic acid, kojic acid, niacinamide, ascorbic acid and licorice. Do not attempt to use these without consulting a dermatologist.
• Chemical peels. In this procedure, a chemical agent is applied to the skin, causing it to blister and peel off. The new skin that is formed is smoother than the old skin. Glycolic acid and salicylic acid are often used for these peels.
• Laser treatment. This procedure uses an intense light source directed at the melanocyte (the cell that contains melanin, which is the pigment that colors skin) to lighten the hyperpigmented lesion. Laser therapy is usually used along with other methods or when the other treatments don't work. It's worth noting that people of color have a higher risk of worsening their hyperpigmentation with laser therapy.

Yes, some types of acne scars go away on their own. Hyperpigmented lesions may resolve with time without any treatment. Most other acne scars are often permanent and may only fade or resolve with treatment. This is especially true of depressed scars caused by cystic acne.

Whether you have depressed, raised or hyperpigmented pimple scars, know that there are many treatments available. Some are over the counter, some are prescribed, and some are procedures that are performed by a doctor. Consult with a knowledgeable dermatologist to find out which treatment is best for you.

Published November 2021.