The best way to get rid of acne scars is to prevent them from happening in the first place. Avoid popping pimples at all costs. A popped pimple will lead to more inflammation and damage to your skin. Instead cover your lesions with hydrocolloid dressings and use the appropriate treatments to prevent acne from developing.
Once your acne is under control you can start treating the scars. It does not make sense to treat scars while you have uncontrolled acne. While acne scars fade over time, this process can be accelerated with acne scar removal treatments. For the best results you should see a dermatologist but if you’re interested in how acne scars are treated read on.
Types of Acne Scars
Most acne scars are not typical scars but a reaction called Post-Inflammatory Hyperpigmentation, which are flat, tan, brown or black spots where an acne lesion was popped. These are simply blemishes or discolorations and are not surface defects. To treat the excess pigment production you can utilize a variety of over the counter skin brightening ingredients. These will be covered later in the article.
Acne scars that are not flat but contain holes or bumps are classified in the following manner:1
- Icepick scars – as the name implies, these scars are narrow and deep. Pitting is usually involved.
- Rolling scars – these scars feature wide depressions with less defined edges.
- Boxcar scars – these scars leave wide depressions with well-defined edges.
- Keloid scars – also known as hypertrophic scars, these appear lumpy and thick. Unfortunately, these are the most difficult scars to get rid of and may return even if treatment was originally successful.
Best Acne Scar Treatments
The best type of acne scar treatment depends on the type of scar.
For Flat, Discolored Acne Scars: Flat, discolored acne scars can be reversed by using skin whitening/brightening products. Dermatologists will often utilize an ingredient called hydroquinone alone or in combination with other ingredients such as a retinoid to increase skin turnover and renewal or hydrocortisone to reduce irritation. Hydroquinone is available over-the-counter at strengths up to 2.0%.
Below are some alternative skin brightening ingredients to hydroquinone:
Natural Skin Brightening Ingredients:
- Retinol : Retinol is a retinoid that is over-the-counter. Retinoids work by stimulating cell renewal and turnover.
- Azelaic Acid is found in wheat, rye and barley. It inhibits melanocyte pigment production.2
- Niacinamide: A form of vitamin B3 that inhibits the transfer of melanin from melanocytes to skin cells above which reduces visible pigmentation.1
- Kojic Acid: A product in the fermenting of malting rice for sake and rice wine. It is used in many dermatology products as a skin lightener. It works by inhibiting the enzyme tyrosinase which is one of the key enzymes for melanin production. It is also exhibits antibiotic and anti-inflammatory properties.1
- Soybean Extract: Derived from the soybean plant, it is commonly used as a skin-lightening ingredient in moisturizers. It can suppress additional pigment from coming to the skin’s surface.1
- Licorice Extract: Licorice extract containing glabridin improves hyperpigmentation by dispersing melanin and inhibiting melanin biosynthesis. It also has anti-inflammatory properties.3
- Arbutin: Arbutin is the most widely prescribed skin-lightening agent worldwide. It is found in the dried leaves of bearberry, blueberry, cranberry, and pear trees. Arbutin inhibits the activity of tyrosinase enzyme which produces melanin.2
- Fungus Lignin Peroxidase is a fungal enzyme that breaks down melanin (skin pigment) in the skin.1
Sun exposure without protection may make pigmentation worse and often time delays acne scars healing. Therefore, it is important to thoroughly apply sunscreen with zinc or titanium dioxide with at least SPF 30 every day and to reapply the sunscreen as needed.
When you use a retinoid or a skin lightening/brightening ingredient that you need to observe strict sun protection precautions or else the hyperpigmented acne scar may get worse.
Depending on the severity of your acne scars your dermatologist may elect to perform chemical peels and/or IPL/laser therapy instead of treatment with hydroquinone. IPL stands for intense pulsed light which applies thermal and light energy to destroy the chromophores (pigmented, color-loving molecules) of the skin. Peels and laser therapy stimulate skin renewal and remodeling by obliterating the upper portions of the skin.
For Acne Scars with Indentations:
While mild acne scars leave a blemish, more severe scars will leave a void or holes which will require more intensive medical treatments. These are treated using the following treatments:
- Chemical peels, Dermabrasion and Skin Needling - Acne scars may respond to therapies such as chemical peels, dermabrasion and skin needling. These processes stimulate a wound healing response that causes the underlying collagen to be remodeled.4 Chemical peels work by replacing the skin’s outer layer, so that new, less scarred skin comes in. Dermabrasion involves surgically sanding the skin’s outer layer, so that it appears smoother. With skin needling, also known as micro needling, tiny needles puncture the skin in the affected area. This procedure induces collagen growth, repairing the skin. If you decide to go the skin needling, expect several treatment sessions.
- Dermal Fillers - Scars with depressions may improve with dermal fillers[5]. Injectable dermal fillers may have temporary, semi-permanent or permanent results, according to the type of filler used. Hyaluronic acid and collagen injections, found in fillers such as Juvederm often used to plump up lines and wrinkles, last between three to 18 months. Semi-permanent fillers, lasting up to two years, consist of poly-l-lactic acid and calcium hydroxylapatite injectables. Patients may require a series of treatments before observing results. Permanent fillers for acne, which may not literally prove permanent but can last for many years, include silicon, polyacrylamide, polymethacrylate, and hydroxyethylmethacrylate.
- Laser resurfacing - Laser resurfacing treatment for acne scars is often used in conjunction with dermal fillers for best results. Generally, a series of laser treatments are required. Laser treatment does not provide instant results, but patience is a virtue. Over the course of several months, the acne scars may diminish considerably. Different types of lasers are used for acne scar removal treatment. Using fine needles, a pulsed dye laser delivers its beam beneath the skin and is directed toward the blood’s hemoglobin.
Treatments for Raised Acne Scars:
Intralesional Corticosteroid Injection - Medical professionals use intralesional corticosteroid injections6 to reduce hypertrophic/keloid scars. It works by inhibiting cellular and protein growth where it is injected. Unfortunately, keloids often form again after the effects of the corticosteroid wears off. Most people will require multiple injections to keep the scars flat.
Again, the best treatment for acne scars is prevention. Below we will discuss how to prevent acne scars.
How to Prevent Acne Scars
An ounce of prevention is always worth a pound of cure. Dermatologists warn patients not to pop a pimple or blackhead, advice that is often not heeded. Squeezing a pimple may remove the pus, but you run the risk of leaving a scar behind. What to do when you feel a zit brewing? A hydrocolloid patch stuck on the pimple overnight can squelch it while you sleep. These “pimple patches” absorb fluid within the blemish, and in just a few hours, that zit is history. Another plus – with a patch on the pimple, you aren’t tempted to pick at it.
Of course, the best way of preventing acne scars is not having pimples in the first place. While there’s no way to guarantee that your skin will never suffer a pimple again, acne supplements can reduce outbreaks and help control inflammation. DrFormulas Dermatrope Acne Supplement was formulated to address the many causes of acne. It contains fish oil, turmeric, and probiotics to address inflammation and DIM to promote hormonal balance.
Sources:
- https://www.dermnetnz.org/topics/acne-scarring/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598204/
- https://www.jaad.org/article/S0190-9622(14)01383-8/abstract
- https://www.asds.net/Skin-Experts/Skin-Treatments/Chemical-Peels/Chemical-Peels-for-Acne-Scars
- https://www.asds.net/Skin-Experts/Skin-Treatments/Dermabrasion/Dermabrasion-for-Acne-Scars
- https://www.allure.com/story/hydrocolloid-bandages-acne-stickers
- https://www.sciencedirect.com/science/article/pii/S2352647515000295
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051300/
About the Author:
Dr. Bryan Do, D.O. is an osteopathic physician whose research interests include gastroenterology, immunology, and dermatology. He is particularly interested in the role of probiotics in the gut-brain-skin axis and has written many articles on the topic. He graduated from University of California, Los Angeles (UCLA) before graduating from Marian University College of Osteopathic Medicine in Indianapolis, Indiana and becoming a Doctor of Osteopathic Medicine. Osteopathic physicians are taught to take a holistic approach to medicine and to consider mind, body, and spirit when treating a patient. Osteopathic physicians receive training in Osteopathic Manipulative Medicine (OMM) in addition to the standard rigorous medical school curriculum. Both physicians with a Doctor of Osteopathic Medicine (D.O.) degree as well as a Doctor of Medicine (M.D.) can practice medicine.