Acne Scars 101: Causes, Treatment, and Prevention

A bad breakout can be intense and uncomfortable. But sometimes, the biggest problems arise after the acne fades away—and the scarring sets in. Fortunately, acne scars are treatable. In fact, depending on the type of scars you’re dealing with, there are many treatment options.

We went to the experts—board-certified dermatologists Joel Kopelman, MD, and Sara Hogan, MD—to learn more. Keep reading to learn all about the types of acne scars you might experience, how to treat them, and even how to prevent them.

What Causes Acne Scars?

Acne scars typically develop when there’s a significant amount of inflammation from acne lesions, or when someone picks at acne lesions. “The extent to which a person develops acne scarring depends on how they heal and their genetic predisposition to scarring,” Hogan says.

Acne, especially cystic acne, can cause significant inflammation, Kopelman explains. And this inflammation gets in the way of the skin’s natural healing process. “In some cases, the body either under-produces or over-produces collagen during the healing phase,” he says. “When there’s too little collagen, the skin heals with depressions, which we see as atrophic scars. On the other hand, when there’s too much collagen, it results in raised scars.”

What Are the Types of Acne Scars?

Acne scars fall under two broad categories: depressed scars and raised scars.

• Depressed acne scars: Also known as atrophic acne scars, these are the most common type of acne scars. They develop when collagen is lost and not fully replaced at the site of your acne lesions.
• Raised acne scars: Also known as hypertrophic acne scars, these develop when there’s too much collagen at the site of your acne lesions.

There are different acne scar subtypes within each of these two categories. Here’s a brief explanation of some acne scar sub-types you might encounter:

Depressed/atrophic acne scar subtypes:

• Ice pick scars: “Ice pick scars are so named because they look like a sharp object punctured the skin,” Hogan says. “They are deep and narrow.”
• Boxcar scars: “Boxcar scars are depressions in the skin with sharply defined borders,” Hogan says. They are broader and tend to have a box-like appearance, adds Kopelman.
• Rolling scars: “Rolling scars are broad depressions and form when bands of scar pull the skin surface down to deeper layers of the skin,” Hogan says. They have a wave-like appearance due to their rounded edges and varying depths, explains Kopelman.

Raised/hypertrophic acne scar subtypes:

• Papular scars: “Papular scars resemble cobblestone, are the same color as skin, and typically occur on the nose and chin,” Hogan says.
• Hypertrophic scars: “Hypertrophic scars are thick, firm, and raised, and can be flesh-colored, pink, or brown,” Hogan says. They tend to form along the jawline, the shoulders, the upper back, and the chest. And they stay within the boundaries of the original acne lesion, according to Kopelman.
• Keloids: “Keloids are also thick, firm, and raised, but grow beyond the borders of the acne lesions,” Hogan says. These usually pop up in the same areas as hypertrophic scars: the jawline, shoulders, upper back, and chest.

How Can You Treat Acne Scars?

Acne scars can be treated in many different ways, depending on the type of scar you’re dealing with. Often, a combination of treatments is needed. Here’s a bit more information on the different treatment options you might come across:

• Chemical peels: Chemical peels are an option for people with mild, superficial scars. “When I apply a chemical solution to the skin, it exfoliates the outer layers, revealing new skin underneath,” Kopelman says. “I’ve seen how this treatment can significantly improve skin texture and reduce the appearance of mild scars.”
• Laser resurfacing: Laser resurfacing can be a good option for people with atrophic (depressed) acne scars, though it’s also sometimes used for raised scars. “The laser removes the outer layer of damaged skin and stimulates collagen production,” Kopelman says. “This treatment is excellent for smoothing out the skin’s surface and encouraging the growth of new, healthier skin.”
• Microneedling: This is a versatile acne treatment option. “By creating tiny punctures in the skin with fine needles, I’m able to stimulate the body’s natural healing process and boost collagen production,” Kopelman says. “For patients with atrophic scars, this treatment can gradually fill the depressions, leading to a smoother appearance.” Research shows that microneedling can fade acne scars by 50-70%.
• Subcision: This minimally invasive procedure can be an option for treating stubborn, tethered scars, according to Kopelman. “This minor surgical technique involves inserting a needle under the skin to break up the fibrous bands that are pulling the skin down,” he says. “I’ve found this method to be particularly effective in releasing and lifting depressed scars.”
• Dermal fillers: Dermal fillers are sometimes used to treat atrophic scars, like boxcar or rolling scars. “By injecting fillers into the depressed areas, I can elevate the skin, making it look more even,” Kopelman says, noting that the procedure is fairly quick with immediate results.
• Corticosteroid injections: This is a treatment option for people with hypertrophic (raised) acne scars. “By reducing inflammation and collagen production, these injections can help flatten and soften the raised tissue,” Kopelman says. “It’s a valuable tool in my arsenal, especially for those with thick, raised scars.”
• TCA (trichloroacetic acid) cross: This option is for people with icepick or boxcar scars. “A high concentration of TCA is applied to the base of individual acne scars to stimulate healing and make them more shallow,” Hogan says.

How to Prevent Acne Scars

When you’re looking to prevent acne scars, early and effective acne treatment is key. Treating your acne helps minimize the risk of severe breakouts, which are more likely to leave scars. It’s especially important if you’re dealing with inflamed acne lesions, deep acne cysts, and nodules. “I always advocate for managing acne promptly to minimize the risk of severe breakouts, which are more likely to leave scars,” Kopelman says.

Another key step? Try your best not to pick, squeeze, or touch your acne. Doing so can increase inflammation and the likelihood that you’ll experience scarring.

“For some patients, I might recommend early intervention with treatments like laser therapy, even during the active acne phase,” Kopelman says. “This proactive approach can help reduce inflammation and promote healing before scars have a chance to form.”

If you’re dealing with acne or acne scars, it’s important to see a board-certified dermatologist to put a treatment plan in place.

The Final Takeaway

Sure, acne scars can be extremely frustrating, but they don’t have to be permanent. With a bit of patience, a great dermatologist, and the right treatment plan, acne scars are absolutely treatable. It’s important to work with a doctor to understand what’s causing your acne scars and to take proactive steps to prevent them moving forward.