Dermatologist Answers: Effective Acne Scar Treatments
There are several acne scar treatment options that range from at-home topical products to professionally administered laser procedures. While patience is important, the key to reducing acne scarring is to be proactive.
Are there different types of acne scars?
Acne scars are not all the same. There are four different types, each classified in terms of appearance:
- Boxcar Scars: These are round or square skin depressions, typically with sharp edges
- Icepick Scars: Appear similar to puncture marks within the skin
- Hypertrophic Scars: These are raised/textured scars that are firm to the touch
- Rolling Scars: Wide and shallow skin indentations, typically round in appearance
Can acne scars disappear without being treated?
The simple answer, unfortunately, is that there is not a simple answer. Initial patience can be important to allow your skin to remodel to help new acne scars fade. It can take up to a year for scars to remodel and reduce in appearance. Physical manipulation of acne lesions (i.e., picking or squeezing the pimple) can increase your body’s inflammatory response, which can reduce collagen in your skin that can result in increased scarring.
Should I wait until my acne improves before I treat my scars?
An important step in treating acne scars is to first reduce active acne, which is essential in order to limit continued scarring. A dermatologist can tailor an acne regimen for you using a number of effective acne treatments. Although certain scar treatments can be started as soon as acne is resolved, it is better to wait to allow your skin to kick off the healing process to minimize the number and frequency of treatments. However, waiting too long can be problematic as it allows old acne scars to become fully remodeled and healed. Typically, my recommendation is to wait a few months after improvement and stabilization of acne before tackling acne scarring treatments.
What at-home options are available for treating acne scars?
There are many home-based treatments that can effectively address mild acne scarring. First, practicing good sun protection by wearing a high quality, broad spectrum sunscreen can help reduce the visibility of acne scars through the reduction of redness and DNA damage. Look for a formula that contains zinc oxide or titanium dioxide and skin protecting antioxidants. A great product that I recommend for my patients is EltaMD Clear.
Oftentimes acne scars develop dark areas (post-inflammatory hyperpigmentation) along the skin. In these instances, the use of an over-the-counter (OTC) skin lightening product can be effective. Some of my favorite OTC brightening creams include SkinMedica Lytera and SkinCeuticals Advanced Pigment Corrector. In cases where OTC brighteners fail, a dermatologist can prescribe a more powerful prescription skin lightener.
Topical products for scars are plentiful; however, it is difficult to decipher through effective topical products over the less effective products. Studies have shown sun protection in addition to silicone-based gels or pads can enhance scar remodeling and reduce overall scar appearance. A recommended scar topical is SkinMedica Scar Recovery Gel, which has multiple ingredients that target remodeling skin and reducing visible scars.
What in-office treatment options are available?
Although topical products can help reduce discoloration (redness, hyperpigmentation) and scar appearance, professional treatments at a dermatology office may be necessary for more aggressive or stubborn scars.
Lasers can treat both discoloration and texture issues stemming from acne scarring. The Vbeam laser, for example, is a great laser treatment for addressing redness with minimal downtime. Additionally, resurfacing lasers, like Fraxel, are effective at addressing raised scars while also stimulating collagen synthesis to decrease the appearance of a scar.
Chemical peels can be used for residual hyperpigmentation, redness, or help reduce depth of acne scars. One technique, called the CROSS method, uses a strong concentration of trichloroactic acid (TCA) that stimulates inflammation with resulting collagen synthesis to aid with acne scarring remodeling. There is minimal downtime with small scabs that typically falls off after 4-7 days. On average 3-4 treatments are required with treatments performed every 3-6 weeks.
Soft tissue dermal fillers can help to reduce the visible appearance of deep acne scars. However, since fillers absorb into the skin over time they will require upkeep in for the form of maintenance treatments about every 4-8 months (time varies depending on product used).
Micro-needling (also known as Collagen Induction Therapy) creates small channels in the skin to help stimulate collagen synthesis. This leads to formation of new tissue and releases the skin’s natural growth factors which promote scar and hyperpigmentation repair and healing.
For more severe acne scarring, a surgical procedure called subcision can be performed by your dermatologist, which consists of inserting a needle to help break up scar tissue to reduce atrophic (or bowed down) appearance of skin.
With so many options available for treating acne scars, it is important to consult with your dermatologist to see which method would be most beneficial for you.