For most of us, acne is a passing phase that disrupts our daily lives as we try to survive our teen years. In most ways, my own experience was typical — a couple of years of misery, anguish, and minor drama, after which acne became an afterthought. A few painful reminders popped up here and there in subsequent years, but they were fairly easy to treat or ignore.
Others have a very different experience, however. Acne can cause scarring, and those scars are difficult to deal with, plus they can be both socially and psychologically debilitating. It’s often hard to know where to start if you have this problem, so let’s explore some ways to deal with and eliminate acne scars.
Topical products can help with mild scarring
To start the process, let’s go to a reliable source. Dr. David Lin deals primarily with more serious acne scarring in his ongoing YouTube video series, and his pronounced Aussie accent makes him an easy listen. His recommendations for mild scarring, though, are fairly basic.
“You can save time, effort and especially money by doing simple things at home,” Lim explains. “Grade one scarring [i.e., the mildest grade] come from pigment changes. You’ve got red scars, which come from post-inflammatory erythema, and dark scars. Most of the literature covers dark scars.”
Dark scars are due to melanin, which is the pigment that gets released after inflammation. Microneedling and topicals are the two choices for mild scarring, and Lin recommends a surprising topical as his first choice out of the gate.
“Use a higher-factor sunscreen,” he says. “Generally speaking, fifty-plus, at least twice a day. That will reduce the amount of pigment.
“If you’ve got established pigment, that’s when you can focus on key ingredients like ascorbic acid, azelaic acid, kojic acid, arbutus, and certainly your alpha hydroxy acids. Or you can exfoliate using two-percent salicylic acid.”
What the key ingredients do
That rundown is a solid good starting point, but it’s also helpful to know what these key ingredients do. Here’s a more thorough breakdown, followed by a more thorough analysis.
- Retinoids
- Vitamin C serum
- Niacinamide
- Alphahydroxy acids (AHA) or beta hydroxy acids (BHA)
- Azelaic acid
Taken as a whole, the specifics offer a comprehensive approach. Retinoids can help promote cell turnover, which can increase collagen production. And vitamin C users already know that this important skincare ingredient can reduce dark spots and brighten the skin.
Niacinamide supports the skin barrier and can help fade pigmentation, while alpha and beta hydroxy acids can improve skin texture by exfoliating dead skin cells. Azelaic acid, meanwhile, can be helpful for both discoloration and redness.
On a related note, post-inflammatory hyperpigmentation (PIH) isn’t a true scar. It actually occurs as a series of flat, discolored spots caused by excess melanin production as the end result of inflammation. These typically fade over time, but dermatologists can treat them with topical bleaching agents such as hydroquinone, or they can do in-office treatments such as chemical peels or laser therapies.
Serious treatment is based on the acne scar grading system
If your acne scars are more serious, you’ll likely be learning a lot about a grading process dermatologists use called the Goodman and Baron system. Your doctor will use this to determine which of the more complex treatments you may need, starting with atrophic scars.
“Atrophic scars refer to depressed scars that sit below the surface of the skin,” says Dr. Teresa Song, a board-certified dermatologist who practices at Marmur Medical while serving as a clinical instructor at Mount Sinai Hospital in New York.
“These include ice pick scars, which appear as deep, narrow puncture-like holes. Boxcar scars are broad with defined edges, and rolling scars are wide, shallow indentations with soft, sloping edges.”
Regardless of the shape and depth, there are serious treatments available for these kinds of scars
“These types of scars can be treated with chemical agents such as TCA CROSS, which induces a controlled chemical injury to the base and walls of the scar,” Song adds. “This triggers an inflammatory response [that promotes] collagen remodeling and skin regeneration.”
Other effective treatments are available as well. Fractionated lasers, for instance, create microscopic channels in the skin to stimulate uniform collagen production and remodel skin texture.
Micro-needling, meanwhile, uses radio frequency involves using mechanical needles that combine with heat energy to stimulate collagen production and improve skin quality in the treated areas.
Red scars require a different kind of treatment
Post-inflammatory erythema (PIE) is another common consequence of acne, characterized by persistent redness caused by the formation of new blood vessels following inflammation.
“This type of scarring is best treated with energy devices that target the vascular system,” Song explains. These include non-invasive light therapies such as broadband light therapy (BBL), or vascular-specific lasers like ClearV and pulsed dye laser (PDL).
In some cases, severe acne can lead to an overgrowth of scar tissue, which results in the formation of keloids. These are thick, raised scars that commonly occur on the chest, back, shoulders, or jawline. Keloids are best treated with a series of steroid injections designed to flatten the scars and make them less visible.
Summing up the process
While the language describing advanced treatments might sound disarmingly technical, it’s fairly easy to sum up the diagnostic process and the treatments that will likely follow.
Start by assessing your level of scarring. This is fairly easy to do, especially since most people are all too familiar with their scars. Mirror checks are simple to perform, and a basic search will reveal a wide variety of photos for comparison.
For mild scarring, the next step is to establish a skincare routine, or enhance yours to address scars if you already have one. There’s plenty of product and ingredient information available, but you may have to do some trial-and-error work to see what products work best for your and rule out those to which you may be sensitive.
For more serious acne scars, skip the topicals and go to a dermatologist. Make sure you find one who’s board-certified. If you know you’re going to be getting advanced treatments, that person should have experience with advanced acne scarring and a wide range of treatment techniques. The process may seem arduous at first, but it is possible to eliminate acne scars, regardless of how severe they are and the level of pain or discomfort they’re causing.
