Treatment and Prevention of Acne Scarring

March 20, 2018

Characterized as depressions in the skin, whether shallow or deep, acne scarring occurs in reaction to skin trauma. Experimentation and technological advancement has led to the development of a multitude of treatment options, but the likelihood of each being effective varies as this is one of the more difficult skin issues to reverse.

Acne scars are one of the more difficult skin issues to overcome. They do not go away over time and corrective measures are often a lengthy and painful process.

For some, genetics play a greater role than others, making them more susceptible to acne and scarring in general. Everyone is, however, vulnerable to scarring as a result of trauma to the skin. Furthermore, it is not always the result of severe acne lesions; mild acne can lead to scarring if it is picked and poked.

The best way to treat acne scars is to do everything possible to break the acne cycle and prevent scarring from occurring in the first place. Starting early is key. Because of hormonal factors, the lesions of the early teenage years tend to be the most severe and result in the worst type of scarring. For that reason, it is highly recommended to start a preventive program as early as twelve years old.

A consistent skin care routine that includes regular exfoliation, along with anti-inflammatory, antibacterial, and antioxidant products, is critical to skin health. It is also important to stick to a nutrient-rich diet, limit ultraviolet exposure, reduce stress, and maintain sufficient rest and hydration.

Once acne scarring has already occurred, the focus switches to corrective procedures. Unfortunately, scars cannot simply be erased, but there is much that can be done to minimize their appearance and greatly enhance the surface texture of the skin to achieve a smoother appearance.

First, it is important to understand exactly what constitutes an acne scar. Dark marks left behind after a pimple disappears are not acne scars. These are the marks of post-inflammatory hyperpigmentation (PIH), the body’s melanin response to inflammation and irritation. Post-inflammatory hyperpigmentation marks linger but are typically not permanent. They can be addressed through a combination of exfoliation and topical brighteners. Vitamin A propionate, kojic acid, mandelic acid, lactic acid, hydroquinone, and niacinamide are among the top ingredients for fading dark marks caused by PIH. Ultraviolet radiation can worsen PIH, so it is imperative to limit exposure and use sunscreen.

True acne scars are not just surface. They are alterations to tissue resulting from of the body’s attempts to heal from damage. They appear as depressions, sometimes quite deep and wide – box car or rolling scars – or small, shallow pockets like those known as ice pick scars. Acne scars can also appear as raised hypertrophic tissue, or in the most severe cases, as dense keloid scars formed by excess tissue in the healing process.

True acne scars require more intensive treatment than the dark marks of PIH.

Before beginning any major corrective treatment for acne scarring, the first consideration is to prevent further damage by bringing acne under control with a targeted treatment program. Once acne is under control and a maintenance regimen is in place, attention may be turned to reducing the scars.

An effective acne management system should include a vitamin A corrective serum to accelerate cell renewal and clear impactions, as well as a vitamin C and E serum to strengthen cell function and help with collagen synthesis.


Chemical Peeling

A peel improves skin texture and tone by removing the top layers of skin, including cellular buildup and impactions. Over time, it will also reduce scar tissue. It takes several chemical peels to equal the depth achieved with one dermabrasion, so the tradeoff is a less-immediate result for a less-invasive procedure.

Dermal Fillers

Liquid collagen injection is a popular technique for filling in sunken acne scarring. The material is injected under a depression where the collagen forms a lattice-like network of fibers. The action stimulates the patient’s tissue to grow in and raise the depression.

As skin ages and loses collagen, acne scars can become more pronounced. For this reason, dermal fillers are often a good option for treating scars in aging skin. Dermal fillers can also be a great option for younger patients with deeper scars. The filler will add volume to the skin, which can enhance the effects of a laser treatment.

While collagen is derived from natural sources, it can still be interpreted by the human body as a foreign substance and cause allergic reactions. Fillers require several injections to improve a scar and results are temporary, meaning the treatment remains ongoing.

Not all scars respond well to fillers. Some will appear worse after injections. A rigid scar that is bound down into the tissue may become more pronounced. If professionals pinch up the area around a scar between their fingers to elevate it and the scar disappears, then it is not bound down to the underlying tissue and an injection may improve it. However, if the professional feels a rigid mass between their fingers, as if the scar is more pronounced when pinched, it is not a good candidate for injection. Each scar should be individually addressed when considering dermal fillers.


Lasers use rapid pulses of light to vaporize the top layers of skin and spur cell renewal and collagen production. The damaged scar tissue is removed in the process and replaced by new, smoother skin. There are varying levels of intensity ranging from non-ablative (non-vaporizing) treatment – best for superficial scarring – to the high-intensity fractional treatment that is used for scarring caused by severe cystic acne. This latter approach is trained on the effected sections of the skin while leaving the surrounding skin intact.

Four to six laser treatments, over a period of two months, can significantly improve skin texture. In addition to diminishing the appearance of scars, skin appears rejuvenated after a course of treatment. The relative ease of mastering the technique has made it very popular among skin care professionals, but it does have some limitations. The results can be inconsistent because of the way the spectral distribution and the nature of the light pulses interact with the geography of the skin.

Furthermore, the process may be painful, and healing is extended. Skin can be raw and red for several days following the procedure. The intense heat can trigger PIH, especially in darker skin tones. Hypopigmentation can also occur over time from repeated insult to the cells.