How to Get Rid of Acne Scars, According to Dermatologists
Pimples are bad enough at the bumpy, red eruption stage. So it's especially frustrating that they don't always stop there. Acne scars—the rotten gift that keeps on giving—can sometimes remain on your skin, a lingering reminder of a breakout's former existence. And ridding yourself of acne scars poses a trickier challenge than excising your average pimple since they don't simply subside with time. But with patience and the right arsenal of products and treatments, you can minimize their appearance.
What are acne scars?
The term "acne scarring" can be used to refer to a multitude of different marks that a breakout may leave behind. "After pimples heal, the skin remembers that there was inflammation there before," says Joshua Zeichner, MD, a board-certified dermatologist in New York City. "Inflammation can stimulate pigment production and cause blood vessels to dilate, which leads to leftover brown and red spots after the pimples heal."
Although it's true that acne scars look different for everyone, there are two primary categories of marks that develop on the skin after pimples resolve. "Brown and red spots are temporary, post-inflammatory pigmentation that fades over weeks to months," says Dr. Zeicher. "When the inflammation leads to collagen damage, permanent structural changes can occur in the skin, which we call scars. True scars are permanent and are the results of structural damage to the skin."
It's not always easy to tell the difference, but brown spots (post-inflammatory hyperpigmentation) and red spots (post-inflammatory erythema) are completely flat. Scars, on the other hand, tend to be either depressed or elevated from the skin. These markings aren't impossible to treat once they exist, but it is mighty difficult, so dermatologists recommend employing practices to prevent them from happening in the first place.
How to Prevent Acne Scarring
"The best way to prevent scars or pigmentation is to treat acne quickly and effectively," says Dr. Zeichner. "Less inflammation in the skin means less collagen damage. I typically recommend treating the entire face if you are acne-prone. Spot treating means you are always playing catch-up. Treating the whole face can help prevent pimples from developing in the first place."
Those with cystic acne are most prone to acne scarring, so you should ask your dermatologist about prescription—topical or hormonal—medications to treat severe acne and reduce the risk of scarring. According to Hadley King, MD, a board-certified dermatologist in New York City, treatments like isotretinoin and cortisone injections can help decrease inflammation within individual acne lesions (aka those giant whoppers) that are more likely to cause potential scarring.
And of course, as everyone and their mother will tell you, it's important not to pick at your pimples (as tempting as it is). Touching and squeezing damage small veins, glands, and tissues surrounding the spots, increasing the risk of inflammation and future discoloration, and even leading to potential infection.
How to Treat Acne Scarring at Home
There are scores of options available—both in-salon and at-home—to speed up the process of getting rid of acne scars and pigmentation. The key is in stimulating collagen to help remodel areas where there is damage or depressed skin. If you're mainly dealing with pigmentation and slightly uneven skin texture, dermatologists recommend these post-acne treatments.
When to Turn to In-office Treatments
If you are not seeing results after trying OTC options, it may be time to see a dermatologist. To diminish rolling (sloping edges that make skin appear wavy), boxcar (box-like depressions with sharply defined edges), or ice-pick (narrow indentations that point down into the skin's surface) scarring, the solution likely lies in a doctor's office. According to Dr. King, optimal results are typically achieved using a battery of treatments, over the course of at least a year. Post-inflammatory hyperpigmentation will fade on its own over time, but the unfortunate truth is that once an acne blemish has scarred, it's permanent. At this point, it's best to use topicals in tandem with professional in-office treatments to be effective.
"The earlier you treat the marks, the better the outcomes," notes Dr. Zeichner. "When it comes to true acne scars, no topical can compare to the effect of a laser to resurface the skin and create new, healthy collagen."
Take note that keloid scarring, which darker skin pigmentation can be prone to, should not be used with treatments that work on the basis of inducing a mild trauma to the skin, such as microneedling. Depending on the severity of your scars, your doctor may utilize steroids or surgery to help flatten scar tissue.