Acne Scars: Types, Prevention and Treatment Options

Marks are not scars

Brown, purple or red flat spots after a pimple heals are post-inflammatory hyperpigmentation or erythema. Run your finger over them: if the skin is smooth, it is a mark, and it will usually fade over three to twelve months — faster with daily sunscreen. See our guide to dark spots for ingredients that help.

Types of true acne scars

Most acne scars are atrophic — depressions caused by loss of collagen during deep inflammation.

• Ice-pick scars: narrow, deep holes, as if made by a sharp tool.
• Boxcar scars: wider depressions with sharp, defined edges, often on the cheeks and temples.
• Rolling scars: broad, shallow dips with sloping edges that give the skin a wavy look.
• Hypertrophic and keloid scars: raised, firm scars from too much collagen, more common on the jawline, chest and back, and in darker skin.

Prevention comes first

Scarring is most closely linked to deep, inflamed acne (nodules and cysts), to how long acne goes untreated, and to picking or squeezing. Getting moderate or severe acne under control early — often with prescription treatment — is the most effective scar treatment of all.

What creams can and cannot do

Over-the-counter products cannot fill in true scars. Retinoids may gradually improve very shallow texture by stimulating collagen, and sunscreen stops scars from looking darker. Be sceptical of products promising to "erase" scars.

Dermatologist treatments

A dermatologist will usually combine several approaches, since most people have more than one scar type. Common options include:

• Microneedling, with or without radiofrequency, to stimulate new collagen.
• Fractional lasers to resurface the skin in controlled sessions.
• Chemical peels, including the focused TCA CROSS technique for ice-pick scars.
• Subcision to release the bands that pull rolling scars down.
• Dermal fillers to lift depressed scars temporarily.
• Steroid injections or silicone gels for raised and keloid scars.