Acne can create scars both physical and psychological, leaving a lasting impact long after a breakout clears up. Some types of acne are more likely than others to leave scars, and how you treat your skin during an acne flare-up can make a big difference.
Here, we’re breaking down the 5 different types of acne scars, from temporary discoloration to true scarring — and revealing what (if anything) you can do about them.
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Technically, pigmentation isn’t actually a type of scar, it's just discoloration of the skin, ranging from pink to red to tan or brown. Hyperpigmentation is sometimes the result of the healing process after inflammation (whether from a pimple or other trauma), known as post-inflammatory hyperpigmentation (PIH).
Hyperpigmentation tends to occur in darker complected people, because they have more melanin (the pigment that lends skin its color) in the first place.
Scar type: not a true scar
What it looks like: darker pink/red/brown spots that remain after a pimple is gone
Who’s affected: all skin types, but more common in darker complected people or those who tan easily, because more melanin is present
How do you treat hyperpigmentation?
The good news is that most of these dark marks will fade and disappear over time. You can do a few things to speed up the healing process, so you're not continually trying to cover marks with makeup and concealer.
These ingredients can help minimize post-inflammatory hyperpigmentation:
- Salicylic acid: this BHA has an exfoliating effect that can minimize dark marks over time. Try: SLMD Salicylic Acid Cleanser, Salicylic Acid Spot Treatment.
- Retinol: this vitamin A derivative supports cell turnover, which can reduce the appearance of hyperpigmentation after acne. Find it in SLMD Retinol Serum.
- Glycolic acid: a powerful alpha hydroxy acid that sloughs away dead skin, including superficial dark marks. SLMD Resurfacing Acne Swipes also contain salicylic acid to exfoliate and penetrate pores.
Be sure to wear a non comedogenic sunscreen daily, especially while using any exfoliating treatments, since your skin will be more sun sensitive.
#2 Keloid scars
Keloid scars are mounds that form as a result of the body trying to heal itself post-inflammation, but your body accidentally produces too many cells.
Scar type: hypertrophic (aka enlarged/raised)
What it looks like: discolored, bumpy/puffy raised scars
Who’s affected: all skin types, but more common in darker skin, may run in families
How to treat keloids
Keloid scars can be frustrating to treat, because they tend to come back. Here’s a typical course of action:
- Cortisone shots — aka corticosteroid injections, which break down collagen and reduce scar tissue, though some scars are not responsive
- Lasers — can improve the appearance of a keloid scar that’s already been diminished with cortisone
- Retinoids – topical vitamin A (like OTC retinol and prescription tretinoin) can be applied once the scar shrinks after a cortisone injection
- Surgery — while hypertrophic scars like keloids can be surgically removed, they tend to grow back, so treating them topically is typically a better bet
#3 Icepick scars
Ice pick scars form when your skin loses collagen and the overlying skin collapses, leaving a deep depression that looks like a hole.
Scar type: atrophic (aka depressed/sunken)
What it looks like: deep pits that almost look like someone took a tiny needle and punctured your skin
How do you treat ice pick acne scars?
Here are a few of the most common procedures for minimizing icepick scars, which are typically difficult to treat:
- Chemical peels — these induce a “burn” that actually causes the skin to heal itself and close the openings (must be performed by a trained professional, or they can make some scarring worse)
- Punch grafting — the scar is removed with a circular tool and the hole is filled with a skin graft, usually from behind the ear; the result may appear slightly raised
- Punch excision — the scar is removed and the edges are sutured together, leaving a flatter, finer scar
#4 Rolling scars
If your skin has undulating scars with soft, smooth “shoulders” — the dermatologist’s term for edges — it’s likely you’ve got rolling acne scars. These scars tend to become more prominent with age, as skin loses its natural tightness and elasticity.
Scar type: atrophic
What it looks like: shallow, wave-like, saucer-shaped scars
Who’s affected: generally, those with long-term inflammatory acne; more common in men
How do you treat rolling acne scars?
Generally speaking, rolling scars respond well to medical treatment, including:
- Microneedling — uses multiple needles to induce tiny skin injuries, stimulating collagen production
- Subcision — a sharp needle is inserted underneath the surface of your skin to break up tough scar tissue
- Lasers — these devices resurface the top layers of the skin, encouraging collagen production (multiple sessions + downtime required)
#5 Boxcar Scars
When you have inflammatory acne (red, inflamed, irritated papules and pustules), boxcar scars are an unfortunately common aftermath. They tend to be shallow, but they have sharper edges, unlike the rounder, softer edges of rolling scars.
Scar type: atrophic
What it looks like: round/oval shaped depressions with sharp vertical edges, reminiscent of chicken pox scars
Who’s affected: those with inflammatory, cystic acne
How do you treat boxcar acne scars?
Boxcar scars can be treated by a dermatologist with a variety of methods:
- Punch excisions — the indented area of the scar is removed and the edges sutured together, closing the gap
- Dermabrasion — resurfacing of the skin with an ablative instrument under local or general anesthesia
- Fillers — both temporary (Juvederm, Restylane) and semipermanent (Bellafill) dermal fillers, as well as autologous fat transfer, can be injected to elevate the scarred skin
Dr. Lee’s last word
Acne scarring is quite common, and it’s something my patients are always eager to improve. While the best approach is prevention — managing the breakouts and not picking at pimples — there are things we dermatologists can do to mitigate scarring. The modalities I use depend on the type of scar, but can include treatments like lasers, excision, subcision and fillers. The good news is that usually, we’re able to make some improvements, which can have such a positive impact on a patient’s self-confidence.
—Dr. Sandra Lee