Scarring impacts up to 95% of people with acne, leaving a physical imprint long after pimples and blemishes are gone. Acne scarring can have a profound impact on how we perceive ourselves: we may not feel confident or like what we see in the mirror. We may not want to have our faces touched.
And scarring can also impact how other people see us: we may be on the receiving end of rude questions, unfair assumptions, and unwanted stigma. One study found that people with acne scarring were perceived by others as insecure, shy, and less likely to have a promising future.
We know those misconceptions are not true. Textured skin is normal and you’re perfect just as you are. But if acne scarring is negatively impacting your quality of life, there are treatments available that can help make your scars less visible. Here’s what you need to know.
3 Acne Scar Types
Not all acne scars form, appear, or are treated in the same way. There are three main types of acne scars, including:
Post-inflammatory hyperpigmentation, or PIH, occurs when inflammation or damage triggers the skin to produce extra melanin. Skin with PIH can appear brown, purple, or tan, depending on your skin type. Although hyperpigmentation can happen to anyone, it’s most prevalent in people with darker skin tones. Hyperpigmentation can fade with time, sun protection, and treatment.
Post-inflammatory erythema, or PIE, occurs as a result of damaged or dilated capillaries near the surface of the skin. PIE appears as pink or red acne scars and is most common in people with lighter skin tones. Skin with PIE may transition from a deep red to soft pink as post-acne spots begin to heal.
Pitted, or atrophic, scars are depressed acne scars that occur when the skin isn’t able to properly repair tissue. They indicate a loss of collagen. There are three types of pitted scars: icepick scars, boxcar scars and rolling scars.
Ice pick scars are small, deep scars that often occur on the cheeks. Skin with ice pick scars is indented and may look like it was pierced by a sharp object. Ice pick scars are less than two millimeters wide but deep, making them difficult to treat. Ice pick scars are the most common form of atrophic scars.
Boxcar scars are oval or round scars that form craters in the skin. They’re wider than ice pick scars and have steep vertical sides. Boxcar scars make up 20–30% of pitted scars and can look similar to chickenpox scars.
Rolling scars are broader and less defined than boxcar or ice pick scars. They lack definitive boundaries and may appear uneven. Rolling scars can measure up to 5 millimeters in diameter.
How to Remove Acne Scars
Reducing the appearance of acne scars isn’t one size fits all, and each type of scarring requires a different approach. The best treatment for pitted acne scars includes chemical peels, microneedling, and laser resurfacing. Skin with post-inflammatory hyperpigmentation can benefit from alpha hydroxy acids, retinoids, tyrosinase inhibitors, and chemical peels. Vascular laser treatment can be helpful to skin with post-inflammatory erythema.
No matter which treatment you choose, patience is critical. Acne scars can fade, but it may take months and or years. Visit a board-certified dermatologist to discuss which treatments are best for you and your skin.
Laser resurfacing is a procedure that uses laser light to break up scar tissue. This can help reduce the appearance of pitted acne scars by improving your skin's texture and reducing its pigmentation.
Laser resurfacing can be expensive, painful and time-consuming. It's also not for everyone. The process has been known to cause bruising, swelling, and redness in some patients.
Microneedling therapy is a minimally invasive procedure designed to stimulate collagen production. It can be helpful in reducing the appearance of pitted acne scars. During the procedure, your provider will puncture the top layer of skin with thin needles in order to break down collagen bundles and trigger the skin’s healing process. New collagen production helps fill in depressions and smooth out skin texture.
Fillers aren’t just for reducing wrinkles and plumping lips—they can also help to fill in boxcar and rolling acne scars. In 2015, the FDA approved injectable polymethyl methacrylate, known by the brand name Bellafill, as a treatment for acne scarring. Other fillers can also be used and may be recommended in conjunction with other treatments, depending on what type of acne scars you have and how deep they go. Fillers aren’t a permanent solution, so they may need to be reinjected in order to maintain results.
Balancing the Skin Microbiome
Maintaining a healthy skin microbiome plays a vital role in the acne and scar healing process, because the skin can only heal when the microbiome is in balance. The same applies to the skin’s natural protective barrier.
To balance your skin microbiome and fortify your skin’s protective barrier, we recommend our Gladskin Blemish Gel. Our Blemish Gel, with the patented protein Micreobalance®, gently restores bacterial balance to acne-prone skin for clearer, healthier looking skin.
It’s a myth that tanning will reduce the appearance of acne scars. Scarred skin is highly sensitive, and sun exposure can increase hyperpigmentation, making it harder for acne scars to fade. Plus, tanning isn’t good for your skin—sun exposure increases your risk of skin cancer and contributes to premature aging. Using sunscreen with an SPF of at least 30 every day can help keep inflammation at bay and prevent any additional discoloration to post-inflammatory hyperpigmentation. Be sure to avoid tanning beds and booths.
If you’re experiencing post-inflammatory hyperpigmentation, tyrosinase inhibitors may be an effective treatment option. Tyrosinase is an enzyme that allows melanin to move to the top layer of skin, which contributes to hyperpigmentation. By blocking the melanogenesis process, tyrosinase inhibitors can reduce hyperpigmentation. Types of tyrosinase inhibitors include kojic acid, tranexamic acid, and alpha arbutin.
Chemical peels speed up the exfoliation process and help remove damaged layers of skin to bring a smooth layer of skin to the surface.
The chemicals used during a peel, as well the depth of the peel, will depend on the severity of scarring as well as skin sensitivity, tone, and past experience with peels. Glycolic acid and salicylic acid are two common options a dermatologist or esthetician may use during a peel.
Depending on the strength of the peel, you may need a series of chemical peels to achieve your desired results.
How to Be Confident With Acne Scars
It’s important to remember that when it comes to acne scarring, you’re not alone. Millions of people live with acne scars. Textured skin is normal and you are perfect just as you are. But the world can be unkind and unfair when you have a facial difference or visible skin condition. Embracing your acne scars and loving your skin can be a profound act of radical self-acceptance, but it’s not always easy.
No matter whether you choose to treat your acne scars or leave them be, you deserve to live a rich, full life where you feel confident and accepted. So be kind to yourself, seek out supportive community, and remember that you’re worthy of all things good. To us, that shows true confidence.