The Lamen


by | Feb 8, 2023

Causes  •  Types  •  Treatment  •  Natural remedies  •  OTC remedies  •  Prevention  •  Seeing a doctor  •  In a nutshell

Acne is one of the most common skin conditions that occurs when the hair follicles (pores) on your skin get clogged. This can be caused by dead skin cells or sebum (oil).

These clogged pores can produce blackheads, whiteheads, or red bumps known as pimples – which might sometimes get infected with bacteria and become pus-filled, resulting in a painful bump.

When these acne heal or go away, they can leave behind blemishes on your skin known as acne. While acne scars can fade away on their own in most instances, some people might experience more prominent blemishes or even permanent scarring.

Continue reading to learn more about what causes acne scars, and different types of acne scars, along with home remedies and medical treatments that can help you get rid of these marks.

What causes acne scars?

Acne scars are typically caused due to more severe acne, being the result of an inflamed lesion such as a cyst or pus-filled pimple.

When acne breakouts reach the deeper layers of your skin, they can damage the skin cells. As acne clears, your body produces collagen – a protein that is the main structural component of the skin. These scars appear as acne.

Post-inflammatory hyperpigmentation

While acne might lead to scarring in some cases, not all marks left behind are actually scars. When a pimple or wound heals, it leaves behind an area of darkened skin. This is known as post-inflammatory hyperpigmentation (PIH).

PIH is caused by the overproduction of melanin which occurs as a natural immune response of your body.

Hyperpigmentation usually fades away on its own, although it may take anywhere from months to years for it to clear away completely.

Post-inflammatory hyperpigmentation is more common in people with darker skin and typically occurs in those who pick on their acne or pimples.

Types of acne scars

Atrophic acne scars

Atrophic scars, also known as depressed scars, have a sunken or indented appearance on the skin.

These are the most common type of acne scars, caused when not enough collagen is produced during the healing of acne, leading to a depressed area on the skin.

Atrophic scars are commonly caused by cystic acne, although other types of acne can cause them as well. You may also develop atrophic scars after chickenpox, and they can become more noticeable as you age.

Atrophic scars are classified into three types: ice pick, boxcar, and rolling scars.

Ice pick scars

Ice pick scars account for nearly 60 to 70 percent of the total atrophic scars diagnosed.

They appear as small, narrow indentations that point down into the skin’s surface, typically less than 2mm wide but up to 5mm deep. They are most common on the cheeks.

Because of their deep and narrow structure, ice pick scars can be more difficult to treat than other forms of acne. They may require multiple treatment sessions, which still may not completely get rid of the scar.

Rolling scars

Rolling scars are characterized by their broad, shallow, wavy appearance, caused by the skin’s loss of collagen and elastin. Rolling scars represent about 15 to 25 percent of the total atrophic scars.

This type of acne scarring is more common in areas of the face where the skin is thick, such as the lower cheeks and the jaw. Just like other forms of atrophic acne scarring, treatment for rolling scars is divided into two stages.

Boxcar scars

Boxcar scars appear as round or oval depressions with sharp vertical edges. This type of scar has a similar appearance to chickenpox scars and can be found on the lower cheeks, jawline, and temples.

Boxcar scars make up nearly 20 to 30 percent of all atrophic scars.

Boxcar scars can be shallow or deep and tend to be wider at the surface than an ice pick scar.

Hypertrophic and keloid scars

Unlike atrophic scars, hypertrophic and keloid scars are caused by excess collagen deposition. These scars appear as a raised mass of scar tissue on the skin.

Hypertrophic scars are of the same size as the acne that caused them, and appear pink in color.

Keloid scars, on the other hand, appear reddish-purple in color and grow past the border of the original acne.

Hypertrophic and keloidal scars are more common in people with darker skin, predominantly occurring on the trunk, including areas like the chest, back, and shoulders.

Treatment for acne scars

A dermatologist will decide the appropriate treatment for your acne scars after determining their type, location, and severity.

According to the American Academy of Dermatology (AAD), asking yourself these questions helps you decide whether you should seek a dermatologist to treat your acne scars:

  • Why do you want to treat your acne scars?
  • Have your scars caused you to be less social?
  • How do you want to look after the treatment?
  • How much are you expecting to spend on the treatment?
  • Home much time off can you take post-treatment?
  • How invested do you want to be in skincare?

Dermatologists often recommend medical treatment for acne scars if an individual answers “yes” to one or more of these questions.

Treatment for atrophic scars

Treatment for atrophic scars depends upon the type of scar you have. Atrophic scars are difficult to treat and can require multiple treatments over time. Even after extended treatment, the scar might not fully go away.

Atrophic scars are typically treated in two stages.

Stage 1 treatment

Stage 1 treatment for atrophic scars involves removing the damaged top layer of the skin to reveal smoother, even-toned skin underneath. This type of treatment is known as resurfacing and is performed by a licensed dermatologist or esthetician using one or more of the following treatments:

  • Chemical peels: Glycolic, trichloroacetic (TCA), or salicylic acid are used in varying amounts (based on the depth of penetration) to destroy and remove the outer, damaged layers of the skin.
  • Microdermabrasion: A non-invasive procedure where very fine crystals are used to gently exfoliate the top layer of dead skin cells, making the acne scars less prominent and shallow. This treatment can be part of a regular facial from an esthetician.
  • Laser therapy: Focused beams of high-energy light are used to remove damaged or abnormal skin cells. This promotes cell growth and stimulates collagen production, along with improving the overall skin texture.
  • Hydradermabrasion: Dead skin cells are removed using a stream of water and a diamond-tipped tool.
  • Microneedling: Also known as collagen induction therapy, this involves creating several micro punctures in the skin to stimulate collagen production. The collagen lightens your scars and continues to improve skin texture over a 12-month period.
  • Dermal fillers: Substances such as hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid are injected into the skin to add volume and improve the appearance of depressed acne scars.
  • Punch excision: Typically used to treat ice pick scars and deep boxcar scars, this involves removing the scar tissue from your skin by cutting it out, then stitching the skin together. The closing of the excision might leave behind a light mark.
  • Subcision: A needle is inserted into the skin to release the scar tissue pulling down on your skin. This helps lift the depressed acne scars, giving the skin a smoother appearance.
  • Punch grafting: This involves removing the scar from your skin, and then replacing the tissue without skin taken from another part of your body. This treatment might require more than 20 replacement grafts in a single session, but is known to be one of the best techniques to treat deep ice pick scars.
  • Sublative rejuvenation: It is a non-invasive technique that uses radio frequency (RF) energy to stimulate collagen and elastin production, giving the skin a better appearance.
  • TCA Cross (chemical reconstruction of skin scars): This technique involves applying trichloroacetic acid (TCA) to acne scars, which causes mild injury to stimulate collagen production and improve the scar’s appearance.

Each technique has its own benefits and demerits, and you should always consult with your dermatologist about them to select the best treatment for yourself.

Stage 2 treatment

After treating the scar, your dermatologist is likely to suggest stage 2 treatments, which involve further improving your skin’s appearance. This involves both treatment and self-care techniques, which may include:

  • chemical peels
  • laser resurfacing
  • sun protection
  • specific cleansers

The choice of treatment depends upon your individual needs, the size, and location of the scar, as well as the patient’s skin type.

Treatment for hypertrophic and keloidal scars

Treatment for hypertrophic and keloid scars involves flattening the scars along with lightening the marks to give your skin a more even, healthier appearance. Your doctor may recommend one or more of the following treatments to help flatten and get rid of your scars.

  • Corticosteroid injections: This is the primary treatment for hypertrophic scars. It involves corticosteroids being injected directly into the scar tissue to soften and flatten the scar. Several shots might be required to sufficiently treat the scars, spread a few weeks apart.
  • Cryotherapy: Your dermatologist freezes the scar tissue with liquid nitrogen (− 196 °C or − 320 °F), destroying and effectively flattening the scar.
  • Surgery: To remove a hypertrophic or keloid scar, the doctor surgically removes the scar and closes the small incision with stitches.
  • Laser therapy

A scar can take up to a year to fully mature, which is why doctors wait at least a year before performing a major procedure such as surgery.

Natural remedies for acne scars

The appearance of acne scars varies for each person, depending on the skin type, tone, as well as severity of the acne. Acne scars typically take anywhere from 6 months to a year to fade away, but they may take even longer.

Deeper scars, however, may fade away only after professional treatment.

In most cases, mild acne scars can be treated right at home, with certain natural remedies even speeding up the process.

  • Aloe vera: While aloe vera may not be able to completely get rid of your acne scars, it does have some potential benefits. Aloe vera has been found to reduce hyperpigmentation, as well as reduce redness and inflammation.
  • Vitamin C: Vitamin C is a powerful antioxidant that promotes collagen production to improve the appearance of scars. A 2022 study found that topical application of vitamin C can improve the treating acne scars.
  • Tea tree oil: Tea tree oil is found in several skincare products, and is known for its antimicrobial properties. Studies have shown it to be effective in managing acne breakouts, with anecdotal evidence suggesting that it can also help reduce acne scars.
  • Black seed oil: Black seed oil is a common medicinal plant, known for its antibacterial, antiviral, and anti-inflammatory properties. Studies have shown that black seed oil not only reduces acne scars but improves their appearance due to its wound-healing properties.
  • Honey: Honey has been used for its therapeutic properties since ancient times. Research has found that Manuka honey, which is made from the nectar of the manuka tree, has anti-microbial and wound-healing properties. Raw honey is especially beneficial for healing acne scars as well as managing acne.
  • Rosehip oil: Rosehip seed oil is derived from the seeds of the wild rose bush Rosa rubiginosa, and has been scientifically proven to be beneficial in wound healing and improve the appearance of scars.

It is important to know that even after these remedies, your acne scars might not completely fade away.

You should also remember to check for allergies before applying any product to your face. In case you experience any adverse reaction, you should stop using the product immediately.

OTC remedies for acne scars

A number of over-the-counter products can be used to reduce the appearance of moderate acne scars.

While they are not completely effective in treating a scar, they are a good alternative for someone who does not want to have a medical procedure performed.

Salicylic acid

Salicylic acid is a type of beta hydroxy acid (BHA) that is a common product used for treating acne and improving the appearance of acne scars. It penetrates your skin and dissolved the dead skin cells, acting as an exfoliant.

Topical salicylic acid reduces swelling and redness, allowing the pimples to shrink.

A study found that a 30 percent salicylic acid solution used three to five times every 3-4 weeks is the most effective.

The product may be used as often as several times a day to a few times a week, depending upon the condition being treated and the concentration of the product.

Topical salicylic acid may cause your skin to become dry or irritated in the beginning. You should start by using the product less often, then gradually increase the frequency of use to allow your skin to adjust to the product.

Remember to not apply salicylic acid to skin that is inflamed, irritated, or infected. In addition, diabetics should avoid using products containing salicylic acid, as it could cause an infection.

Alpha hydroxy acids (AHAs)

Alpha hydroxy acids are a group of acids including glycolic acid, lactic acid, and citric acid, which are common in skincare products.

AHAs work by exfoliating the skin, which gets rid of dead skin cells and promotes cell turnover, giving your skin a new, smoother appearance.

The exfoliating effect of AHAs helps improve the overall texture and tone of the skin, as well as improve the appearance of acne scars.

A 2015 study found that a 12-week treatment with a combination of retinoic and glycolic acid significantly improved acne scars in patients.

While alpha hydroxy acids are effective in improving the appearance of acne scars, they can cause some side effects, especially if used in high concentrations or if your skin is sensitive.

According to the Food and Drug Administration (FDA), common side effects of using AHAs include burning, rash, swelling, hyperpigmentation, and increased sensitivity to sunlight.


Retinoids are derivatives of vitamin A and can be effective in improving the appearance of acne scars by promoting collagen production.

Topical retinoids have been shown to improve the appearance of both atrophic and hypertrophic acne scars.

Studies have shown retinoids to be effective in the development of new lesions as well as improve the appearance of previous lesions.

It is important to remember that retinoids can cause side effects such as dryness, irritation, and inflammation, particularly during the first few weeks of usage.

Initially, you should use a low-strength retinoid, and gradually increase the strength and frequency of use as your skin grows accustomed to it.

Retinoids also increase your sensitivity to the sun and can increase the risk of sunburn. Therefore, you should always use sunscreen when using topical retinoids.

Azelaic acid

Azelaic acid is a naturally occurring acid found in grains like wheat, rye, and barley.

Available in OTC gels and creams for the skin, azelaic acid has antimicrobial and anti-inflammatory properties making it an effective treatment for acne and rosacea.

Azelaic acid is available in 15 to 20 percent formulation. Extensive clinical trials have shown a topical 20 percent azelaic acid cream to be effective in treating all types of acne and is non-irritant in most cases.

Azelaic acid works by clearing out clogged pores on the skin and reducing inflammation for reducing and treating acne.

Moreover, it increases cell turnover, which produces newer skin cells quicker to improve the appearance of scars as well as reduce hyperpigmentation.

While azelaic acid is considered to be well tolerated, it might cause some mild side effects such as redness, dryness, and itchiness.


Sun protection is just as important as cleaning and moisturizing your skin. Not only does it give your skin a better appearance and protect you from sunburns, but avoids hyperpigmentation.

Applying sunscreen is even more important if you have been using some sort of medication or topical product to improve the appearance of acne scars.

These products can make your skin even more sensitive to sunlight and may stop the at-home treatment from having an effect.

Silicone dressings

Silicone dressings, also known as silicone gel sheeting (SGS) are used to improve the appearance of hypertrophic and keloid scars.

Although scientists don’t yet know the reason behind this, they believe that improves the hydration of wounded skin and reduces skin tension to improve the appearance of scars among other benefits.

While the treatment using silicone dressings is non-invasive, you might be required to wear the dressings for 6 to 12 months to achieve noticeable results.

How to prevent acne scars

Acne scars are a part of the healing process of acne, and as a result, you can’t prevent scarring completely. However, there are certain strategies that reduce your chances of reducing acne scars and avoid any serious scarring.

  • Treat acne early and effectively. The first step to preventing acne scars is to treat your acne as soon as they develop. This can be done by using OTC or prescription medications.
  • Don’t squeeze or pop your pimples. Despite the temptation, squeezing or popping your pimples can only lead to the spreading of infection and deeper damage to the skin. Popping your pimples can lead to more noticeable and even permanent scars.
  • Clean, exfoliate, and moisturize. Preventing acne and the consequent scarring requires you to maintain clear and healthy skin. Using lightweight, oil-free cleanser, exfoliating your skin once or twice a week, and applying a skin-specific moisturizer are all essential for keeping your pores clean and avoiding acne.
  • Don’t scratch the wound.
  • See a dermatologist if you have acne-prone skin.

It is important to know that some people are more prone to scarring from acne. If you have a history of scarring, you should see a dermatologist rather than go for home remedies and OTC treatments for your acne scars.

Should you see a doctor?

A visit to the dermatologist is typically recommended over applying any products by yourself or trying out any natural remedies. This is to ensure the best possible treatment and improve the appearance of your scars as much as possible.

In general, you should consider seeing a doctor for your acne scars if you experience any of the following:

  • multiple scars
  • wounded scars
  • other skin conditions

Visiting a dermatologist can not only get you the best possible treatment but get you access to more effective skincare products as well as address other skin issues that you might not be aware of.

In a nutshell

Acne scars appear when the acne clears away from your skin, and are a part of the natural healing process. These scars may be more prominent if you experience severe acne or pop, squeeze, or pick at them.

There are a number of techniques, both professional and home treatments, that can improve the appearance of acne and give your skin a smoother appearance. However, certain types of acne scars can only be treated effectively by a professional.

If you experience severe acne scars or are experiencing other skin conditions, it is recommended that you see a doctor rather than try any home treatments.