MDacne
About 15% of people are left with post-acne scars after their active acne is reduced. Wondering what kind of scars you have and how you should treat them?
You're in the right place!
There are two main categories of post-acne marks. The first category includes flat, smooth brown or pink spots that do not change the skin's texture. Then, there are "real acne scars," which alter the skin's texture. These real acne scars look like pits (icepick scars), valley-like depressions in the skin (rolling or boxed scars), or elevated hard-to-the-touch bumps (hypertrophic and keloid scars).
Why do you get acne scars?
While a pimple is healing, your skin produces new collagen fibers to replace the damaged tissue. If this process is disrupted, these new collagen fibers can pull downward, resulting in a depressed scar that appears as a slight indentation or a shiny, slightly raised surface. If you pick at a pimple excessively or if the acne lesion is highly inflamed, it can destroy collagen in the skin, leading to insufficient collagen production for proper healing and resulting in a depressed (or atrophic) scar. Conversely, if the healing response is overly vigorous, it may lead to a raised (or hypertrophic) scar.
How to treat flat brown acne marks?
Treatment of post-acne brown flat spots is usually straightforward. Your first step should be to control your active acne with an effective anti-acne treatment protocol. Avoid picking or popping your pimples, as this commonly leads to acne scars. The second step is to use an oil-free sunscreen. Excessive sun exposure can darken your post-acne dark spots, so it's important to protect your skin from UV rays by avoiding the sun and tanning salons. The third step involves finding a high-quality dark spot remover designed for acne-prone skin. Not all dark spot correctors are the same; the best ones typically contain Hydroquinone. Newer formulations may also include Arbutin, a natural alternative to Hydroquinone, as well as retinoids and plant-based complexes that help fade post-acne spots faster with less skin irritation. For more stubborn brown spots, superficial peels or intense pulsed light treatments can be considered, but these should be performed by a dermatologist.
How to treat flat pink and red acne marks?
The enlargement of microscopic capillaries causes pink or red post-acne spots. These spots typically fade within two to three months after your acne is controlled. If you wish to expedite fading, a couple of IPL (Intense Pulsed Light) or laser treatments will effectively do the job.
What are the five main types of real acne scars?
There are five distinct types of real acne scars: icepick scars, rolling scars, boxed scars, hypertrophic acne scars, and keloid acne scars.
What are icepick acne scars?
Another type of "real acne scar" is called an icepick scar. These scars are smaller in diameter (1-2 mm) and can be deep, with possible tracks extending into the dermis or subcutaneous tissue. Although the surface opening is narrow and steep-sided, a broad base may develop into depressed or boxcar scars. Icepick scars are commonly found on the cheeks.
What are boxcar (boxed) acne scars?
"Boxcar scars" are characterized by their shallow (0.5 mm) or deep (0.5 mm) nature and often range from 1.5 to 4 mm in diameter. They feature sharply defined edges with steep, almost vertical walls. Shallow scars can be treated with resurfacing or possibly punch elevation, while deep scars are typically addressed through punch excision, elevation, or another suitable method.
What are rolling acne scars?
Lastly, there are soft "rolling acne scars." These scars can be circular or linear, often exceeding 4 mm in diameter, and feature gently sloped edges that blend with normal-appearing skin. Treatment typically involves subcision.
What are hypertrophic acne scars and keloid acne scars?
Hypertrophic acne scars are elevated scars confined within the boundaries of the original pimple, while keloid acne scars are elevated scars larger than the original pimple. Keloids are commonly found on the chest, back, shoulders, and ears. Both hypertrophic scars and keloids exhibit thicker, more abundant collagen that is stretched and aligned in the same plane as the epidermis. The prevalence of these scars is estimated to be 5 to 15 times higher in African Americans and 3 to 5 times higher in Asians compared to Caucasians. It is estimated that they affect between 4.5% and 16% of the African American and Hispanic populations.
What is the best cream for acne scars?
Topical creams cannot eliminate true depressed (atrophic) acne scars. However, using topical retinoids over extended periods can help smooth the skin. Acting as a topical form of vitamin A, retinol has been shown to promote skin cell turnover and increase the production of new collagen fibers in the dermis.
A topical scar cream containing peptides and ceramides can accelerate the healing of blemishes, strengthen the skin barrier, reduce inflammation, and improve texture in newer scars.
If your main concern is post-acne dark spots, you may also consider using a Dark Spot Remover. This can be used alongside your acne treatment to expedite the treatment of dark spots.
What are the best supplements to treat and prevent acne scars?
Taking acne supplements can aid in the wound healing process and reduce the risk of scarring. The most crucial vitamins and minerals that contribute to wound healing and treatment of existing scars include the B vitamins, Vitamin A, and the minerals zinc and selenium. Vitamins C and D also play a role, albeit to a lesser extent.
Regular "one size fits all" skin and hair multivitamins are not ideal for individuals with acne scars. They often contain high levels of biotin and vitamin E, which can counteract the beneficial effects of vitamins A and B5 on active acne and scars. A better option is to choose vitamin and mineral supplements specifically formulated for acne and acne scars. These formulations provide appropriate levels of vitamins (especially A and B5) and zinc, while minimizing biotin and vitamin E content.
What are the best office treatments for real acne scars?
Real acne scars are the hardest to treat, but there's hope — a few new in-office technologies show promise. Dermatologists use the most popular technologies to treat acne scars: microneedle radiofrequency, fractional lasers, subcision (cutting under the scar with a scalpel), and injectable fillers (a temporary solution).
Microneedle radiofrequency
Microneedle radiofrequency is regarded today as the gold standard for treating acne scars. It uses extra-sharp gold-plated microneedles to heat the deep part of the skin. These minute needles (300 microns wide) penetrate the skin gently to a depth of up to 3.5 mm with minimal pain or discomfort. Once they reach the deep part of the skin (dermis), they produce heat. This heat promotes a natural healing process that builds new collagen and decreases the depth of the scars. In addition to its efficacy in treating acne scars, microneedle radiofrequency causes minimal downtime. The skin is red for a few hours, and the patient can return to school or work the next day.
Ablative and non-ablative fractional lasers
Laser treatments come in two forms: ablative and non-ablative. Ablative lasers resurface the skin by removing outer layers, while non-ablative lasers create changes in the dermis without causing damage to the skin's surface. The carbon dioxide laser is the most common ablative laser used to treat acne scars. Ablative fractional lasers create micro burns in the skin that trigger the buildup of new collagen. The results are usually similar to microneedle radiofrequency but with more pain, downtime, and risk of post-treatment hypo- and hyperpigmentation. The typical result of fractional ablative laser treatment is that the "new" skin is smoother, atrophic scars are reduced in depth, and the overall scarring is softened. After ablative laser treatment, the skin generally heals within two weeks but can remain red for some time after healing. The redness fades over several weeks to several months.
Non-ablative lasers tighten the skin and stimulate new collagen formation. These lasers are less effective than microneedle radiofrequency or ablative lasers and have minimal effects on deep, pitted scars. Pulsed dye lasers are another kind of non-ablative laser used to improve raised scars and keloids.
Subcision (cutting under the scar with a scalpel)
One of the causes of depressed scars is collagen fibers that pull down the skin's surface. In a subcutaneous incision, also known as subcision, a needle or small scalpel is inserted to run parallel to the skin's surface. Once these bands have been released, the skin surface lifts, smoothing its appearance. This procedure is invasive, requires local anesthesia, and is more costly than microneedle or laser treatments.
Injectable dermal fillers
Similar to wrinkles, depressed scars can be filled with injectables, known as dermal fillers. Substances used as dermal fillers can include human and bovine collagen, hyaluronic acid, or fat transferred from the patient's own body. A filler substance is injected into the acne scar, elevating the scar base to be even with the skin's surface. Unfortunately, these fillers degrade over time, and procedures need to be repeated every few months.
Shop
Vitamins + Minerals Supplements
Conclusions
The best way to prevent acne scars is to treat your active acne effectively. By doing so, you can avoid the struggle with acne scars altogether. If you already have acne scars, there are ways to treat them. For flat "scars," a good dark spot corrector cream will suffice. However, if the scars are deeper, pitted, or depressed, you will need more than just topical creams.
Acne dark scars - best treatments 2018
The best way to get rid of post-acne dark spots
References:
Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45(1):109-117. doi:10.1067/mjd.2001.114011. PMID: 11423818.
To find the right acne treatments for your unique skin, take the free skin assessment by clicking here.
