What Causes Acne Scars and How to Treat Them

We’ve mentioned this before in our 12 Myths About Acne blog post, but it’s not uncommon for adults to struggle with acne. Acne can do some serious damage to your skin cells, and while you can work to repair the skin cells, it’s not always easy to return your skin to exactly how it was before. Deep depressions and scar tissue can remain on your skin even after your acne has healed.

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What are acne scars?

Acne scars are a direct result of a deep trauma to the skin related to acne. There are external factors, such as picking at the skin, that can worsen even small acne lesions and result in scarring. These scars manifest as areas of depressed or raised skin and can occur anywhere on the face or body. They change the overall texture of the skin and don’t always improve over time.

Acne scars can also result from the body’s natural attempt at healing itself. The skin pores become clogged with dead skin cells and slowly fill with excess oil, which can allow bacteria to grow. These pores can result in acne lesions (whiteheads or blackheads). When they rupture, the contents that spill into the skin is irritating and can cause inflammation, which presents itself as redness and tenderness. The skin will naturally form new collagen fibers to repair this issue, however, raised acne scars occur when the skin overproduces collagen. However, depressed acne scars result when not enough collagen has been produced.


What causes acne scars?

When the pores become clogged with oil or dead skin cells, your body has an inflammatory reaction which results in acne. When acne is close to the surface of the skin, it often heals with minimal damage to the skin. Acne that affects and damages the deeper layers of the skin more often results in scarring.


What type of acne usually causes scarring?

There are various types of acne, and some are more prone to scarring than others. Whiteheads and blackheads very rarely result in scarring. Inflammatory acne, such as cysts or nodules, is most likely to create long term scarring because that type of acne affects the deeper layers of the skin.

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Common Types of Acne Scars

  • Keloid Scars: A keloid scar is a raised scar that results from an overactive response to acne. Excessive buildup of collagen and skin tissue leaves a ridge or bump on the skin. These types of scars are sometimes painful to the touch or itchy. Keloid scars are typically found on the back, shoulders, or jawline.
  • Atrophic Scars: Atrophic scars are depressions in the skin that result from the production of too little skin tissue during the healing response. There are several types of atrophic scars, including:
    • Ice Pick Scars: these scars appear as triangular shaped chisels in the skin. They are often found in areas where the skin is typically thin, such as the forehead or upper cheek area.
    • Boxcar Scars: these scars are deep indents in the skin with clearly defined edges. These are typically found on the lower cheeks and jawline.
    • Rolling Scars: these scars are typically present where the skin is thicker, in areas such as the cheeks. They have sloped edges and make the skin appear wavy or unevenly textured.


Why do I have acne scars?

If you have acne scars, know that you are not alone. Of people between ages 11 and 30, 80% have acne, and 20% of those with acne have acne scars. So what causes one person to develop acne scars while another person does not? It depends on many factors, many of which are unavoidable:

  • Genetics: Some people have genetic histories that make them more prone to scarring than others. This includes all types of skin damage, not just acne. If you have a family history of scarring or acne scarring, you may consider prioritizing acne prevention.
  • Gender: Both men and women deal with acne, however, scarring is more prevalent in men. Androgen hormones, which are more common in men, typically make acne more severe and persistent, which are two more factors that lead to acne scarring.
  • Acne Severity: The deeper, more inflamed, and more severe your acne is, the more likely it is that it will result in scarring.
  • Acne Persistence: The more frequently you have breakouts, the more your risk for scarring increases.
  • Puberty: Hormonal fluctuations cause teenagers to be more prone to acne. More acne and more frequent breakouts increase the chances of scarring.
  • Sun Exposure: Sun exposure not only decreases the skin’s ability to heal properly, but it can also make scarring more visible. Scars darken more quickly than the surrounding skin, and sometimes permanently.
  • Lack of Treatment: The longer you wait to treat your acne, the more increased risk of scarring. If you are already regularly washing your face and using over-the-counter medications and aren’t seeing any results, consider talking to a dermatologist to create a plan that truly works for you.
  • Picking and Touching: Picking at acne causes more trauma to the skin and is more likely to result in scarring and delay the healing process.


Acne scarring vs. hyperpigmentation

Hyperpigmentation can also result from acne, however, this discoloration is not a scar in itself. Hyperpigmentation is dark spots that are left behind on the skin when broken blood vessels do not perfectly heal. It often happens when pimples are popped, which leaves a wound that can change the skin’s texture and color. Spots can appear dark brown or red, and are more likely to fade after a few months.


How to prevent acne scars

Acne scars are primarily prevented through the prevention of acne. When you have acne, how you choose to treat it matters when it comes to potential scars.


1. Minimize Excess Oil

Acne results from excess oil, dead skin cells, bacteria, and other impurities that become trapped in the pores. To minimize the build-up, practice these things:

  • Keep your hands and face clean and wash them regularly
  • Choose a face wash that is specific to oily skin
  • Choose moisturizers that do not contain oil
  • Use a gentle chemical exfoliant once a week, such as salicylic and/or glycolic acid pads or peels. We recommend avoiding physical exfoliants, such as scrubs and brushes, as these can increase irritation and inflammation.


2. Treat Acne in Early Stages

Scarring occurs more often in severe acne, so it’s important to treat breakouts in the early stages. Here are some tips to reduce acne-related inflammation before it worsens:

  • Wash your face daily and exfoliate weekly
  • Choose products that contain acne-fighting ingredients, like benzoyl peroxide or salicylic acid
  • Use spot treatments when needed
  • Maintain a healthy diet, as unhealthy foods can lead to an increase in your bodies inflammation.


3. Don’t Pop Your Zits!

If you do get a severe breakout, resist the urge to pop your zits or pick at them. This is a great way to avoid scarring. Any squeezing, popping, or picking at acne will increase your risk of scarring due to:

  • Bacteria and other impurities getting pushed further into the pore
  • Causing more trauma to the surrounding skin cells, resulting in more irritation and inflammation


While it can be frustrating to have acne, stay away from the temptation to pick at it. Acne is short term, while acne scars are long term. If you’d like more tips to prevent scarring, talk with your dermatologist.


How to treat acne scars

Acne scars can affect your self-esteem, confidence, and overall quality of life. The best way to treat active acne lesions is to prevent future scarring. However, if you already have acne scars, there are many effective treatments that can improve skin texture and reduce acne scarring. Here are different types of treatments that may help:

  • Medical-grade Chemical Peels: Chemical peels are an acid-based solution that are topically applied to either the entire face or in just specific areas of pitted scarring. They remove the outer layer of skin and stimulate collagen repair. Multiple sessions may be necessary to see significant results. A series of chemical peel treatments can leave the skin looking smoother overall and less scarred.
  • Dermal Fillers: These are injectable hyaluronic acid, such as Belotero, Juvederm, or Restylane. These can be injected into depressions in the skin to help smooth out the skin texture and improve the appearance of the skin. Dermal fillers are temporary and often need multiple sessions to significantly improve the scars.
  • Laser Resurfacing: Lasers provide pixelated columns of laser heat in a controlled manner to either heat the skin or remove the skin in order to improve the appearance of scars. The exact number of treatments and amount of downtime involved with this treatment varies for each individual. Your dermatologist can help you decide the frequency that is right for you.


If you’d like to talk with a board-certified dermatologist, like our spectacular Dr. Kristi Hawley, about your acne scars and create a plan that works for you, contact us below.