As an inflammatory skin disorder that produces painful nodules and cysts, acne results from sebum (your skin’s natural oil), dead skin cells, and even minute hairs clogging and causing infections in hair follicles or skin pores. 

When acne pimples burst and weep pus, bacteria can also infect surrounding follicles, even under the skin. This spreads acne and contributes to broader acne “breakouts.”

Acne inflicts damage to underlying skin tissues too, similar to the damage caused by puncture wounds. Following an acne breakout, damaged skin tissue and skin substructure attempts to repair itself by producing collagen.

Collagen is a structural protein essential for the proper healing of skin wounds. While mild abrasions of the skin typically heal without leaving a scar, more serious conditions, like acne, force the body to produce too much collagen. 

When large amounts of collagen try to "heal" a wound, a scar develops.

Are acne scars treatable? Yes!

Fortunately, the best ingredients to treat acne scars are available by prescription and in some over-the-counter products. Here’s the story on healing acne scars.

Summary

• Acne scars occur when the skin’s natural healing process creates too much collagen at the site of injury. 
• Acne scars can be treated with a variety of medications, including prescription and non-prescription retinoids like tretinoin. Medical procedures in a dermatology office can also help reduce acne scarring. 

Is Acne Scarring Common? Who is at Risk for Acne Scars?

About one out of five people who develop acne as a teenager or young adult will have acne scars. Some acne sufferers are more at risk for scarring, too. Factors increasing the risk for acne scars include:

Inflammatory acne. Inflammatory acne presents swollen, painful nodules and cysts that reach deep into the skin.

Picking, popping, or squeezing acne cysts. This exacerbates inflammation under the skin and encourages excess production of collagen.

Genetics. If a parent has acne scars, it's likely their child will also have scars if the child develops acne.

Delaying or neglecting to treat acne. The longer you allow acne to worsen and spread, the bigger the risk of having acne scars.

Acne scars are described by dermatologists as deep and narrow (ice pick scar), shallow and wavy (rolling scar), and resembling chicken pox scars (boxcar scars). Hypertrophic acne scars rise above the skin's surface and are associated with severe acne.

Keloid Scars and Acne

Unlike other scars, keloids continue growing past the area of the initial wound. Keloid scars often rise above the skin and have a smooth, purplish-pink or dark brown surface.

Scar tissue is the culprit behind the formation of keloids. 

Excessive amounts of collagen necessary for wound repair accumulate and form the large, lumpy mass that distinguishes keloid scars from hypertrophic scars. 

Keloids almost always form on the shoulders, chest, and back. Rarely are they found on the face, although people who exhibit a vulnerability to keloid development may find them appearing along their jawline.

How to treat acne scars at home involves applying medicated topicals that promote new skin cell production and control collagen release. Tretinoin and other retinoids are a primary tool in fading mild to moderate acne scars and may help reduce acne lesions. These are often dermatologists’ first pick when treating scarring, wrinkling, and a variety of skin conditions.

Topical Retinoids for Acne Scarring

Topical retinoids, such as tretinoin (0.01%, 0.025%, and 0.05%) and tazarotene (0.1%), are clinically proven to inhibit the development of new acne lesions and microcomedones, as well as reduce the appearance of acne scars and hyperpigmentation.

As a group of chemical compounds containing vitamin A, retinoids are highly effective for improving skin appearance and health. Retinoids, like tretinoin, not only stimulate new skin cell growth, but also diminish age spots, mild birthmarks, and other skin discolorations. Topical retinoids are often prescribed as a primary treatment due to their ability to block inflammatory pathways conducive to acne. 

Retinoids exfoliate the skin by increasing the rate of skin-cell turnover. This means as more new skin cells are made, old cells die and flake off more quickly. Over time, this type of exfoliation reveals a new layer of skin that is not damaged by acne scars, dark spots, or fine lines.

Studies indicate that 0.01% and 0.025% tretinoin reduces microcomedone development by up to 80% when used daily for 12 weeks. 

Moreover, topical retinoids can treat secondary lesions associated with acne, such as hyperpigmentation and scarring. A pilot study involving individuals with acne scarring used a topical retinoid for several months. At the end of week 24, subjects showed significantly reduced scar visibility and smoother skin texture. 

Post-inflammatory hyperpigmentation is often seen in people with moderate to severe acne. Usually pink, tan, or brown in color, hyperpigmentation is what happens when the skin produces too much pigment (melanin) in response to acne inflammation. Topical retinoids containing tretinoin can significantly lighten post-inflammatory hyperpigmentation by inhibiting the transfer of melanin to skin cells and accelerating cell growth and turnover.

Tretinoin for Acne Scars

Some medications, generically referred to as retinoids, contain different amounts of tretinoin. Various brandname tretinoin formulations available in the U.S. include:

• Retin-A (cream or gel with 0.025% tretinoin)
• Renova (cream only with 0.02% tretinoin)
• Avita (cream or gel with 0.025% tretinoin)
• Atralin (gel only with 0.05% tretinoin)
• Retin-A Micro (cream or gel with 0.04% tretinoin)
• Generic Tretinoin (cream in a range of concentrations) in custom formulas by Nava MD

In some cases, dermatologists may recommend combining tretinoin with a procedure called iontophoresis. 

A noninvasive technique for administering anti-inflammatory medications, like tretinoin, directly into underlying tissue, iontophoresis was previously used successfully for decades to optimize the delivery of transdermal medications. Iontophoresis makes it easier for topical tretinoin to penetrate the skin and expedite the reduction of acne scars

Can Acne Scars Be Treated Without Experiencing Side Effects of Topical Medications?

Even when using the best ingredients to treat acne scars, some people may experience mild to moderate side effects that temporarily irritate their skin. Initially, dryness, itchiness, and peeling can occur when using acne scar topicals, which this is largely the skin's reaction to accelerated regeneration.

Once the skin adjusts to a particular retinoid, usually within a few weeks, side effects subside and disappear.

‍How to Treat Deep Acne Scars

Intense Pulsed Light Therapy

‍Deeply indented acne scars may not respond fully to topical retinoids because the damage is too severe. 

Dermatologists may recommend intense pulsed light (IPL) therapy for smoothing acne depressions. By adjusting light pulses to emit specific wavelength frequencies, dermatologists use IPL to trigger porphyrin, a substance containing oxygen molecules that is found in the skin's oil glands.

When light pulses from an IPL device activate porphyrin, a large amount of oxygen is released that oxidizes (kills) bacteria responsible for acne inflammation. In addition, IPL energy safely evaporates dead skin cells and stimulates new cell growth to create a layer of new, unscarred skin.

Chemical Peels

While chemical peels are generally not recommended for use during acne outbreaks, they can help reduce acne scarring and mild hyperpigmentation. A chemical peel typically consists of glycolic acid, alpha-hydroxy, and trichloroacetic acid and works as an exfoliator to remove damaged and dead skin cells. If the scarring is severe, dermatologists may use a "deep" chemical peel with additional substances to penetrate deeper under the skin.

Pixel Laser Resurfacing

An ablative type of laser treatment to reduce acne scars and hyperpigmentation, Pixel Laser Resurfacing treats "pixel" (tiny) areas of skin without affecting the surrounding dermis. 

This is the reason pixel laser can be so effective at smoothing severe acne scars. 

By leaving the surrounding skin untouched by ablative laser energy, the "intact" skin offers a reservoir of beneficial chemicals that promote the production of collagen and proper healing of treated areas. Pixel laser resurfacing also works to tighten loose collagen fibers, synthesize new collagen fibers, and diminish discoloration left behind by acne cysts.

Conclusion

Treating and fading acne scars is very achievable with common medications like retinoids, the most effective of which are prescription. Medical treatments like peels and light therapy can help too, though they’re often reserved for deeper and more severe acne scars. They also tend to be more expensive. 

Nava MD is your online dermatologist for acne scarring and acne prevention. We help patients with custom prescription formulas for their acne severity, skin condition, and skin type. Formulas are prescribed by licensed dermatologists online, with medications shipped directly to your door if prescribed. 

It's fast, easy, and you never even have to leave home.

‍Learn more and get started with a free consultation today.

References

https://my.clevelandclinic.org/health/diseases/21222-acne-scars

https://www.healthline.com/health/skin/retin-a-for-acne#takeaway

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/#CR12

https://europepmc.org/article/med/1283729

https://pubmed.ncbi.nlm.nih.gov/10192170/

https://link.springer.com/article/10.1007/s13555-017-0185-2

https://firoozgar.iums.ac.ir/files/rcrdc/files/%D9%85%D9%82%D8%A7%D9%84%D8%A7%D8%AA_99/ACNE_SCAR%3B_A_REVIEW_OF_CLASSIFICATION.pdf

https://onlinelibrary.wiley.com/doi/full/10.1111/ajd.12715

http://www.medicallaser.net/PDFs/SmoothBeam/1450_nm_Diode_Laser_Acne_Treatment.pdf