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We Asked Dermatologists How to Treat All the Different Types of Acne Scars You Can Get

There's no one-size-fits-all way to correct them.
Photo: Imaxtree

Photo: Imaxtree

It's easy to feel betrayed whenever a pimple pops up your skin, but one thing that can worsen the blow is the scarring it leaves behind in its wake. It's almost like being incorrectly crowned Miss Universe by Steve Harvey: First comes the glory (making the zit go away), then comes the sting that the reality is actually much worse (the scar is there to stay, at least for a while). But while the frustration and annoyance of acne scars is widely lamented, what people talk about a lot less is that there are different types of scars, and they require different treatments. 

Before we dive into what makes every person's leftover markings unique like snowflakes, a quick rundown on how to avoid getting them in the first place: According to Dr. Joshua Zeichner, the director of cosmetic and clinical research at Mount Sinai in New York City, the only real way to prevent scarring is to prevent pimples as best as possible. This means starting by washing your face twice a day (at minimum). Dr. Zeichner also notes that roughly 6 percent of all the pimples that appear on your skin will leave scarring behind; while that may sound like a small percentage, he points out that given the number of pimples people typically experience, it can be quite significant. 

Of course, picking, squeezing and popping said blemishes is also a key thing to avoid if you want to prevent scarring. For more severe or chronic breakouts, Dr. Zeichner recommends Epiduo Forte, a prescription medication that he says not only prevents acne, but has been proven to minimize the risk of scarring as well.

There are two relatively straightforward categories that encompass all acne scars: hyperpigmentation (dark or red marks) and indented, or depressed, scars (blemishes that actually form topographical cavities on the surface of skin). The difference here is easy to spot visually. However, the technical differences between the two are what really separate them: Brown and red stains left on the skin fall into the pigmentation category, but they are also different from one another. The brownish markings left behind are affectionately known as post-inflammatory hyperpigmentation (PIH), whereas red or pink markings are known as post-inflammatory erythema (PIE). These scars are all typically expected to go away on their own over the course of several weeks to a couple months. But there are ways to speed that process along.

Dr. Zeichner's strategy for aiding in the hyperpigmentation healing process includes chemical exfoliation and vitamin C. Chemical exfoliants like salicylic and azelaic acid are incredibly helpful when it comes to dark marks, since they break down the bonds between skin cells, in turn making it easier to slough off dull or pigmented surface cells. Salicylic acid is considered a beta hydroxy acid (BHA) and penetrates deeper into the skin than alpha hydroxy acids (AHA), such as azelaic, so the quicker you want that mark gone, the more heavily you may want to rely on salicylic, if your skin can hold up to that level of exfoliation. 

If you're unsure where to start, Dr. Zeichner recommends arming yourself with a simple salicylic acid-spiked cleanser, like Neutrogena Acne Proofing Gel Cleanser. For the slightly more advanced acid user, post-cleansing exfoliation liquids like Paula's Choice Skin Perfecting 2% BHA Liquid and Glossier Solution are also good options (not to mention Fashionista editor favorites). 

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Another powerful ingredient most dermatologists turn to in order to fade acne scars is vitamin C, a powerful antioxidant which can repair damage to skin, including hyperpigmentation. Dr. Zeicher personally favors the PCA Skin C and E Strength Max serum, since the inclusion of vitamin E also helps to protect skin and bolster it against damaging free-radicals. When incorporating either vitamin C or any chemical exfoliants into your routine, it's especially crucial to remember to load up on sunscreen, as these ingredients can make skin even more sensitive to sun exposure. Another benefit of sunscreen is that it can help keep dark marks from becoming even darker and more noticeable. Win-win.

As for depressed scars, the news is a bit more, uh... depressing. These indentations in the skin are caused by damage to collagen, and unfortunately they won't disappear on their own. According to Los Angeles-based dermatologist Dr. Annie Chiu, there are three different types of scars that fall within the "indented" category: ice pick scars, box scars and rolling scars. She describes ice pick scars as narrow indentations that are smaller than 2mm wide, and extend deep into the skin, giving the appearance of small holes. A box scar looks like a punched hole that can be either round or linear but has distinctive lines. Lastly, the rolling scar has gentle, sloping edges that disappear when skin is stretched.

The good news? All of these types of scars can be improved upon with the right treatment strategy. Dr. Zeichner suggests starting with a topical retinoid to stimulate the damaged collagen and spur the production new, plump skin that fills out the scar. (For an inexpensive over-the-counter option that's Fashionista-editor-approved, try Differin Gel.) Dr. Zeichner also recommends in-office laser treatments like Fraxel, which punches microscopic holes in your skin to create a controlled wound that will heal itself in a more cosmetically appealing manner. 

Along the same lines is a process known as microneedling which Dr. Chiu says can be done in the office (more a more intense treatment) or at home. Like Fraxel, microneedling creates small wounds in the skin that encourage collagen production and new skin healing. Unlike Fraxel, microneedling is done with physical metal points rather than laser. If your scars are very deep, Dr. Chiu also suggests speaking to your dermatologist about dermal fillers, injectibles which can soften the look of ice pick, boxed and rolling scars.

Above all else, the real key to healing acne scars — no matter what type — is patience. The process genuinely takes time, no matter how aggressive your treatment plan may be. In the mean time, click through the gallery below to see some of the products that can help.

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