If you’ve experienced acne scars, whether as the result of a breakout or even just one rogue pimple, we know you know how it feels (not good). To help you figure out the best gameplan for you and your skin, we’ve devised this expert guide to types of acne scars, what causes acne scars, and more need-to-know info.
Atrophic acne scars are the most common type of acne scars. You can tell an acne scar is atrophic because it’ll look like a depression, crater, dent, or hole in the surface of the skin. These are caused by destruction and loss of collagen—because when you pop a pimple, or if you just happen to get a particularly big or cystic pimple, it damages the surrounding skin.
There are different types of atrophic acne scars:
Rolling scars: wide and shallow scars, usually around 4-5 mm.
Boxcar scars: U-shaped, crater-like, wide depressions that may be shallow or deep, with sharp edges.
Ice pick scars: narrow ( < 2mm) deep depressions with steep edges, tapering to an even narrower base.
With atrophic scars, the ice pick type is the most common, followed by the boxcar type and the rolling type—and you may even have a combination of different kinds.
We get it—scars are no fun, but as they say, “know thine enemy,” right? Raised acne scars are less common (but equally annoying), but here’s how to tell if you have one: this type of acne scar looks like a bump, maybe wide and flat, and feels firm to the touch. Hypertrophic acne scars are caused by excess collagen forming around the wound/pimple during the healing process. They may look like raised bumps, but they aren’t pimples, so definitely don’t try to pop them!
A type of hypertrophic acne scar, keloidal acne scars (aka “keloids”) are bumpy, discolored (pink or red, often), and raised. A keloid may also be bigger than the original pimple. Hypertrophic acne scars and keloidal acne scars tend to occur on the body more often than on the face.
While a pimple is healing, your skin is also producing new collagen to rebuild itself. If you pick at a pimple too much—or if the pimple gets really inflamed—you end up with a depressed (aka “atrophic”) scar. On the other hand, if the healing response gets a little too enthusiastic, it may result in a raised (aka “hypertrophic”) scar.
Simply put, the wound healing process goes through 3 stages:
Your skin rebuilds
Your skin strengthens itself
Usually, the type of scar that forms depends on the final stage.
“During the third stage of wound healing, an atrophic scar can form if there is destruction and loss of collagen,” says Curology provider Nicole Hangsterfer, PA-C. “This will present as an indentation in the skin. Less frequently, if there is a collagen gain, a hypertrophic scar or keloid can form. It will likely appear firm and raised.”
Seeing spots, even after your breakout has cleared up? There’s a difference between the red or brown marks that linger after a pimple has run its course and an actual acne scar.
A scar may appear as a little pit in the skin’s surface, or a shiny, slightly raised surface. If it’s just a red or a brown spot, it’s probably not a scar—and it should fade in time. Phew!
Red (or “erythema”) and brown (hyperpigmentation) marks may take up to 6 months or longer to fade on their own. The good news is, you might be able to speed up the process. Certain topical treatments (like your custom Curology cream) can help with fading red or brown spots. Retinoids, azelaic acid, niacinamide, and/or vitamin C can all help fade hyperpigmentation a little faster.
You can fade acne spots with treatments only available in a cosmetic dermatologist’s office, too—but it’ll cost you. Examples of in-office treatments for post-acne spots and hyperpigmentation are pulsed dye lasers (PDL) such as the V-Beam (which is used to reduce redness in the skin) and infrared long-pulsed Nd:YAG lasers, such as Laser Genesis.
We’ve covered the different types of acne scars. Now, what can you do about them? Different types of acne scars may require a different approach to see an improvement—since, for example, some are deeper than others. And keep in mind that it often takes several treatments to see an improvement . Scars are stubborn! Topical treatments aren’t really effective against scars, so you might need to see a cosmetic dermatologist in-person to get the results you’re seeking.
Acne scar treatment options provided by dermatologists in-office may include:
Microneedling (involves a tool that repeatedly punctures the skin with tiny needles to stimulate collagen formation)
Laser (including fractional and ablative)
Fractional radiofrequency (microneedling with heat)
Minor surgery (such as subcision: cutting the fibers that pull the surface of the skin down in depressed scars; or punch excision: cutting out ice-pick type scars)
TCA peel solution (Trichloroacetic acid peels are a type of chemical peel that can range in depth, from superficial to deep)
Dermabrasion (rotating instrument removes the superficial skin layers)
Injectable fillers (such as hyaluronic acid fillers)
Don’t pick or pop your pimples! This is your best way to avoid acne scars.
Wear sunscreen every day. Sun exposure leads to collagen breakdown, which is bad news for your skin’s natural healing process. Wearing sunscreen everyday is an essential step for many reasons besides just preventing or reducing acne scarring.
Be patient and persistent with your plan for treating acne scars and post-acne spots. We know, it’s easier said than done! At the risk of sounding like your mother: if you do nothing else, do tip #2 (wear sunscreen). Really.
Sometimes, scars appear shiny and show through regular concealers. Try covering shiny scars with a matte tinted sunscreen. Physical sunscreens (those made with zinc oxide or titanium dioxide) typically work the best.
Wearing sunscreen also helps with the mark-fading process because it protects the skin from collagen breakdown, and collagen helps repair post-acne damage.
We know acne scars and post-acne marks are tough to fade and repair, but we hope this guide helps and makes it easier for you. Remember, we’re always here to help you through your skin-related challenges, from treating and preventing acne to dealing with the aftermath of a breakout.
Of course, the best way to avoid permanent scars and post-acne spots is not to break out in the first place. If you’re dealing with acne breakouts, sign up for a free trial of Curology to get checked out by one of our medical providers. Your free trial bottle of Curology custom cream will be delivered to your door—you just pay $4.95 for shipping and handling—plus, you can try our non-comedogenic cleanser and moisturizer if you wish!