How to get rid of acne scars: your ultimate guide

What are acne scars?

If your acne scars are causing you to shy away from the mirror, to cover your face in public, or even to avoid seeing friends and family, you're not alone. Sadly, acne scars can be a source of great distress and low self-esteem. Many people even feel embarrassed, but this skin issue is far from rare - in fact, at least 40% of people with acne have the scars to show for it¹.

So why does acne so often leave a mark? Dr Sunil Chopra² explains: "Most superficial wounds heal without scarring; however, acne scars occur when the dermis (inner layer of skin) is damaged.

"Acne scars are usually the product of inflammation. These inflamed blemishes occur when the pore (tiny holes in your skin that hair follicles grow through) become engorged with excess oil, dead skin cells, and bacteria.

"When the pore swells it can break its wall. Ruptures that occur near the skin's surface (the epidermis layer) usually heal quickly. However, more serious damage occurs when there is a deeper break in the pore wall. This damages the dermis and to repair itself the skin forms new collagen fibres which results in a scar."

How long does it take for acne scars to fade?

The good news is that acne scars tend to fade over time. However, this does depend on how deep into your skin the damage goes.

According to Dr Chopra, an uneven skin texture is a good indication of deep scarring. There are several different types of acne scars. These include:

• Ice pick scars - deep punctures.

• Boxcar scars - indentations in the skin that are broader in shape.

• Rolling scars - look like mini hills (raised) and valleys (indentations).

• Keloids - raised and usually red or pink.

How to get rid of acne scars

If you feel that acne scars are affecting your self-confidence, you'll be pleased to know that there is a range of treatment options. The catch is that a lot of them come with a premium price tag, but some options such as topical treatment (that you rub directly on to your acne scars) are widely available on the NHS.

Laser resurfacing

This increasingly popular approach involves targeting lasers at the problem areas to stimulate the growth of healthy skin tissue in replacement of damaged or dead skin cells. Dr Chopra says:

"The Fraxel Laser combines two different wavelengths; one acts as a gentle exfoliant on the skin's surface, while the other creates micro-channels within the skin to trigger collagen production (a key building block of skin).

"For textured acne scars such as boxcar and ice pick, lasers can be more effective than any topical treatment. This is because they reach deep enough to break up the scar tissue that's causing the texture in a way that a topical treatment wouldn't be able to."

Other energy-based procedures

There is an emerging trend that combines laser resurfacing with other energy-based treatments to stimulate collagen production. Whereas laser therapy uses light, these treatments use heat energy. For example:

• Radiofrequency devices - send a current of heat deep into the skin to tighten collagen.

• Intense pulsed light - sends pulses of scattered light that converts to heat, triggering collagen production.

Microdermabrasion

Also known as dermabrasion, this procedure is suitable for more severe scarring. Here, the very top layer of skin is removed with a rapidly rotating device. This can completely remove surface acne scars and reduce the visibility of deeper scars.

Cosmetic surgery

Surgery isn't right for everyone, but there are two popular minor procedures:

• Punch excision - involves cutting out individual acne scars and repairing the wound with stitches or a skin graft.

• Subcision - involves inserting needles under each scar to loosen and untether scar tissue.

Injections

This is a temporary solution, and you will need to repeat treatments if you are pleased with the reduction in visible scarring. There are two main types:

• Soft tissue fillers (dermal fillers) - injecting substances such as collagen or fat can plump the skin on top of the acne scars.

• Botox (onabotulinumtoxinA) - injecting Botox relaxes the skin around the scars, reducing the appearance of uneven skin texture.

Chemical peels

Certain peeling agents - such as salicylic acid, lactic acid, and glycolic acid - exfoliate the skin surface, effectively removing any dead skin cells responsible for acne lesions. At the same time, these peels stimulate new healthy cells to grow. You will likely need to have a series of chemical peels in order to see a significant improvement³.

While you can purchase cheaper at-home peels, these will have a smaller concentration of peeling agents, making the results less noticeable and more short-term.

Micro-needling

During this simple technique, a device studded with small needles is rolled over your skin to trigger collagen formation. Results are relatively subtle, one study found that four sessions could improve the appearance of acne scars in a range of severities⁴.

Patient picks for Acne

Skin, nail and hair health

Pregnancy acne: why it happens and how to treat it

We all know the stereotype of the radiant expectant mother, with her glowing, picture-perfect, clear skin, but the reality of unpredictable pregnancy hormones can be somewhat different. For women affected by adult acne, not knowing how their skin will react - or how to keep it under control without many of the most commonly prescribed treatments - may be a concern during pregnancy or when planning to conceive. But there are a number of safe options to keep pregnancy acne at bay.

by Sarah Graham

Skin, nail and hair health

Acne

Acne (also called 'zits', spots or pimples) is a common condition, particularly in teenagers. It can also occasionally affect middle-aged people and babies. It often causes a lot of worry and distress but can usually be cleared up, or at least improved a lot, with the right treatment. The treatment can take about a month to work and may need to continue for a while, even after the spots have cleared.

by Dr Colin Tidy, MRCGP

Acne scar creams - Your FAQs

If you're wondering how to get rid of acne scars on a budget, then topical creams, gels, lotions, and pads that you apply directly on to your scars may be a good choice. These are the most convenient and cost-effective treatment, although how well they work will depend on the type and severity of your scarring.

Some are available on prescription, including antibiotic and retinoid lotions. However, the skincare industry also markets lots of products with a wide range of ingredients that all claim to diminish the appearance of acne scars.

Dr Chopra reviews some of the most popular products and ingredients on the market (the following views belong to Dr Chopra and not to Patient).

Does Differin help acne scars?

"Differin Gel contains adapalene, which can help to refine the appearance of scars and pores. As a result, using Differin Gel may help to promote a more even skin tone and decrease the appearance of scars."

Does Sudocrem help acne scars?

"Sudocrem contains zinc oxide which is highly effective in the treatment of thickened, wide, and raised scars (hypertrophic scars)."

Does Epiduo help with acne scars?

"Epiduo contains two active ingredients, adapalene 0.1% and benzoyl peroxide 2.5%. Adapalene is a retinoid that increases the turnover of skin cells. Benzoyl peroxide is a keratolytic that breaks down keratin, a protein that forms part of the skin's structure. Together, these can help to increase cell turnover and reduce acne scarring⁵."

Does salicylic acid remove acne scars?

"Salicylic acid is a peeling agent that causes the shedding of the epidermal layers. It can help to clear the debris and skin cells in your pores that can lead to acne and also helps to reduce swelling and redness which may reduce the appearance of scarring."

Are you making these mistakes?

Does sunlight help with acne scars?

On the contrary, too much sun exposure can cause further discoloration for acne scars. "Scar tissue is more susceptible to sun damage than the rest of your skin, so it's vital that you protect scars, and skin, from the sun's UV radiation with a high factor SPF (sun protection factor)," adds Dr Chopra.

Do sunbeds help with acne scars?

No - Dr Chopra describes this as a 'common misconception'. Just like the UV from the sun, sunbeds can actively damage and worsen acne scars and so should be avoided.

Does Bio-Oil help acne scars?

"I would not advise using Bio-Oil on acne scars," says Dr Chopra. "The many fragrance types can sensitise skin, and it can also block your pores and cause acne."

Further reading

1. Dréno, Tan, Kang, Rueda, Lozada, Bettoli and Layton "How people with facial acne scars are perceived in society: an online survey".

2. Dr Sunil Chopra, London Dermatology Centre.

3. Kontochristopoulos and latsidaki "Chemical peels in active acne and acne scars".

4. Afzal, Ahmad, Mehrose, Saleem, Yousaf, Mujahid, Rehman and Tarar "Efficacy of micro-needling on post acne scars".

5. Dréno, Bissonnette, Gagné-Henley, Barankin, Lynde, Kerrouche and Tan "Prevention and reduction of atrophic acne scars with Adapalene 0.3%/Benzoyl Peroxide 2.5% gel in subjects with moderate or severe facial acne".