Eliminating Scars From Acne: Addressing The Physical And Mental

Acne scars are the marks that acne, a common skin condition, can leave behind. These scars can come in many different forms.

Even though acne scars occur in many different people, they still can make you feel insecure about yourself. Let’s look at different ways to handle the after-effects of acne, both in terms of the physical scars and the low self-esteem or other mental health challenges you may have experienced as a result.

How acne scars form

Acne forms when the pores of your skin become engorged with bacteria, dead skin cells, and/or excess oil. Pores are tiny openings in your skin that release sweat and oil, and they can swell up when they get clogged. This is what leads to an acne lesion—commonly referred to as a zit or pimple. 

Many people only experience shallow acne lesions, which dermatologists typically classify as “minor acne”. This type usually heals quickly and poses little risk of scarring, rarely causing lasting damage or noticeable scars. For those who have experienced more severe acne, the walls of some of their pores may have sustained deeper breaks. In these instances, infected material and bacteria can spill into the nearby tissue, creating deeper scars and damaging underlying tissue. The skin usually tries to repair these areas by forming new collagen fibers. Oftentimes, however, the repair job isn’t as flawless and smooth as before—or too much collagen may be formed, leading to severe scarring. In cases like these, scar tissue is left behind, commonly presenting as red or brown marks or dark spots due to post-inflammatory pigmentation, depending on skin type.

Different types of acne scars

Some acne scars are hypertrophic, or raised scars, while others are atrophic, or depressed. Hypertrophic scars are usually found on the jawline, shoulders, chest, and back. They can be tender, itchy, and even painful. 

Atrophic scars come in three different variations: 

• Ice-pick scars, which most often form on the upper cheeks and forehead where the skin is thinner. They look like tiny craters, and they’re typically narrow and deep. 

• Boxcar scars, which are more commonly found on the jaw and lower cheeks. They’re indented shapes with defined edges. 

• Rolling scars, which are usually located on the lower cheeks and jaw. They have sloping edges that result in a wavy, rolling appearance to the skin.

You might also notice discoloration or post-inflammatory hyperpigmentation, especially for people with darker skin tones, as a breakout is healing or shortly after. This type of mark isn’t considered an acne scar, and the skin in these areas usually heals on its own in a matter of months.

How to get rid of acne scars

So your acne has finally cleared up—and now you’re left with scars. Some may go away on their own with time, but others may not without treatment. There are several options for acne scar treatment, ranging from over-the-counter medicated creams to natural remedies to procedures performed by a dermatologist. Note that your acne must be completely cleared up before you try most of the treatments listed below. For most people, acne is at its worst between the ages of 15 and 17 and subsides after that, but everyone’s skin is different. There is no single best treatment for improving the appearance of acne scars, and different people may require different skin care regimens. Before attempting to treat acne scars on your own, it’s typically wise to consult your dermatologist—especially since different skin types, skin tones, and scars may require different treatments. Before attempting any treatments, it may also be advised to have a consistent skincare routine to support skin health. That said, we’ve listed some common methods below.

Topical acne scar treatments

Some common topical acne scar treatments that people can do at home on the advice of a dermatologist include:

• Salicylic acid. You may already be familiar with salicylic acid since it’s often used to treat active breakouts. However, many people don’t know that it can also help clear up the scars acne leaves behind because it reduces redness and inflammation. 

• Azelaic acid. For patients with sensitive skin, azelaic acid may be an option. It has similar qualities to salicylic acid in that it can be both a treatment for acne and scarring but is gentler on the skin.  

• Topical retinoids. Retinoids are often recommended for those with a darker skin tone because they can help with hyperpigmentation. They come in the form of a cream or a gentle exfoliator. Tretinoin is a common retinoid used in acne-scar treatment.

• Alpha hydroxy acids. These include lactic acid and glycolic acid treatments and are typically referred to as AHAs. They’re mild acids that remove the outer layer of skin to reveal smoother skin underneath. 

• Hyaluronic acid. Hyaluronic acid is a gentle ingredient that moisturizes and nourishes the skin. It can reduce both hyperpigmentation and the appearance of acne scars, especially when used regularly over time. 

• Natural remedies. You might also choose to try out a variety of different at-home treatments for acne scars. Lemon juice, baking soda, raw honey, aloe vera gel, shea butter, and coconut oil are a few options that may help.

Medical procedures for treating acne scars

The following are common medical procedures that a dermatologist may recommend you consider. Be sure to consult with a licensed medical professional if you’re thinking about any of these, and do not attempt to try any on your own at home.

• Chemical peels. During a chemical peel, your dermatologist will apply a special chemical solution to your acne scars that removes the skin's outer layer and stimulates new skin to grow. Usually, this new skin is much smoother and less scarred.

• Microdermabrasion. This procedure involves a special machine that sprays tiny crystalline particles on the skin to remove the top layer. Similar to a chemical peel, this process reveals the typically smoother, less scarred skin underneath. 

• Dermabrasion. It’s more intense than microdermabrasion. As such, it’s recommended for moderate to severe acne scars. It involves surgical sanding or planing of the skin where the scars are located.

• Excision and punch replacement graft. In this more aggressive acne scar treatment, scars are cut out of the skin, and the surrounding skin is stitched together. In some cases, a skin graft taken from behind the ear is used to fill the wound.

• Microneedling. Skin needling treatment uses tiny needles to create controlled micro-injuries in the location of acne scars and then stimulates collagen production to encourage new, smoother skin to grow.

• Laser and light therapy. During skin surface laser treatment, a painless beam of light is used to target acne scars. Laser and light therapy is typically combined with other treatments for maximum effectiveness, such as chemical peels.

• Laser resurfacing. For this treatment, a laser is used to remove the scarred top layers of skin so new, healthier skin can grow in its place.

• Soft-tissue fillers. This method is often recommended for depressed or atrophic acne scars. It involves injecting a filler directly into the scar to smooth the appearance of the skin.

• Subcision. During subcision, a needle breaks apart the fibrous bands of tissue that make up acne scars, which can help reduce their appearance.

Coping with the emotional effects of acne

Research shows that having acne—especially in moderate or severe cases—can negatively impact a person’s self-esteem and even influence their life choices. These effects are especially common in teenage girls, according to studies. For instance, fear of being judged, feeling down about one’s personal appearance, or being bullied can affect the mental health of an individual with acne and may even cause them to avoid social events, turn down jobs, or drop out of school. If you’re experiencing mental health effects related to acne, focusing on your talents, achievements, and good qualities and joining an online or local support group may help. You might also prioritize taking care of your body in other ways, such as maintaining a healthy diet and a regular exercise routine, which can positively impact your mental health.

Another method for coping with the mental or emotional effects of acne is to meet with a therapist. They can help you learn positive self-talk, build self-esteem, manage symptoms of conditions like depression or anxiety, and simply provide a safe space to express and sort through your emotions. If you’d feel more comfortable seeking therapy virtually—via phone, video, and/or online chat—you might consider an online therapy platform like BetterHelp if you’re over 18 or an online therapy platform like TeenCounseling if you’re between 13 and 18. Services like these can match you with a licensed therapist who you can meet online to discuss the challenges you may be facing. Research suggests that online therapy offers similar benefits to in-person sessions, so you can choose the format that feels right for you. You can read client reviews of TeenCounseling therapists below.

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