Does acne cause scarring?

Why does acne leave scars?

A scar forms when damage reaches the dermis, the deeper layer of skin. Your body makes collagen, a structural protein, to repair that damage. The repair tissue is thicker and less flexible than the surrounding skin. Inflammatory acne includes swollen, sore pimples and deeper lumps called nodules and cysts. Whiteheads and blackheads sit closer to the surface and usually are not swollen or painful. Deep, painful breakouts deserve medical attention, particularly if they are already leaving scars.123

What do acne scars look like?

Acne scars can be sunken or raised. Sunken scars look like pits or indentations; different patterns include ice pick and rolling scars. Raised scars include hypertrophic scars, which stay within the damaged area, and keloids, which extend beyond it. Scars can also look pinker, lighter or darker than nearby skin. Colour alone does not tell you which treatment to choose: a clinician assesses texture, size and colour together.45

How can you reduce the risk of scarring?

• Leave spots alone. Picking, popping and squeezing can cause scars and infection, and make acne look worse.
• Treat active acne. Reducing breakouts reduces inflammation and helps prevent new scars. A pharmacist can advise on treatments such as benzoyl peroxide or salicylic acid.
• Wash twice daily with a gentle cleanser. Do not scrub, because irritation can make acne worse.
• Remove makeup at the end of the day and choose noncomedogenic skincare and makeup, meaning products designed not to clog pores.
• Follow your clinician's treatment instructions. Inflammatory acne often takes several months of care and treatment to improve, and can return after it clears.

If picking feels hard to stop, mention that when you seek acne treatment. Repeated picking can leave sores, pigmentation and scars even when there are few active spots. Some people need help changing the habit; compulsive picking can need psychological therapy as well as treatment for any remaining acne.6

When should you see a doctor?

See a doctor if spots are deep, painful, numerous or causing scars, or if acne is not improving with treatment you have tried yourself. Seek help for signs of infection, including hot, swollen and red skin; redness can be harder to see on brown and black skin. Acne affecting your mental health is also a reason to get help. Prescription treatments or a referral to a dermatologist, a skin specialist, can be appropriate.2

Can existing acne scars be treated?

Yes. Treatment can make scars less noticeable, although established scars can persist even as their colour fades. Scar treatment is optional, so an appointment does not have to become a shopping list of procedures. Usually, active acne is brought under control first. Mild scarring can become less noticeable with a retinoid or salicylic acid. Sunken scars can need peels, lasers, microneedling, fillers or minor surgery. Raised scars need a different approach, such as medication injections or laser treatment. More than one treatment is sometimes needed.457

Microdermabrasion and dermabrasion have similar names but different jobs, because skincare apparently needed a spelling test. Microdermabrasion can even out skin tone but does not treat acne scars; dermabrasion can improve scar texture. Procedures can involve several visits and recovery time: microneedling commonly requires four to six treatments. Discuss your goals, budget and available downtime. Before any scar procedure, tell your dermatologist about acne medicines used within the last two years, because some combinations or timings can cause unwanted side effects.57