Dermatologists Explain Why Certain Acne Scars—And What You Can Do to Help

why does acne scar

Stocksy

Noticing a new breakout is annoying, and realizing it’s going to scar is even more frustrating. We’ve all experienced that moment: You’ve exfoliated, you’ve spot treated, and you’ve avoided picking at your face, and finally your acne is finally starting to clear—except, instead of healing completely and letting your skin return to its previous state, it leaves a dark mark that’s just as noticeable and irritating as the pimple itself. Not all acne leaves a mark, but enough does, and it’s not always totally clear what acne is going to scar and why.

It’s an issue I’ve run into more than a few times during my life, both during my teens and again more recently. Even when my skin is clear with no active blemishes, I still bear 12 year-old scars as well as newer ones. Some are raised, some are flat, and some are caved in. And while you can cover a red mark with foundation or concealer, it’s not easy to fake smooth skin texture. And of course you don't have to cover up anything at all. But I want to.

Not all of my acne scars, though, and I’ve often wondered if I’m doing unconsciously doing something that prevents them from leaving a mark. I try to treat them all equally with spot treatments, and I avoid touching them or popping them, but still, some linger on my skin for years while others disappear without a trace. 

To understand why this happens, I turned to the experts to figure out why only some acne scars—and, if there’s anything we can do to help. Below, find their advice

Why Does Acne Scar?

According to the experts, any breakout can scar, even if you don’t touch your face at all while it's active—but, cystic acne tends to leave marks the most. Celebrity esthetician and skincare expert Renée Rouleau says the issue is inflammation that has damaged the skin, much like a cut elsewhere on your body. “Red or dark acne scars and marks are the result of inflammation within the dermis that triggers the skin to produce pigment cells,” she says. “In addition, capillaries become dilated, or can even break during the blemish cycle, which brings out some additional redness. The blemish must be cared for properly to expedite the fading and healing process to prevent long-term damage to the skin.”

Why Don't All Breakouts Scar?

According to Rouleau, it can happen with any pimple that injures the skin in any way. “If the infection broke through the skin’s surface, it will automatically trigger a melanin response. If it was a cyst and never broke through, the bump (inflammation) underneath stretched and damaged the surrounding tissue, which then resulted in an increase of melanin activity,” she explains. “Unfortunately, even when you are careful about not picking a blemish, you can still get a dark, discolored mark."

The good news is messing with a breakout less should ensure a much quicker recovery. "As far as chronic and severe cystic breakouts are concerned, these can be permanent," Rouleau says. "But longterm use of retinoids and professional treatments can help minimize their appearance by smoothing out your skin’s texture."

NYC-based cosmetic dermatologist Michele Green, M.D., agrees, saying, “In general, acne that scars tends to be pustular or cystic because it is infected. Comedonal acne, which mostly consists of whiteheads or blackheads, is much less likely to scar.” However, she says, picking at your skin when you have a whitehead or a blackhead is a guaranteed way to leave a scar, again due to the fact that it traumatizes the skin and triggers an inflammatory response.

How to Avoid Acne Scars

Unfortunately, the answer isn’t much better here. If the acne is cystic, or if it breaks the surface, you can be pretty sure that the damage will leave some sort of mark—at least for a bit. "Acne creates trauma to the skin, it’s a form of an injury and there will always be some sort of inflamed scarring as a result," Rouleau says.

Dr. Green adds: “If the skin is getting pustular or cystic acne, or it appears that you might be beginning to scar, then it is time to consult a board-certified dermatologist. Solutions like acne surgery and cortisone injections to treat these acne cysts, as well as oral antibiotics, retinoids, Accutane, or a hormonal treatment such as Spirnolactone or birth control pills may be helpful."

The Best Way to Remove Acne Scars

Thankfully, this news isn’t as bleak. Just because you have some acne that scarred, that doesn’t mean that you have to wait months—sometimes years—for them to fade. There are treatments to help lighten the scars or even get rid of them completely, and the one you choose basically depends on your skin type and the type of scarring you have. 

Fillers

“Very deep scars can be filled, since the collagen has been lost due to the scarring,” Green says. “Depending on the depth and type of scars, there are different fillers like Bellafill, Restylane, and Sculptra that are very effective. Treating the surface irregularities with lasers such as Fraxel and eMatrix Radiofrequency laser are amazing at smoothing out the texture and acne scars. Red scars and keloidal scars respond best to the V-Beam laser since it is the gold standard for reducing redness and eliminating them."

Diet

According to Thornfeldt, your diet and the supplements you take can have something to do with how fast your scars heal. "There are supplements that can help improve skin repair, like Zinc (ideally picolinate), glucosamine plus MSM, and collagen peptides orally,” he says. “[Foods] low in caffeine, alcohol, and milk chocolate are anti-inflammatory.

Lifestyle Changes

Avoiding the sun will also help speed up healing, so don’t skimp on the sunscreen. As Rouleau says, “From the moment the sun rises to when it sets, all of the daylight that gets on your skin, even on a cloudy day during winter, is keeping the dark pigment cells awake. Sunscreen gives them an opportunity to fade your acne scars,” she explains. “Of course, adding in an exfoliating product and a skin brightening product will dramatically fade acne scars faster, [but] if I had to choose just one, I’d say sunscreen.”

Skincare Products

"I recommend that you apply your regular acid serum to your skin in the evening as usual, and follow with moisturizer," Rouleau suggests. "Then, immediately wipe the scarred area with a damp cotton swab to remove previously applied products. Apply a very thin layer of my Post-Breakout Fading Gel. It’s recommended to use this gel no more than four nights a week. A post-breakout scar is very delicate and you don’t want to cause irritation. If redness or irritation occurs, cut back on usage or discontinue completely."

The Bottom Line

At the end of the day, though, it’s important to remember that we all get acne scars, and even if you do end up with a few—or more than a few, as in my case!—it’s completely common. And, if you want to, there are things you can do to help them fade away. 

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