The only thing worse than acne is the scarring that all too often follows. It’s bad enough that we have to endure a week of feeling like people are focusing on the red spots on our faces, but once the pimples turn into scars, getting our skin back to its original state becomes an uphill battle. Luckily, there are ways to get rid of acne scars, but the first step in repairing your skin is understanding what’s causing the scars and knowing the difference between scars and discoloration.
“A lot of people think they have scars and don’t. After the acne has cleared, people see the purple, lasting effect on the skin. I tell them they don’t actually have scars, and that purple part will go away with time,” Dr. Debra Luftman, a dermatologist and member of the Simple Advisory Board, explains to us. Many people misdiagnose scars on their skin and then use the wrong products, so being able to differentiate helps to treat your skin properly.
For a full grasp on how to get rid of acne scars, we spoke with Dr. Diane Berson, a New York-based dermatologist. Below, Dr. Berson explains everything you need to know about what causes acne scars, the difference between scars and discoloration, and the best ways to help get rid of acne scars.
Beauty High: What causes acne to scar?
Dr. Diane Berson: Basically, a lot of this can depend on the skin type. Some people are more prone than others to develop pigmentation at the site of pimples, or scarring. Generally, the more enflammed the acne is, the more likely it is to leave pigmentation or scars. If you have a very inflamed pimple or very inflamed cysts, the cystic regions are more likely to leave scarring. It’s a result of the inflammation of the pimple and the area surrounding the pimple that causes changes in the dermis,
which causes changes in the collagen. The deeper regions, like the cysts, are more likely to cause scarring.
A lot of people refer to spots as the scar. If you have pigmentation in the area, we can often fade that. If you have a scar, which is destruction of the dermis, then you’ll require treatments — they don’t get better on their own. The discoloration is called post-inflammatory hyperpigmentation. It refers to where you have pigmentation, which can come from acne, eczema, or any kind of inflammation on the skin.
Also, there are different types of scars. Atrophic scars are the kind where the skin is indented due to a loss of collagen. They’re very similar to stretch marks, where the skin first turns pink, then purple, and finally white. This comes as a result of inflamed acne. Hypertrophic scars are the kind that are actually raised, similar to a keloid. They’re caused when inflammation actually stimulates collagen production, which is why the scar becomes raised.
Are there any natural ways to get rid of acne scars?
It’s really hard, but it depends on the scar. If it’s just very early scarring, hypothetically there are some natural anti-inflammatory ingredients, like a botanical anti-inflammatory. You can also try vitamin E in the early stages. Sun protection helps, too, but a true scar really needs treatment.
Is there a certain way to apply acne scar products? Should they be applied all over the face or only on the scar?
I’s actually both. Prescription retinoid goes all over the face to even out the scars. Then for individual scar treatments like a filler or a laser, you’d go for one pass all over the face, then an extra pass on the scars themselves. If you’re using injectables, they only go on the scars.
How often should you apply scar product? Can you over-apply?
This depends on what you’re using. For prescription retinoids, I’d say to use them every night, but if you have skin that gets irritated easily, you can begin by using them every other night to gradually acclimate your skin.
What’s the difference between an acne scar and other skin discolorations? Is the treatment different?
Scars can be atrophic or hypertrophic, as I mentioned earlier. Skin discoloration is known as post-inflammatory hyper pigmentation, which occurs after any kind of inflammation (which includes acne, but can also be from other rashes like eczema). Generally people with fair skin may develop red spots, but people with a darker tone may develop the true hyperpigmentation, or brown spots. Other causes of discoloration are chronic sun damage, which can come as freckles or hyperpigmentation. Melasma, which can occur after pregnancy, causes skin pigmentation in certain areas of the face. This develops from hormonal changes — which can be from either pregnancy or the birth control pill — and this plus sun damage can cause discoloration.
If you do have excess pigmentation, the first rule is to wear sunblock, and then there are over-the-counter products you can use. As for over-the-counter products geared towards hyperpigmentation, the new Olay Pro-X for Even Skin Tone is wonderful because it’s developed with our gold standard. There’s no prescription necessary, and it works to even out skin tone and fade any pigmentation on the skin.
For fading pigmentation in more extreme cases, I’d use prescription retinoids. Of course, there’s some pigmentation that calls for in-office procedures such as laser treatments, peels, or microdermabrasion, but the at-home treatments should be used following these procedures to maintain the skin.
For acne scarring in-office, we use non-invasive fraxel and lasers. As for the at-home treatment, I’d prescribe retinoids to stimulate collagen to help restore the skin.
Will sun exposure make the scar any worse?
If the scar is pigmentation, yes. With any post-inflammatory pigmentation, the sun can make the scar and the pigmentation worse. Sun protection is key.