Guide to Treating Acne Scars and Skin Damage

The good news is that the zit that took up residency on your chin for the last three days is finally gone. But the bad news is that the breakout left its mark in the form of a scar.

“Even without picking, acne lesions, particularly cysts, can lead to scarring because of the intense, collagen-damaging skin inflammation with which they are associated,” says Tina Alster, MD, a clinical professor of dermatology at Georgetown University Medical Center. Luckily, you don’t have to grin and bear the telltale signs of a breakout forever. Read on for dermatologists’ top strategies for healing acne scars and keeping new ones at bay.
What Does an Acne Scar Look Like?

Acne scars develop in areas where former cystic blemish lesions have been present. Acne scars come in three varieties, says Hayes Gladstone, MD, a professor of dermatology at Stanford University.

Atrophic, which are mostly shallow
Boxcar-shaped
Ice pick-shaped, which are narrow and deeper.

People with deeper skin tones may also notice darkening (or hyperpigmentation) within the scars, while people with lighter skin tones may show redness (or erythema) within the scars, says Alster.
What Makes Acne Worse?
Sun

Exposing scars to the sun can cause them to darken and slow the healing process, says Alster. How? Ultraviolet rays stimulate melanocytes (pigment-producing cells), leading to further discoloration. Your safest bet: Before heading outdoors, slather on a broad-spectrum sunscreen with an SPF of 15 or higher, with the physical blocker zinc oxide, and reapply every two hours.
Picking and Squeezing

Scars, which are made mainly of collagen (a protein fiber normally found in the skin's second layer), are the body's way of repairing itself. Acne scars are typically indented because of collagen loss from intense inflammation, says Alster. Picking leads to further inflammation and injury of the skin, which adds to the skin’s discoloration and scarring. Squeezing or trying to pop a pimple causes pus and bacteria to filter deeper into the skin, resulting in more collagen damage, notes Ron Moy, MD, professor of dermatology at UCLA.
Vitamin E

You may have heard that applying topical vitamin E to a scar will help it heal faster. But according to a study from researchers at the University of Miami, applying the nutrient directly onto a scar can actually hinder its healing. In the study, vitamin E had no effect (or made matters worse) for 90% of the patients, and 33% who used topical vitamin E developed a contact dermatitis.
What Makes Acne Scars Better?
Cortisone and Fade Creams

First, if the scar is red or swollen, use an over-the-counter cortisone cream to calm the skin, says Alster. The cortisone is absorbed by skin cells and reduces inflammation. Next, you’ll want to concentrate on lightening any hyperpigmentation left from the acne scar. “Hydroquinone, a popular skin lightener, has recently fallen out of favor and is now being omitted from many fading creams due to irritation and carcinogenic concern,” says Alster.

But there are other ingredients to look for over-the-counter that help lighten hyperpigmentation. Kojic acid (a natural skin lightener derived from mushroom extract), arbutin (aka bearberry extract), and even vitamin C (ascorbic acid) are great alternative ingredients to look for in over-the-counter lightening creams, notes Alster. Unfortunately, there is no over-the-counter treatment that can fill in the indentations of atrophic acne scars.
Laser and Filler Treatments

If your acne scars don’t fade away on their own, it may be time to consider booking an appointment with your dermatologist. Within one to three sessions, laser skin resurfacing using fractionated laser technology can even out the skin surface and increase new collagen formation to help fill in acne scars.

Non-ablative lasers stimulate the production of collagen without damaging the skin's surface. Meanwhile, ablative lasers (i.e. CO2 and erbium) vaporize the scar, allowing smoother skin to take its place. Filler injections can also prove beneficial at filling in the indentations left behind from deep acne scars, says Moy. But the downside to fillers is that they need to be repeated every four to six months, as the product re-absorbs into the skin over time.
Patience

The main key to seeing acne scars fade is patience. A few weeks after you break out and subsequently scar, new blood vessels move into the injured area to provide nourishment to the skin, which is why most early scars look pink, says Alster. Months later, collagen (the building blocks of the skin) start to reform, filling in the injured section of skin. Because cystic acne destroys skin and fat, it can take up to a year for the scars to fade, says Moy.