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WHAT CAUSES ACNE SCARS AND HOW TO HELP PREVENT AND MANAGE SCARRING

Acne occurs when the pores of the skin become clogged with dead skin cells, oil, or bacteria. This blockage leads to the formation of pimples, blackheads, whiteheads, or cysts and can scar if the deeper layers of the skin are damaged.1 A good skincare routine and appropriate treatment through your dermatologist, can help you to manage acne breakouts and reduce the potential for scarring, promoting healthier-looking skin.²

Acne on Face

WHAT ARE ACNE SCARS?

There are three main types of acne scars: ice pick scars, rolling scars, and boxcar scars.³ These scars can vary in appearance and may require different acne treatments for improvement:³,⁴


  • Ice pick scars are small, deep holes, or pits, that resemble the marks left by an ice pick or a needle. They are characterised by narrow openings that extend into the deeper layers of the skin.  
  • Rolling scars have a wavy or rolling appearance and give the skin an uneven texture.  
  • Boxcar scars are broad, rectangular, or oval depressions with well-defined edges. Boxcar scars often have sharp, vertical sides and resemble small craters or indentations on the skin's surface. 

Acne can also cause dark spots called post-inflammatory hyperpigmentation (PIH). PIH occurs due to an overproduction of melanin in response to inflammation caused by acne, and while not technically ‘acne scars’ they are often mistaken for scarring. These spots appear as flat areas of increased pigmentation that can range in colour from pink or red to brown or black. Unlike scars, PIH does not involve changes in the texture or contour of the skin, and they tend to fade over time.¹

washing face

WHAT CAUSES ACNE SCARS AND DARK SPOTS?

The majority of acne scars are caused by the underproduction of collagen during the skin's healing process.³ When collagen production is insufficient, it can result in depressions or indentations on the skin's surface, as this essential protein helps support the structure and firmness of the skin. However, around 10 to 20 percent of acne scars are due to an overproduction of collagen during the healing process,³ and result in raised, thickened areas of scar tissue.⁵

 

After acne has healed, an overproduction of melanin can also occur, which is triggered as an inflammatory response during acne breakouts - this is what leads to a post-inflammatory hyperpigmentation or dark spots.⁶

How to avoid acne scars and dark spots

Acne scarring can sometimes have a genetic component that makes an individual more prone to developing scars.⁵ To help minimise the chances of acne scarring and dark spots, you might want to follow two key practices. 


  1. Implement the right skincare routine. Developing a proper skincare routine includes using appropriate cleansers and moisturisers that suit your skin type and using acne-fighting products recommended by your dermatologist. This can help reduce breakouts and manage your acne, reducing the chances of developing dark spots and scarring.² Please refer to our article Getting Started on a Skincare Routine, if you haven’t yet established a skincare routine that suits your skin type. 
  2. It is crucial to resist the temptation of picking, squeezing, or popping acne lesions. Picking or popping spots can cause damage to the skin, prolong the healing process, and increase the risk of inflammation and scarring.⁵ It is essential to let acne scars heal naturally. 

Skincare routine to help reduce appearance of dark spots

When it comes to helping reduce the appearance of dark spots from acne or preventing hyperpigmentation, there are some products you can incorporate into your skincare routine. 


Using sunscreen is essential for all skin types, not only for acne-prone skin. Sun exposure can exacerbate pigmentation irregularities, lead to dark spots and darken existing spots. Using a broad-spectrum sunscreen with a high sun protection factor (SPF) can help protect the skin from harmful UV rays and minimise the risk of hyperpigmentation.⁷ Cetaphil offers a range of sunscreens that provide effective sun protection without clogging pores – including Cetaphil Sun SPF 50+ Ultra-Light Lotion and Cetaphil Sun SPF 50+ Kids Liposomal Lotion. 


Exfoliation is another useful technique to reduce the appearance of dark spots.6 By removing dead skin cells with a gentle exfoliator, such as Cetaphil Bright Healthy Radiance Gentle Renewing Cleanser, you can help promote surface cell turnover and help fade the visible signs of hyperpigmentation. 


In addition, certain ingredients have been found to be beneficial in addressing dark spots. Niacinamide is a well-known ingredient that helps to promote a more even skin tone.⁸ Antioxidants such as vitamin C can also aid in brightening the skin and reducing the appearance of dark spots.⁷ Cetaphil Bright Healthy Radiance Perfecting Serum contains both niacinamide and antioxidants to help improve your skin's appearance and reduce the appearance of dark spots. 

Skincare routine to help prevent acne scar

Establishing a consistent skincare routine tailored to acne-prone skin can help manage and minimise acne breakouts, ultimately reducing the chances of scarring occurring.²


When choosing skincare products, it is important to look for formulations that won’t clog your pores and that reduce the risk of further breakouts, such as Cetaphil Pro Acne Prone Oil Control Foam Wash and Cetaphil Pro Acne Prone Oil-Free Facial Moisturising Lotion SPF 25. 

How to get rid of acne scars?

If acne scarring, such as ice pick scars, rolling scars, and boxcar scars, has already occurred, there are various treatments available to help reduce their appearance. These treatments are typically performed by dermatologists or skincare specialists, including exfoliation, laser therapy, punch excision, and subcision. 


However, it's important to consult with a dermatologist to determine the most suitable treatment option based on your individual skin type and scar characteristics. The time it takes for acne scars to fade will vary depending on various factors, including the severity of your scars, your skin type, and the treatment methods used. It may take several months or more for acne scars to fade significantly. 

The Bottom Line

Understanding the underlying causes of different types of acne scars and post-inflammatory hyperpigmentation can help you find appropriate skincare products options. Dermatologists can also provide you with valuable insights and recommend appropriate treatments to achieve desired results. 

References


  1. American Academy of Dermatology Association. Acne: signs and symptoms. https://www.aad.org/public/diseases/acne/really-acne/symptoms Accessed 31 May, 2023 
  2. American Academy of Dermatology Association. Acne overview. https://www.aad.org/public/diseases/acne/really-acne/overview Accessed 31 May, 2023 
  3. Bhargava S, Cunha PR, Lee J et al. Acne Scarring Management: Systematic Review and Evaluation of the Evidence. Am J Clin Dermatol 19, 459–477 (2018). doi:10.1007/s40257-018-0358-5 
  4. Fabbrocini G, Annunziata MC, et al. Acne Scars: Pathogenesis, Classification and Treatment. Dermatology research and practice. 2010. 893080. doi:10.1155/2010/893080.  
  5. American Academy of Dermatology Association. Acne Scars: Who gets and causes. https://www.aad.org/public/diseases/acne/derm-treat/scars/causes Accessed 31 May, 2023 
  6. Nautiyal A, Wairkar S. Management of Hyperpigmentation: Current Treatments and Emerging Therapies. Pigment Cell & Melanoma Research.2021;34. doi:10.1111/pcmr.12986  
  7. Desai SR. Hyperpigmentation therapy: a review. J Clin Aesthet Dermatol. 2014;7(8):13-7. PMID: 25161755 
  8. Hakozaki T, Minwalla L, Zhuang J, Chhoa M, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002;147(1):20-31. doi: 10.1046/j.1365-2133.2002.04834