Acne Scars: What Causes Acne Scars and How Do I Prevent Acne Scars?

Every clinic day, I have at least two patients who come in to be treated for “acne scars” – but these acne scars are usually not true scars. A true acne scar is a permanent change in the fibrous connective tissue of the skin. Examples of true acne scars include ice pick and boxcar scars. Red spots from acne and dark spots from acne are not scars and are reversible. 

If you are struggling with acne scars or discoloration due to acne, here’s what you need to know about what causes acne scars and how to prevent acne scars from happening again in the future.

What Causes Acne Scars?

True acne scarring happens as a result of damage to the dermis of the skin. During the healing process after having acne, the skin may produce too little collagen. This can result in a depressed scar on the skin that looks like an indention or crater. If it is narrow and deep, it is called an “icepick acne scar.” If it is wide with jagged edges, it is called a “boxcar acne scar.”

Inflammation and infection are the biggest causes of acne scars because they affect collagen deposition in the dermis. Picking the skin and not treating acne soon enough or properly leads to acne scars.Several factors determine whether or not you develop acne scars, including genetics, the type of acne, and whether or not the acne was treated quickly and properly. 

Red Acne Scars – Red Spots Caused By Pimples

Pink or red spots caused by pimples are not acne scars. They will go one of three routes: 1)They will disappear, 2) They will hyperpigment, or 3) They will scar. Both genetics and how you treat them will determine which outcome will occur. 

The best way to treat red spots from acne is with sunscreen in the day and retinoids such as retinol, tretinoin, adapalene, tazarotene and trifarotene. The type of retinoid depends upon your Baumann Skin Type. My favorite strong retinol to treat acne is Essopi Retinol Treatment Serum 10X, but it is too strong for many skin types. Be patient, as it can take 4 to 12 weeks for the red spots to disappear. My advice is cover them, protect them, and do not pick them and you will have the best long term result.

Dark Spots Caused by Pimples

Dark brown spots on the skin after acne are called post-inflammatory hyperpigmentation (PIH). PIH is more common in darker skin types that have more melanin. Darker skin types often do not notice the pink and red acne spots and they get dark spots after almost every pimple. The good news is these dark spots from acne are not true scars. The dark spots are caused by inflammation which usually starts as a red mark. Sun exposure and light exposure increase melanin production in inflamed skin. Your computer and cell phone have blue light so your phone can cause the pink or red acne spots to turn dark. 

How to Fade Acne Scars

Although dark spots from acne are not true scars, I get asked “How to fade acne scars?” every day. This is a step wise plan to fade marks from acne:

  1. Get your acne under control with a personalized skin care routine for your Baumann Skin Type, or you will never get ahead of the inflammation/ pigmentation cycle. You can find a dermatologist, get an online consult, or get a dermatologist-developed skin care routine at
  2. Wear a noncomedogenic iron oxide continuing facial foundation or tinted sunscreen every day – even indoors – to help prevent the red spots from turning to dark spots. 
  3. Darks spots can be treated with a hyperpigmentation cream in a personalized skin care regimen designed for acne and pigmentation. These can take 8 to 12 weeks to clear, but wearing SPF and using a retinoid with a hyperpigmentation cream may speed this up.
  4. For red spots, use a retinoid every night as directed for your unique skin type.

Can Acne Scars Be Removed?

True acne scars can be treated to look better with lasers, microneedling and dermal fillers. Treatment depends upon the type of acne scars.  Icepick scars can only be completely removed by excision surgery. Boxcar scars- the treatment depends upon their depth and width. Learn more about acne treatments here.

Before you panic, make sure what you see on your skin is really an acne scar. Close your eyes and feel it. Can you tell where it is without looking? Does it feel firmer than the rest of your skin? Do you feel an indentation? Scars will either feel firm or indented. If you cannot feel it on your skin with your eyes closed, it is unlikely to be an acne scar.

How to Prevent Acne Scars?

Follow these important tips to prevent acne scars:

  • Get your acne under control- Acne treatments take 8 weeks to work because acne is an 8 week cycle so the time to start is NOW! Get on a personalized skin care regimen as soon as you can that treats your acne skin type.
  • Don’t pop or pick pimples. Popping pimples can damage the skin and cause an acne scar or pigmentation problems. 
  • Apply an antibacterial such as benzoyl peroxide, silver, or an antibiotic. These ingredients can help to eliminate acne-causing bacteria within the hair follicle (pore).
  • Don’t pick the scabs. Scabs that form on the skin after an acne lesion are part of the skin’s healing process. Leave them be! Picking at scabs will increase the chances of scarring. 
  • Cover the area with SPF. Sun exposure can cause pigmentation problems after acne, so always wear sunscreen. Or even better, you can use an SPF-containing concealer like Dermablend to protect against UV damage and conceal the pimple while it heals.

How To Treat Acne Scars?

There are many ways to treat acne scars depending upon your budget and pain tolerance. Click here to learn more about treating acne scars.

Bottom Line

Many acne scars are not true scars, meaning the skin is not permanently damaged. Post-inflammatory hyperpigmentation can be treated with the proper skin-lightening ingredients and acne treatment products. True acne scars can be treated with lasers, microneedling and/ or fillers to help reduce their appearance. 

If you currently have acne, follow the steps listed in this article to prevent scars and PIH from forming. 

For more skincare tips and tricks from Dr. Baumann, don’t forget to follow Baumann Cosmetic on Facebook, Instagram, and YouTube

©2020 Metabeauty, Inc.

October 20, 2020 Acne