Dr. Eric Schweiger - MD

Acne Scars Overview

Why does acne cause scarring?

These are two major types of acne lesions, inflammatory (such as a “pimple” or a cyst) and non-inflammatory (such as a “blackhead”or “whitehead”.) Inflammatory acne is more likely to cause scarring on the skin. Inflammatory acne lesions may cause damage to the skin; after this occurs, the skin naturally produces new collagen fibers to repair the area. However, the new collagen fibers do not always produce a skin surface that looks perfectly smooth, and this is how many types of acne scars occur.


What are the different types of acne scarring?

The most common types of acne scars are atrophic, ice pick and hypertrophic scars. Atrophic scars are shallow pitted scars with smooth borders. Ice pick scars are a specific type of atrophic scars; ice pick scars are deep, pitted scars with very sharp borders. Hypertrophic scars are less common on the face that atrophic scars, we often see them on the back and chest. Hypertrophic scars are raised scars that are palpable above the skin’s surface.

Are the dark spots left behind after acne permanent scars or just temporary?

Inflammatory acne lesions (“pimples” and cysts) do not always leave behind acne scars. Sometimes instead (or sometimes in addition to acne scars), they leave behind something called “post-inflammatory hyperpigmentation” (brown spots) or post-inflammatory erythema (redness.) Usually these conditions improve over time, especially with the use of topical medications, such as retinoids or hydroquinone. However, often times these conditions need to be treated similarly to textural acne scars.


How are acne scars treated?

There are many ways to treat acne scars; the choice of treatment depends on the type of acne scarring. Fractional CO2 Laser and the Fraxel Laser are the best treatment options for most types of acne scarring. The KTP laser is very effective for the treatment of post-inflammatory erythema (redness) and chemical peels can be helpful when treating post-inflammatory hyperpigmentation (brown spots.)

How can acne scarring be avoided?

It is important to treat inflammatory acne lesions with the proper medications or in-office treatment. Often this means using prescription medications and procedures, such as PDT or Isolaz, to treat the inflammatory acne effectively. Once an inflammatory acne lesion (a “pimple” or a cyst) occurs, it is important not to pick at the lesion or try to squeeze it out. In addition to the physical trauma that picking at the skin causes anyhow, this can force debris deeper into the skin and actually make the acne lesion worse.