Acne scars guide according to dermatologists

The first thing we have to clarify is that acne scars are not the same thing with acne postinflammatory discoloration. That beeing said, let’s understand what acne scars really are.

When we talk about acne, the problem is excess oil production and bacteria that can cause severe damage like inflammation and follicle wall destruction. Our skin tries to repair and rebalance herself by producing new collagen, that usually isn’t enough. So, let’s dive in and crack the code!


Hypertrophic Scars: These scars appear when your body produces too much collagen to heal an active wound, leading to an enlarged, thickened area on the skin’s surface. This is a keloid – you may have heard the term. It can appear anywhere but mostly on the chest and back.

Atrophic Scars: Unlike hypertrophic scarring atrophic scars develop when there is a shortage in collagen production. Basically, it means that your body doesn’t produce enough collagen to heal the acne’s active wound.

What can you see?

Boxcar scars – wide, U-shaped, round or oval, with sharp edges. The most important thing is the depth of the scar—the more superficial it is, the better because they respond very well to resurfacing treatments.

Ice pick scars – narrow, deep V-shaped scars. They look like small round
holes as if a sharp object has hit the skin. These are difficult to treat and appear in severe, nodular acne. You need to have patience with this one!

Rolling scars – wide with irregular, rolled edges. They can vary in depth and have an uneven, wavy look. It is possible to confuse them with boxcar scars.


I know you may feel distressed and think that it ruins your appearance, confidence and human interaction, but you need to know that you are not alone and many people deal with this annoying but temporary situation.

So, what can we do?

Before thinking about dermatological procedures, I advise my patients to start a topic therapy and skincare regimen to see if they have an overall improvement of their skin. If this isn’t working out, then we start making a fighting plan against scarring and choose the best option. We have excellent choices like microneedling, laser, professional peelings, PRP, fillers, corticoid injections or surgery. You need to talk to your dermatologist. He will pick the best treatment for you!

“If budget is a concern, ask your doctor to make you a treatment plan for the next weeks rather than having a step by step approach. It is the best way to make an idea about what’s next and adequately prepare for it. I see many patients quitting their treatment halfway because of price reasons. Start therapy whenever you are ready and stick to it!”

Before starting treatment, please be aware of the difference between acne scars and post-inflammatory hyperpigmentation. Most people tend to confuse them and think that erythema, brown or red spots are signs of acne scars. No, this is hyperpigmentation because your skin tried really hard to fight bacteria and inflammation and repair itself. Acne scars are actual changes in the skin’s texture. Also, don’t confuse them with brown spots because of excessive sun exposure. Those have another action mechanism. When you stay too much in the sun without adequate sun protection, the melanin levels in your skin go crazy, and hyperpigmentation appears!

Happily, we have lots of skincare products that help you fight post-inflammatory hyperpigmentation. My favorites definitely include:

Acids like AHA, BHA
Vitamin C
Retinol (of course)
Lactic acid (hydrating as well)
Kojic acid
Azelaic acid
Antioxidant-rich extracts like broccoli or avocado.
Remember always to keep your skin hydrated! Centella asiatica or Ceramides do the trick very well for acne-prone skin. Don’t over-exfoliate and try to avoid moisture loss or overdrying as it can make hyperpigmentation worse!

Check out our Instagram page @dermacons_skin_boutique for the latest news and skincare trends!

With love,
Your dermatologist