Severe Acne Scars: Causes, Prevention, and Treatment

Severe Acne Scars: Causes, Prevention, and Treatment

If you thought that acne scars were just a teen problem, you were absolutely wrong! There are millions of adults struggling with acne scarring and trying to find the best solution.

The appearance of unwanted acne can bring much frustration and even ruin someone's self-esteem. It's as if the fact that we have to cope with acne is not enough - we get to keep the scars as a bonus! And the cherry on top? Sometimes they're so severe that even makeup doesn't cover them. Yep, it happens to many of us. So if that sounds like you, you're far from alone in this fight.

Although the best thing to do is prevent acne with an amazing skincare routine, this isn't always possible.

But don't despair! In this article, we'll explore all the solutions and preventive measures that are proven effective in the war against acne scars. And no, they don't have to be stressful, expensive, cause even more scarring, or last for ages.

What Causes Acne To Leave Scars And How To Prevent It?

acne scars

To solve the problem of acne scars and get the best results, you need as much information as possible about them. What's the best way to destroy a problem other than to tackle it at the root?

Acne scars, or post-acne marks, commonly occur in severe forms of acne, like cystic or hormonal acne. But, in some cases, even mild acne can leave visible traces, such as darker skin, red bumps, and other types of skin damage. In this context, we need to understand the different types of acne scars and how to treat each type.

Acne Types

acne types

Atrophic Scars

Atrophic scars, also called depressed scars, are most commonly found on the face. A depressed scar appears when collagen production slows down while the wound is healing. The lack of collagen formation makes the scar tissue sit below the surrounding surface. There are three types of depressed scars: ice-pick, rolling, and boxcar scars.

  • Ice-pick scars are deep, narrow depressions shaped like the letter "V," with sharply defined edges that go deep into the skin. Ice-pick scars are considered the most difficult scars to treat due to the impression they leave.
  • Boxcar scars are atrophic acne scars with wide depressions shaped like the letter "U." This type of acne scar varies in depth, from very shallow to deep. The more superficial the acne scarring is, the better it responds to treatment.
  • Rolling scars are broad depressions with a sloping edge, meaning they are not defined and are most often irregular..

Medical Treatments

In cases of ice-pick or boxcar scars, seeking treatment can go a long way. Some of the most famous treatment methods include: dermabrasion, laser resurfacing, punch grafting for deep scars, chemical reconstruction of skin scarring with trichloracetic acid, and subcision (a surgical technique in which the fibrous band under the scar is divided, allowing the skin to return to its normal position.)

For rolling scars, common treatment measures include soft tissue augmentation techniques such as hyaluronic acid, collagen, gelatin matrix, dermabrasion, skin needling, or laser resurfacing.

Keloid Scars

acne scars

Keloid scars, or raised scars, are deeper acne scars that can grow even larger than the original acne. Raised scars form because our skin doesn't know that the acne breakout has healed and continues to produce collagen, making the scar bigger and more visible. The most common type of raised scar is the hypertrophic scar.

  • Hypertrophic and keloid scars are more prevalent in men. These raised scars are found on the upper body, on areas like the chest and back, although they can appear almost everywhere. These acne scars are most likely to develop after a cystic acne condition. These raised scars sit above the surrounding skin because the body produces too much collagen during the healing process.

Medical Treatments

Hypertrophic and keloid scars are most often treated with strong topical steroids applied under occlusion to the scar for a few weeks, intralesional steroid injections into the body of the scar, silicone gel dressings applied for 24 hours a day continuously for a couple of months, skin needling, cryotherapy (freezing), and surgical revision.

Unfortunately, even after successful treatment, hypertrophic scars are prone to recur.


discolored leaf

Discoloration scarsor dark spots, occur after a pimple has cleared. Technically this isn't a scar, and it's expected to fade in time. You will most likely see a postinflammatory discoloration if your acne lesions have recently healed. The spots can appear in three colors: red, brown, or white discoloration. Be patient, and expect to see improvement in lighter or darker skin after a few months.

General Treatments Against Acne Scars

If acne scars make you feel embarrassed, shy, and uncomfortable around other people, here are some treatments and remedies to leave them behind once and for all.

Home remedies and acne scar treatments can be successful, but before you start any treatment, you should visit the dermatologist's office to determine the best solution for your type of acne scarring. Depressed acne scars will need different treatments to raised scars.

sad woman hiding face

Products Based on Alpha Hydroxy Acids

Alpha hydroxy acids, also known as AHAs, can be found in creams or other products that treat acne. Because they help clear clogged pores, they are known to be very effective in making acne scars less noticeable. They can also help if your sebaceous glands are producing too much oil.


Don't be surprised! Not only does sunscreen protect the skin from sun exposure and ultraviolet rays, but it can also be used as a treatment for removing acne scars. Sunscreen makes acne scars fade away with the sun tan - to a certain extent.

Scars Fillers

Fillers (such as dermal fillers) refer to substances, such as collagen, hyaluronic acid, or fat, that are used to "fill out" acne scars. The procedure works for depressed acne scars. It's a great solution because there's no recovery time. However, you will have to repeat it every few months since things like dermal fillers eventually absorb into the skin.

One collagen substance commonly used in this procedure is bellafill, which we'll explain below.


Bellafill is an injection for facial acne scars that provides immediate improvements - but it's prohibited for use on people under the age of 21. The injected collagen brings back that natural glow and lifts the skin to soften the acne scar tissue.

sad woman

Punch Excisions

In contrast to the filler procedure, punch excisions are used for keloid scars. They're actually a small surgical procedure intended to remove the acne scar by making an excision on the skin - in other words, cutting it out. The hole left by the incision can be repaired with stitches or a skin graft. The skin heals after, revealing smoother skin.

Chemical Peels

Chemical peels are a great treatment against acne since, as the name suggests, they peel off the top layer of the skin and get rid of dead skin cells, leaving space for new skin cells to grow. Depending on the severity of your acne scars, chemical peels come in different depths with different acid concentrations.

Consult your dermatologist about the best chemical peel solution for your acne scarring. Chemical peels are also great if you're still suffering from acne.

Methods of Severe Acne Scar Prevention

woman face in water

Don't Pick At Your Skin

For most people, squeezing a pimple is tempting. You think you know how to pop it, and tomorrow morning it will magically disappear, right? No - you're wrong!

This is the most common reason why acne scars form in the first place. When you're picking or squeezing your acne, bacteria and other debris will burrow deeper into the skin, causing inflammation. The more inflammation you have, the more likely you will end up with post-inflammatory hyperpigmentation and permanent scarring.

Seek Treatment as Soon as Acne Develops

Don't wait for your skin to become inflamed or severely irritated before taking action.

Certain types of acne have the potential to cause serious damage to your skin tissue when left untreated. Fast action will keep those breakouts at a minimum, meaning fewer possibilities for acne scars to develop. Even if you have mild or moderate acne, seek a doctor's advice ASAP.

Invest in a Good Acne-Beating Skin Routine

If you're starting to develop acne, as well as seeking acne treatment, you'll want to invest in a good skin care routine. The best way to treat acne scars is by avoiding them altogether, and good skin care products will help you do that by minimizing inflammation and pimples.

Try Misumi's Complete Clear 3-Step System. This routine will work as an acne treatment every day. It unclogs pores and hair follicles, cleans the skin's surface, calms redness, and reduces breakouts.

sad face

Use Face Cleaners

Even if you don't currently have acne, there are a lot of useful products that will clean your skin thoroughly, and you'll be less likely to develop deep-rooted breakouts. Develop a healthy anti-acne skincare routine, preferably including a salicylic acid cleanser, and stick to it! Try Misumi's Clear Skin Salicylic Cleanser.

Eat For Your Skin

You'll all know that famous saying - you are what you eat! To keep your skin glowing and reduce inflammation, try to stay away from junk food, as it's bad for your skin.

Natural Remedies Against Acne Scars

home remedies breakfast

If you don't want to use chemical-based products, we suspect you want to know how to get rid of the scars naturally. Here's the easiest way to improve your condition through daily diet changes and natural skincare routines.


Cut one lemon in half and rub it on the surface of the skin. Lemon is a natural bleach that can reduce the visibility of scars and darker skin tones. For extra help, drink freshly squeezed lemon juice for 15 days without adding sugar or water.


Dip some almonds in hot water and leave them overnight. In the morning, peel off their scalp and crush them until you make a thick paste. Add a little rose water to make a cream. Let it sink into your acne scars for 5 to 10 minutes. Wash your face before and after applying this treatment for acne scars.

breakfast fruit


Ground one clove of garlic until it releases its fluid, then apply the liquid directly on the scars. Garlic is a natural antibiotic, so it's enough to work for only 15 minutes. Make sure to rinse off with warm water to hydrate the skin.

Egg whites

Egg whites have healing qualities that can help eliminate acne scars, or simply make them less visible. Egg whites are filled with proteins and amino acids, which tighten the pores and illuminate the damaged skin.

Blend three egg whites until you get a white, soft cream. Use your fingers to apply the fluid to your problematic skin areas. Allow it to dry for several minutes, and then rinse it with warm water. Do this 2-3 times a week. It can take up to a couple of months until you see results.



Honey retains moisture very well. By maintaining the moistness of the renewed skin tissue, honey helps regenerate the cells. Honey has an antibacterial power, which makes it an excellent choice for wound healing, such as burns, ulcers, bacterial infections, acne scars, etc.

Mix one teaspoon of cinnamon, sea nut, lemon juice, and honey. After you get a thick paste, apply a layer on the skin's surface. Let it stand for 15-20 minutes, then rinse with warm water. Repeat the same 3-4 times a week, and the scars will soon disappear.


Can severe acne scars be fixed?

You can do many things to lessen the appearance of acne scars, from ablative laser treatment to surgery. Treatment for acne scars varies depending on the types of acne scars you have. For example, fillers are often used to improve the appearance of depressed scarring. There are also other current treatment modalities and resurfacing procedures you can use for deeper scars.

But if you don't like the idea of those treatments, you can always try home remedies or topical retinoids to help.

Which acne scars are permanent?

The types of acne scars left by cystic acne are most likely to be permanent. Inflammatory cystic acne is more likely to leave depressed acne scars (like ice-pick and rolling scars). However, with effective treatment (such as things like laser therapy), you can lessen the appearance of most scars. Uneven skin color caused by scarring tends to fade over time.

Which acne scars are the hardest to treat?

Ice-pick scars are difficult to treat. These v-shaped scars go deep into the surface of the skin, which makes them difficult to fix. With depressed scars, you can try things like bellafill, which is an injection of collagen that softens the scar tissue.


Acne scars can cause low mood, a lack of confidence, and psychological distress. However, there are many ways to treat acne scars, from laser therapy and minor surgery to topical retinoids. Make sure to visit your dermatologist's office before you start treating acne scars yourself. The last thing you'll want to do is make it worse.


Acne Scarring—Pathogenesis, Evaluation, and Treatment Options

Effective Treatments of Atrophic Acne Scars


A systematic review of treatments for acne scarring

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