Acne Scars (Acne Scarring)


Last updated: November 2023

What are acne scars?

Acne scars are permanent textural changes and indentations that occur on the skin due to severe acne. They often appear on the face, and sometimes on the back and chest.

The term “scarring” is not used for the temporary red and brown marks left early after acne has occurred as these marks will almost always improve without treatment.

Who gets acne scars?

Individuals with moderate or severe acne are more likely to develop acne scars. It is particularly common in nodulocystic acne, acne conglobata, acne fulminans and infantile acne.

What causes acne scars?

When large pus-filled acne cysts penetrate deep in the skin, they damage the surrounding skin tissue. If not enough collagen is produced during the healing process, an indentation (scar) is left on the skin. If too much collagen is produced, scarring can be lumpy, known as “hypertrophic” or “keloid” scarring. These scars often occur on the chest and back.

What do acne scars look like?

There are several types of acne scars including:

  • Boxcar scars: Broad depressed scars with well-defined edges. Most commonly located on the cheeks and temples.
  • Ice-pick scars: Deep and narrow scars that extend into the lower layer of the skin.
  • Rolling scars: Broad depressed scares with a sloping edge.
  • Atrophic scars: Flat, thin or depressed scars.
  • Hypertrophic or keloid scars: Thick, lumpy, red scars that are found around the jawline, neck, chest and back areas.

Most individuals will have a mixture of acne scars, such as boxcar, ice-pick and atrophic scars.

How are acne scars diagnosed?

Acne scars are diagnosed clinically by examining the skin and determining whether acne scarring is present and what type it is.

How are acne scars treated?

Treatment options will vary depending on the individual and their needs.

Acne scar treatment is aimed at improving and softening the appearance of the scarring, and may include:

  • Fillers
  • Intralesional corticosteroids
  • Laser treatments, such as fractional non-ablative (non-wounding) lasers and ablative (wounding) lasers
  • Radiofrequency
  • TCA CROSS (Chemical reconstruction of skin scars)
  • Surgical treatment, such as punch excision, punch elevation and subcision
  • Vascular lasers, such as pulse dye lasers, potassium titanyl phosphate (KTP) and alexandrite laser
  • Skin needling
  • Dermabrasion

Often a combination of treatments may be required.

What is the likely outcome of acne scars?

Acne scars may never completely disappear, but their appearance usually improves over time. The degree of improvement will depend on individual characteristics, the type of acne scar and severity.

Dr Davin LimNovember 2023


2019 © Australasian College of Dermatologists.

You may use for personal use only. Please refer to our disclaimer.