What Causes Acne Scars?

Acne scars are permanent marks on the skin, which can come about as a complication of severe acne. There are forms of cosmetic surgery which can be used to reduce the prominence of the scarring if patients wish to go down this route.

What are acne scars?

Acne scars are a complication of the skin condition, acne. Not everyone who suffers from acne will develop scars as a result, it is most likely to occur in serious and prolonged cases of acne. Scarring can occur wherever acne is present on the body, and for the large part is irreversible, although there are some treatments available which diminish the prominence of the scarring.

Acne scars can be categorized into three main types:

  • Boxcar Scars
  • Rolling Scars
  • Ice Pick Scars

Ice pick scars are recognizable as very small, deep holes in the skin, which look like pinholes or marks made by a narrow, sharp object.

Rolling scars is the name given to the acne scars which make the surface of the skin uneven. Rather than being smooth, skin with rolling scars will be bumpy, like rolling hills and valleys

Boxcar scars look like miniature craters in the skin. As opposed to ice pick scars, boxcar scars are large, but shallow holes on the surface of the skin.

What causes acne scars?

Acne scars are most likely to occur in patients who are suffering from inflammatory acne, with acne cysts or nodules present on the skin. Mild acne, which usually comprises whiteheads and blackheads across the skin, is unlikely to result in scarring.

Scarring occurs when the acne lesions, pimples, nodules or cysts rupture. The fluid contained inside these lesions irritates the skin and causes further inflammation around the spots themselves. To heal the skin, and to repair the damage caused by the acne, the skin will change the levels of collagen it is producing. If too much collagen is produced, raised scars will appear on the skin. If not enough collagen is produced to repair the damage fully, pitted scars will appear in the skin.

Who is most likely to get acne scars?

There are a number of factors which can make certain individuals more likely to develop scars from their acne. These factors include:

  • A genetic family history of acne scarring
  • Not receiving treatment for severe acne, but allowing the skin to try and heal itself unaided
  • Picking, scratching or constantly touching acne

What can you do to prevent them?

If you are suffering from acne, there are several things which you can do to prevent scarring. Most of these methods involve taking the best care of your acne whilst it is affecting you, rather than allowing it to develop, spread or become more inflamed.

Some of the best ways of preventing acne scarring include:

  • Washing your face regularly using warm water and hypoallergenic soap products
  • Leave pimples to heal - do not pick, squeeze or pop them
  • Look after your skin - adhere to your normal skincare regimes, and make sure to avoid the sun, or use plenty of sunscreen if you are spending time outside
  • Speak to your doctor about acne medication - tackling the acne with specialist creams and drugs will reduce the severity of the condition and will make scarring less likely
  • Follow the advice of your doctor or dermatologist

Is there any treatment for acne scars?

According to medical classifications, any medical or surgical treatments for acne scars come under the heading of cosmetic surgery. This means that the treatments can be seen as elective procedures, making them expensive and often not covered by regular health insurance policies. However, there are exceptional circumstances in which this is not the case. If there is a case where the acne scarring is causing significant psychological distress, treatment may be considered as vital.

There are four main types of treatment for acne scarring:

  • Laser treatment (ablative or non-ablative)
  • Punch techniques (excision, elevation or grafting)
  • Subcision
  • Dermabrasion

Laser treatment is only effective in cases of mild or moderate acne scarring. Ablative laser treatment is where small patches of the skin near the scars are removed to create new layers of skin which are much smoother-looking. Non-ablative laser treatment uses the lasers to provoke the skin into producing more collagen. Collagen is a protein which is found in healthy skin, it helps skin cells to grow and repair themselves. Increasing the collagen in the skin around acne scars can stimulate the skin into repairing some of the damage and making it smoother and scarring less visible.

Punch techniques

Punch techniques are specifically used in treatments for boxcar scars and ice pick scars. Punch techniques involve removing the individual scars surgically, and either sealing the wound, elevating the base of the scar or grafting the hole with skin and tissue taken from somewhere else on the patient’s body.


Dermabrasion is a treatment for acne scarring where the top layer of the skin is removed. This is a painful and unpleasant procedure, as layers of skin have to be removed from all of the areas where acne scarring is present. The procedure is either carried out using a laser, or a special type of wire brush.

Recovery from dermabrasion can take several months, with the skin looking red and sore for most of this time. However, as the skin starts to heal, there should be noticeable differences in the appearance, with a vast improvement to the scarring.


Subcision is another form of surgical treatment for acne scarring. This treatment method is only used to improve the appearance of rolling scars. The treatment involves removing the upper layer of the affected skin. Blood is allowed to pool and clot underneath the skin, which then forms connective tissue. The overall result is that the rolling scar is raised up so that the lower areas of the skin are levelled out.

Subcision is often combined with other methods, such as dermabrasion or laser surgery, to improve the appearance of the other types of acne scars on the skin.