Welcome to Ask Curology, a series on the Curology blog where one of our in-house licensed dermatology providers answers your questions about all things skincare. This week, we’re talking about the best acne scar treatments, according to science.
After six months of using my prescription cream, my skin is finally clear! The downside is that now I’m left with all sorts of pockmarks and dark spots on my cheeks. I started looking into treatments for skin texture and the amount of information out there is overwhelming. How can I tell what type of acne scar I have, and what’s the best treatment for me?
Scared of Scars
Congratulations on your clear skin! In terms of scarring, you’re not alone. One of the more common concerns we see as Curology providers is in regards to acne “scarring” — you can always talk to us for advice and formula tweaks! There is a lot of confusion as to what scarring actually is and how it can be treated.
When an acne breakout occurs, the skin and the tissue beneath it is damaged. Once the acne clears, the body tries to repair this damage by producing collagen, which gives the skin support. If too much or too little collagen is produced, a scar forms.
Atrophic scars are the most common type of acne scars. They can be further classified into 3 different types:
Ice pick scars — small divots that look like enlarged pores
Boxcar scars — depressions in the skin with sharp edges
Rolling scars — depressions in the skin with sloping edges
Atrophic scars result from an abnormal breakdown of collagen and subcutaneous fat, resulting in depressions or pits as the skin heals. Other types of scars include kelodial (thick, raised tissue) and hypertrophic (raised scars) — these are less common when it comes to healing acne.
Treating scars can be challenging. Tretinoin (included in some Curology formulas) may help reduce the appearance of scarring over the long-term due to its collagen stimulating effect. However, because of the different types of acne scarring, it usually takes several different types of procedures in order to see measurable change. Some possible treatments for acne scars include fractionated laser, needling, subcision, fillers, or dermabrasion, just to name a few. If you are looking for more noticeable improvement, I recommend being evaluated by an in-office cosmetic dermatologist once your acne is under control for at least six months.
Pigment change is often confused with scarring. Post-inflammatory hyperpigmentation (PIH) is brown and implies melanin deposition in the skin. Post-inflammatory erythema (PIE) indicates redness, or dilated capillaries. Ingredients included in several Curology formulas, such as tretinoin, azelaic acid, niacinamide, tranexamic acid, clindamycin, and zinc, can be helpful in treating PIH and PIE. For additional improvement, alpha hydroxy acids (AHAs) or vitamin C can be helpful.
Of course, one of the most important things you can do to prevent hyperpigmentation from worsening is to wear a broad-spectrum sunscreen with an SPF of at least 30 on a daily basis. This, in addition to your Curology medication and the passage of time, is all that is needed for treating hyperpigmentation.
Like your pimples, acne scars don’t heal overnight — it takes patience and persistence. That said, get in touch with your Curology medical provider if you think your formula needs to be tweaked for your updated skin concerns. And to the readers who haven’t yet tried Curology, you can always sign up for a free month of custom skincare for just $4.95 (plus tax) to cover the cost of shipping and handling. Subject to consultation.
Allison Buckley, NP-C
Allison Buckley, NP-C