Back acne scars: how to get rid of them

Back acne can leave three kinds of marks: flat dark spots, sunken dents, and raised bumps. Each needs a different plan. Flat spots are a change in skin color, and the American Academy of Dermatology (AAD) says they usually fade. Dents and raised bumps are scars, a change in the shape of the skin, and they usually need a dermatologist. This guide covers how to tell them apart on your back, what causes them, and how to get rid of back acne scars step by step. For acne scars anywhere on the body, see acne scar treatment.

How common back acne scars are

Scarring on the back is common. A 2010 study in the Journal of Cutaneous Medicine and Surgery examined 973 people with acne and reported acne scarring at the face in 87 percent, the back in 51 percent and the chest in 38 percent. Scarring that the researchers called clinically relevant, meaning mild or worse, was on the back in 24 percent. A 2024 expert report adds that acne on the trunk is often overlooked, partly because a doctor has to ask the patient to remove clothing to see it. Back scarring was more severe in people with more severe acne.

Scars on the trunk are also hard to treat. In a 2024 report, 36 dermatologists from the Korean Acne and Rosacea Society agreed that scars, "including atrophic, hypertrophic scars, and keloids," were the part of chest and back acne that responded least to treatment.

What back acne scars look like

Use two mirrors, or ask someone to take a photo of your back in daylight with light from the side. Then compare what you see with this table.

What you see	What it is	Does it fade?
Flat brown, red, pink or bluish gray spots	Post-inflammatory hyperpigmentation, a color change	Usually fades (AAD)
Small dents or pits	Sunken (atrophic) scars	Stays without treatment (AAD)
Firm bumps that stay inside the old spot	Hypertrophic scars	Often flatten over time (AAD, NHS)
Bumps that keep growing past the old spot	Keloids	Stay without treatment (AAD)
Small, soft, skin-colored bumps that look like acne	Papular scars	Treated with lasers (AAD)

The AAD says hypertrophic scars usually develop "on the jaw line or areas of the trunk like the chest or back," and that papular scars develop on the nose, chin, jawline or back and "can be mistaken for acne." Its keloid page lists the upper back, chest and shoulder among the places keloids most often form. The types of acne scars guide explains each type in more detail.

What causes back acne scars

The AAD names three causes of acne scars, and all apply to the back:

• Deep acne. The AAD says acne "that went deep into your skin, like a deep and painful pimple, such as an acne cyst or nodule" is most likely to scar. A 2019 study followed 23 people with severe nodular acne on the back for four weeks without treatment. After four weeks, 77.3 percent of the nodules present at the start had turned into sunken scars.
• Picking and squeezing. The AAD says trying to get rid of acne this way "can increase inflammation, leading to scarring."
• Family history. A close blood relative with acne scars raises the risk.

For keloids, the AAD's list of causes includes a "bout with acne or chickenpox (usually developing on the face, chest, or back)." It says Black people, people aged 10 to 30, people with a family history of keloids and pregnant people have a higher risk. The NHS lists south Asian, Chinese, African Caribbean and Black African origin as risk factors.

Step 1: stop new back acne scars

The AAD says that if you have breakouts, "your plan will likely begin with acne treatment. Stopping acne breakouts can reduce inflammation and prevent new acne scars." It adds that scar treatment "typically begins after you have acne under control."

The guide back acne covers the AAD's steps for clearing it, including a benzoyl peroxide wash that the AAD says works best when left on the back for two to five minutes before rinsing. The free Skinli acne plan also builds a routine around benzoyl peroxide 2.5 percent and adapalene 0.1 percent, and tells you when to see a doctor.

Deep back acne needs a doctor. The 2024 acne guideline of the American Academy of Dermatology strongly recommends isotretinoin, a prescription pill, for acne that is severe or causing scarring. The guide severe acne and when to see a dermatologist explains the visit.

Step 2: let the dark marks fade

Many people call the brown or red spots on their back scars, but most are flat color changes. The AAD says a spot that is a few shades darker than your natural skin color "will usually fade within 6 to 12 months," and that color deep in the skin can take years. Sun slows this down. The AAD's aftercare advice says the sun can darken treated skin, so cover your back with clothing or use sunscreen with SPF 30 or higher when your back is exposed.

For treatments that fade flat marks, see hyperpigmentation and dark marks after pimples.

Step 3: treatment for sunken scars on the back

The AAD's list of treatments for sunken acne scars includes chemical peels, fillers, laser, microneedling, radiofrequency and minor scar surgery. Most of the research on these treatments comes from the face, and some approvals are for the face only:

• Microneedling. The FDA has authorized microneedling devices "to improve the appearance of facial acne scars, facial wrinkles, and abdominal scars" in adults 22 or older. It says it "may not have reviewed the use of certain microneedling devices for all locations in the body." See microneedling for acne scars.
• Fillers. The FDA says permanent fillers "are approved for only nasolabial folds and cheek acne scars." A back scar is outside that approval.
• Chemical peels. NICE, the UK body that writes treatment guidelines, lists a glycolic acid peel as an option for severe acne scarring in a specialist dermatology team. The FDA warns against buying or using strong peels at home, because they "may cause severe chemical burns, pain, swelling, infection, skin color changes, and disfiguring scars." See chemical peels for acne scars.
• Laser. NICE also lists carbon dioxide laser treatment for severe scarring in the same setting. See laser treatment for acne scars.

A dermatologist will choose based on the type and number of scars, your skin tone, your budget and how much recovery time you can take, the AAD says. Treatment is rarely a single visit: the AAD says "you may need three or more treatments to get the best results." The AAD also says medical insurance does not cover the cost of acne scar treatment.

Raised scars and keloids on the back and chest

The chest and back are where raised acne scars most often form. A 2017 review in Scars, Burns and Healing says hypertrophic scars and keloids are more commonly seen on the chest and shoulders. For hypertrophic scars, the AAD lists laser, injections of a corticosteroid or another medicine, and prescription medicine applied to the scar. For keloids, it says dermatologists often combine treatments, because keloids "can be difficult to get rid of, and some return after treatment."

The AAD says that if you notice skin thickening where acne was, "wearing a pressure garment can prevent (or reduce the size of) a keloid." A pressure garment is tight clothing worn over the area. People who form keloids should avoid microneedling: the AAD says you should not have it if you "have (or had) a raised scar called a keloid." The guide raised acne scars covers silicone gel sheets, injections and the rest.

What creams can do for back acne scars

The AAD says that for mild acne scarring, "a retinoid or salicylic acid can make scarring less noticeable." Tretinoin is a prescription retinoid. Its drug label lists one use, the treatment of acne, and warns about redness, peeling and sensitivity to the sun. The three controlled trials of retinoid gels on acne scars reviewed for this hub, from 2018, 2019 and 2023, all studied scars on the face. The guide tretinoin for acne scars covers what those trials found. On the back, a cream is most useful for treating the acne itself and for mild scarring. Deep dents and keloids need procedures. For popular natural remedies, and the ones that can irritate skin, see home remedies for acne scars.

When to see a dermatologist

See a dermatologist if back acne is deep, painful or leaving dents, if a scar on your back or chest keeps growing, or if scars bother you. Ask someone to check your back if you cannot see it well, because the 2010 study shows back scarring is common. Skinli gives general education and is not a doctor.