How to get rid of acne scars: what works

An acne scar is a change in the shape of the skin left after a breakout heals. Some scars sit lower than the skin around them, like small dents. Others sit higher, like firm bumps. This guide covers what makes scars form, whether they go away, what creams can and cannot do at home, and what dermatologists use. It is part of the guide on how to get rid of acne.

Scars and flat marks are different problems

Look at the mark in daylight and run a finger over it. A scar changes the surface: it is lower or higher than the skin next to it. A flat mark has the same smooth surface, and only its color has changed.

The American Academy of Dermatology (AAD) calls the flat red, pink, brown or bluish gray spot left after a pimple post-inflammatory hyperpigmentation. It says these flat spots are not scars, that they usually fade over time, and that treatment can clear them more quickly. Skinli's guide to dark marks after pimples covers how to fade flat dark marks. The rest of this page is about true scars.

Types of acne scars

The AAD says most people who get acne scars get sunken scars, often more than one type. The NHS describes them as shallow holes in the skin.

Scar	What it looks like
Ice pick	Small but deep. The AAD calls it the most common acne scar
Rolling	Wide and shallow. Many rolling scars give the skin a wavy look
Boxcar	Round or oval dents, wider than ice pick scars and narrower than rolling scars
Hypertrophic (raised)	Firm, usually on the jawline, chest or back. Often appears 1 to 2 months after a breakout clears
Keloid (raised)	Grows larger than the breakout that caused it. Thickening skin usually begins 3 to 12 months after acne clears
Papular (raised)	Skin colored or lighter than the person's skin tone, often on the nose, chin, jawline or back

The AAD explains the difference. As skin heals, it makes collagen, the protein that supports it. Too little collagen leaves a sunken scar. Too much leaves a raised scar. Raised scars are more common in people with darker skin tones, and they are more likely to itch or hurt.

Do acne scars go away?

The AAD's answer is direct: acne scars can fade, but they rarely go away. A board-certified dermatologist can minimize how they look, and the AAD says newer treatments improve results. NICE, which writes clinical guidance for England, asks doctors to explain how acne scars may change over time. It advises referral to a scar specialist team when severe scarring persists a year after acne has cleared.

What makes scars more likely

The AAD lists three risk factors:

• Deep acne. Cysts and nodules cause intense inflammation. In general, the deeper the acne goes, the more likely it is to scar, though some people scar after blackheads and whiteheads.
• Picking. Picking, popping, squeezing or scratching acne increases inflammation.
• Family history. A close blood relative who gets acne scars raises your risk.

NICE adds that the risk of scarring increases with how severe acne is and how long it lasts. The AAD says it is not possible to predict who will scar, and that treating acne early may prevent scars. That makes active acne the first thing to treat. The AAD's scar pages say the same: stopping breakouts reduces inflammation and prevents new scars, and scar treatment usually starts once acne is under control.

What creams can do at home

The AAD's scar treatment page says that for mild acne scarring, a retinoid or salicylic acid applied to the skin can make scarring less noticeable. For moderate and deep scars, it lists procedures. Here is what the evidence shows for the three creams people ask about most.

Tretinoin

Tretinoin is a prescription retinoid. NIAMS, part of the US National Institutes of Health, says retinoids can help prevent acne and help with scarring. The studies on scars are small. In a 1999 study, 32 people had tretinoin gel pushed into their scars with a small electric current, twice a week for 3 months, in a clinic. Scar depth decreased in 94 percent of them. The study had no comparison group, and it tested a clinic method, so it tells us little about tretinoin cream used at home. Prescription retinoids for acne covers how to get tretinoin.

A related 2018 trial tested adapalene 0.3 percent with benzoyl peroxide 2.5 percent, a prescription gel, on one half of the face in 67 people with moderate or severe acne. Over 24 weeks, the scar count fell 15.5 percent on the treated side and rose 14.4 percent on the side with a gel without active ingredients. The gel's maker funded the study. It suggests that treating acne with a retinoid gel may help prevent and reduce some sunken scars.

Retinol

Retinol is a retinoid sold in cosmetic products without a prescription. The AAD's dark spots page lists retinol among the retinoids that can fade dark spots. This guide found no study of retinol on sunken acne scars in the medical sources it uses. A 2023 review of creams and gels for acne scars concluded that there is a lack of evidence to support their widespread use. Retinoids for acne explains how retinol differs from adapalene and tretinoin.

Salicylic acid

The AAD names salicylic acid, with retinoids, as a medicine for mild scarring. The FDA allows it at 0.5 to 2 percent in acne products sold without a prescription. This guide found no other Tier 1 source on salicylic acid creams for scars.

In short, creams are for mild scarring and for preventing new scars. For deeper dents, the AAD lists procedures.

Deciding whether to treat scars

The AAD says treatment is not for everyone, and some people see no need to treat their scars. It suggests three questions before booking a consultation: Do you often wish you could get rid of your scars? Do they limit your chances to date, get a job, advance at work or do well at school? Are you less social than before you had them? If you answer yes to one or more, talking to a dermatologist can help.

It also helps to know what you want. Some treatments make scars less noticeable, and others smooth out a wavy skin surface. Think about your budget, how much recovery time you can take, and how much time you can give to treatment and skin care. NICE asks doctors to discuss the distress scars can cause, as part of the same conversation.

Scars on darker skin

The AAD says raised scars, including keloids, are more common in people with darker skin tones. If you notice skin thickening where a breakout cleared, the AAD says wearing a pressure garment can prevent a keloid or reduce its size, so show a dermatologist early. The AAD lists microneedling and radiofrequency as safe for all skin tones.

What dermatologists use

The AAD says a dermatologist plans treatment around the type and number of scars, your age and skin tone, your budget and other factors. Tell the dermatologist about every acne treatment you have used in the last two years, because some scar treatments cause side effects during or soon after certain acne medicines.

Treatment	For	What the AAD says
Chemical peel	Sunken scars	Helps the skin make collagen and elastin. A mild peel may need 3 to 5 sessions, every 2 to 4 weeks
Fillers	Sunken scars	Add volume. Most last 3 months to 2 years
Laser	Sunken and raised scars	Resurfaces skin. As it heals, it makes new collagen
Microneedling	Sunken scars	Tiny needles prompt new collagen. Safe for all skin tones
Radiofrequency	Sunken scars	Energy waves help the skin make collagen. Safe for all skin tones
Scar surgery	Sunken scars	Removes a scar or lifts it from the tissue below
Steroid injections	Raised scars	Used for hypertrophic scars and keloids

Keloids often need more than one treatment, and the AAD says some return. For severe scarring that persists a year after acne clears, NICE suggests a specialist team consider carbon dioxide laser treatment or a glycolic acid peel. The 2024 AAD guideline strongly recommends isotretinoin, a prescription pill, for acne that is causing scarring.

Cost, sessions and aftercare

The AAD says medical insurance does not cover acne scar treatment, and that treatment is rarely finished in one visit: you may need three or more sessions. After treatment, it says the sun can darken treated skin, so you will need daily sunscreen and to limit time outdoors for 6 to 8 weeks, even on cloudy or cool days. Keep treating acne, because new breakouts can cause new scars.

When to see a doctor

See a doctor as soon as acne starts leaving sunken or raised scars. NICE advises considering a dermatologist referral for acne that is leading to scarring, and the NHS says to see a GP if spots are deep, painful or causing scars. Severe acne and when to see a dermatologist explains how to prepare for the visit.