Causes of Acne Scars and How to Prevent Them

Don't squeeze that pimple

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Acne is often a temporary problem, but acne scars can be permanent. Scarring is part of the skin's normal healing process after it has been damaged by a wound or injury. Fortunately, there are things you can do to prevent acne scars from forming.

This article will explain causes of acne scars and how you can prevent them.

Woman popping pimple on her face
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Causes of Acne Scars

Acne scars are most often the product of an inflamed lesion, such as a papule, pustule, or cyst. Inflamed blemishes occur when the follicle, or pore, becomes engorged with excess oil, dead skin cells, and bacteria. The pore swells, causing a break in the follicle wall.

If the rupture occurs near the skin's surface, the lesion is usually minor and heals quickly. More serious lesions arise when there is a deep break in the follicle wall. The infected material spills out into the dermis (the second of the three skin layers) and destroys healthy skin tissue.

To repair the damage done to the dermis, the skin forms new collagen fibers. Collagen is the fibrous protein that gives the skin its strength and flexibility. Unfortunately, the finished "repair job" never looks as smooth and flawless as before the injury.

Types of Acne Scars

There are two main types of acne scars:

  • Atrophic scars: Atrophic scars are the most common type of acne scar. These develop when there is a loss of tissue. Ice pick scars and boxcar scars are two examples of atrophic scars.
  • Hypertrophic scars: As the wound heals, the body sometimes produces too much collagen, which creates a mass of raised tissue on the skin's surface. This type of scarring is called hypertrophic, or keloid, scarring.

Often, what is taken to be an acne scar is not a true scar at all, but rather post-inflammatory hyperpigmentation (PIH). This temporary discoloration of the skin will eventually fade on its own. Certain treatment medications, such as Retin-A (tretinoin), may speed up the fading time.

Prevention of Acne Scars

You can't completely prevent scarring, but these strategies can minimize your chance of developing acne scars.

Treat Acne as Soon as It Develops

The best thing you can do is get acne under control as soon as possible. Begin treating it right away, and see your healthcare provider or dermatologist if your acne isn't getting any better with over-the-counter acne treatments.

Quick treatment helps to keep breakouts to a minimum and prevents acne from developing into a more severe form. Prevent pimples and you'll prevent scarring.

Reduce Inflammation

Large, inflamed acne blemishes are much more likely to leave scars behind than non-inflamed breakouts and blackheads. Your goal should always be to calm inflammation and avoid doing anything that will further irritate your skin. Aggressive scrubbing and harsh skincare products should be avoided.

Don't Squeeze, Pop, or Pick at Pimples

Pass up the temptation to pick or squeeze a pimple. Doing so can force debris deeper into the dermis, spreading an infection to other tissue and worsening inflammation. This is especially true for deep, serious blemishes like nodules and cysts.

Remind yourself that popping pimples can extend the healing time and ups the chance of it leaving a permanent scar. Allow the blemish to heal on its own. If you've already picked at a blemish, take steps to help heal it and minimize skin damage.

Don't Pick at Scabs

Picking at scabs should also be avoided. A scab is the skin's natural "bandage" which protects the wound as it heals. Picking a scab off a wound before it is ready prolongs the healing process and increases the chances of scarring.

Know If You Are Prone to Scarring

The reality is some people are more prone to scarring while others come through a case of severe acne without a scar in sight. If you are highly prone to scarring, talk to a dermatologist to discuss acne treatment options.

See Your Healthcare Provider for Deep Breakouts or Cysts

While smaller blemishes can still scar the skin, it's the big ones that usually do the most damage. Because they extend deeper into the skin, deep nodular breakouts or cystic breakouts are more likely to destroy skin tissue and leave scars.

Over-the-counter acne products won't help these types of breakouts. It's best to see your dermatologist about prescription treatment options.

A Word From Verywell

Despite your best efforts, You may still develop some acne scarring. Luckily, there are scar treatments to help minimize the appearance of scarring. Don't hesitate to talk to your healthcare provider or dermatologist. They can explain the treatment options available to you.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Dermatology Association. Scars: Who gets and causes

  2. American Academy of Dermatology Association. Acne: Who gets and causes.

  3. Tanghetti EA. The role of inflammation in the pathology of acne. J Clin Aesthet Dermatol. 2013;6(9):27-35.

  4. Gozali MV, Zhou B. Effective treatments of atrophic acne scarsJ Clin Aesthet Dermatol. 2015;8(5):33–40.

  5. Mari W, Alsabri SG, Tabal N, Younes S, Sherif A, Simman R. Novel insights on understanding of keloid scar: article review. J Am Coll Clin Wound Spec. 2015;7(1-3):1-7. doi:10.1016/j.jccw.2016.10.001

  6. Kwon SY, Park SD, Park K. Comparative effect of topical silicone gel and topical tretinoin cream for the prevention of hypertrophic scar and keloid formation and the improvement of scars. J Eur Acad Dermatol Venereol. 2014;28(8):1025-33. doi:10.1111/jdv.12242

  7. Shi C, Zhu J, Yang D. The pivotal role of inflammation in scar/keloid formation after acne. Dermatoendocrinol. 2017;9(1):e1448327. doi:10.1080/19381980.2018.1448327

  8. American Academy of Dermatology Association. 10 skin care habits that can worsen acne.

  9. Glass DA. Current understanding of the genetic causes of keloid formation. J Investig Dermatol Symp Proc. 2017 Oct;18(2):S50-S53. doi:10.1016/j.jisp.2016.10.024

  10. Al-Kathiri L, Al-Najjar T. Severe nodulocystic acne not responding to isotretinoin therapy successfully treated with oral dapsone. Oman Med J. 2018;33(5):433-6. doi:10.5001/omj.2018.79

By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.