Most zits are temporary annoyances that disappear with salicylic acid, a retinoid, a little concealer, and a ton of patience. So it’s too bad that acne scars can last for months, years, and even decades after the memories of the pimples themselves have faded.
We spoke to experts to find out how you get acne scars; why some breakouts scar while others practically vanish within days; and what you can do to prevent scars and treat the ones you have.
What Causes Acne Scars
So how do you get acne scars? Ciraldo says scars occur because of inflammation. Inflammation can usually be traced to:
- Picking skin
- Untreated acne
- Genetic predisposition
Ciraldo adds that picking and popping blemishes “accounts for the majority of acne scars” she sees in patients. Those scars fall into four categories:
- Rolling scars occur when “skin heals with an uneven, wavy contour” after “moderate to severe acne.”
- Ice-pick scars leave skin with a “linear depression” (“sort of like a cut that wasn’t stitched up,” she explains).
- Boxcar scars are box-like scars that leave a “wider, depressed” scar.
- Keloid scars occur when the skin produces too much collagen, giving scars a raised appearance.
BTW, those annoying red and brown marks you get when a pimple heals are not scars. “We reserve the term ‘acne scar’ for true scar tissue,” Ciraldo says; discoloration from acne is called post-inflammatory hyperpigmentation.
Are Some People More Prone to Acne Scars?
For some people, scarring is, unfortunately, a genetic factor. “There are definitely families that have a genetic tendency to bad scarring,” Ciraldo says, pointing to the hereditary nature of issues like hyperpigmentation and keloid scarring.
Keloid scarring, in particular, is more common in certain ethnic populations. “Keloids are more common in both dark skin as well as Asian skin,” Ciraldo says, adding that fair-skinned redheads are also prone to keloids.
If your parents or siblings have a history of scarring or struggle with post-inflammatory hyperpigmentation, it’s all the more important that you chat with a derm. “It is essential to see a dermatologist for guidance on acne treatment and how to treat any acne scars that may form,” she insists.
Why Don’t All Breakouts Scar?
When you get an absolute unit of a zit on your chin, you never know whether it will go away quietly in a week or haunt you for years. So why do some pimples scar and others don’t?
“There has to be significant inflammation in order for acne to scar,” Ciraldo explains. “When the skin is inflamed, extra blood cells move into the area. These cells turn on an enzyme production that includes specific wound-healing enzymes to produce collagen.”
If your collagen functions normally, your skin doesn’t scar. But sometimes, “collagen-inhibiting enzymes, so-called MMPI enzymes,” mess with collagen production, Ciraldo explains. That’s when you get a scar.
Cystic acne is the type of acne most likely to leave scars. “In general, acne that scars tend to be pustular or cystic because it is infected,” Green says. “Comedonal acne, which mostly consists of whiteheads or blackheads, is much less likely to scar.”
However, picking at your skin when you have a whitehead or a blackhead increases inflammation, boosting your odds of getting a scar.
How to Avoid Acne Scars
The best way to stop acne scarring is to stop acne before it starts. “I strongly recommend getting on an acne regimen if you are breaking out to both resolve existing acne ASAP and prevent new acne from forming to minimize the risk of scarring,” Ciraldo says.