The only thing worse than breaking out? Those deep, dark marks your pimples leave on your skin long after they’re gone. Whether it’s a deep indent in your skin, or a dark spot that’s more obvious than your original breakout, scarring and pigmentation can make blemishes even more of a bummer.
Some traces of blemishes — particularly hyperpigmentation — respond well to topical skincare. Other types of blemish scars, like keloids or ice pick scars, are best treated in your dermatologist’s office first. Here’s everything you need to know about blemish scars — and how to treat them.
What are the most common blemish scars — and how do I treat them?
Technically, pigmentation isn’t actually a type of scar, just darker discolouration of the skin, sometimes a result of the healing process after inflammation caused by a pimple.
How to treat hyperpigmentation
The good news? Most of these marks fade and disappear over time, but you can speed up the process with salicylic acid (to exfoliate) and retinol (to increase cell turnover). A cleanser like SLMD Skincare Salicylic Acid Cleanser will improve discolouration by gently exfoliating the skin's surface, fading those dark spots over time. Adding SLMD Skincare Retinol Serum to boost cell regeneration will also help reduce hyperpigmentation.
Another critical step in healing and preventing post-inflammatory hyperpigmentation is to apply (and reapply!) a broad-spectrum SPF, as sun exposure is going to darken those marks even more.
Keloid scars are mounds that form as a result of the body trying to heal itself post-inflammation, but your body accidentally produces too many cells.
How to treat keloids
Keloid scars can be frustrating to treat, because they tend to come back. Here’s a typical course of action:
- Cortisone shots — aka corticosteroid injections, which break down collagen and reduce scar tissue, though some scars are not responsive
- Lasers — can improve the appearance of a keloid scar that’s already been diminished with cortisone
- Retinoids – topical vitamin A (like OTC retinol and prescription tretinoin) can be applied once the scar shrinks after a cortisone injection
- Surgery — while hypertrophic scars like keloids can be surgically removed, they tend to grow back, so treating them topically is typically a better bet
Ice pick scars
Ice pick scars form when your skin loses collagen and the overlying skin collapses, leaving a deep depression that looks like a hole.
How do you treat ice pick blemish scars?
Here are a few of the most common procedures for minimizing icepick scars, which are typically difficult to treat:
- Chemical peels — these induce a “burn” that actually causes the skin to heal itself and close the openings (must be performed by a trained professional, or they can make some scarring worse)
- Punch grafting — the scar is removed with a circular tool and the hole is filled with a skin graft, usually from behind the ear; the result may appear slightly raised
- Punch excision — the scar is removed and the edges are sutured together, leaving a flatter, finer scar
If your skin has undulating scars with soft, smooth “shoulders” — the dermatologist’s term for edges — it’s likely you’ve got rolling blemish scars. These scars tend to become more prominent with age, as skin loses its natural tightness and elasticity.
How do you treat rolling blemish scars?
Generally speaking, rolling scars respond well to medical treatment, including:
- Microneedling — uses multiple needles to induce tiny skin injuries, stimulating collagen production
- Subcision — a sharp needle is inserted underneath the surface of your skin to break up tough scar tissue
- Lasers — these devices resurface the top layers of the skin, encouraging collagen production (multiple sessions + downtime required)
When you have inflammatory blemishes (red, inflamed, irritated papules and pustules), boxcar scars are an unfortunately common aftermath. They tend to be shallow, but they have sharper edges, unlike the rounder, softer edges of rolling scars.
How do you treat boxcar blemish scars?
Boxcar scars can be treated by a dermatologist with a variety of methods:
- Punch excisions — the indented area of the scar is removed and the edges sutured together, closing the gap
- Dermabrasion — resurfacing of the skin with an ablative instrument under local or general anesthesia
- Fillers — both temporary (Juvederm, Restylane) and semipermanent (Bellafill) dermal fillers, as well as autologous fat transfer, can be injected to elevate the scarred skin
Dr. Lee’s last word
Blemish scarring is quite common, and it’s something my patients are always eager to improve. While the best approach is prevention — managing the breakouts and not picking at pimples — there are things we dermatologists can do to mitigate scarring. The modalities I use depend on the type of scar, but can include treatments like lasers, excision, subcision and fillers. The good news is that usually, we’re able to make some improvements, which can have such a positive impact on a patient’s self-confidence.
— Dr. Sandra Lee