Key points
- Acne scars are common and can form even when acne is treated well [1].
- In a meta-analysis that pooled 37 studies, 47% of people with acne had scars, and male sex, a family history of acne, and severe acne were risk factors [2].
- Scars call for different treatments depending on their type, and the choice of method determines the results [3].
- Microneedling improved scars in all of the studies reviewed, but the evidence comparing it with other treatments was inconsistent [4].
Why do acne scars form?
The inflammatory lesions that often come with acne are likely to leave scars [3]. Different types of scars form depending on whether too much or too little collagen is produced as the wound heals [3].
A 2024 medical education publication explained that acne scars are common and can form even when acne is managed effectively [1]. It nevertheless pointed out that in acne care, scar treatment is often not addressed enough or is overlooked [1].
How common are they, and who is more likely to get them?
A 2023 systematic review and meta-analysis pooled and analyzed 37 studies that included 24,649 people with acne [2]. Among people with acne, the proportion who had scars was 47% (95% confidence interval, 38% to 56%) [2]. This proportion varied depending on age, sex, acne severity, and where the patients were recruited [2].
The risk factors identified were male sex (odds ratio 1.58), a family history of acne (odds ratio 2.73), and acne severity [2]. The odds ratio is a measure of how strongly a factor is linked to scarring, and for acne severity it was 2.34 for moderate acne and 5.51 for severe acne [2]. The researchers concluded that to reduce scarring, it is important to pay attention to acne from its early stages and treat it effectively [2]. However, these figures pool studies from many countries, so they cannot be applied directly to any particular group.
- Male sex
- A family history of acne
- Moderate or more severe acne
Types of scars and how they are assessed
Acne scars can be divided into textural scars, in which the skin surface becomes uneven, and pigmented scars, in which discoloration remains [1]. Using a scar assessment tool and identifying the specific subtype of scar makes it possible to plan treatment tailored to it [1].
However, assessment methods also have limitations. A 2018 literature review pointed out that although there are several rating scales, most do not reflect the color or depth of scars or how they change over time, and that a well-validated standard scale is still needed [5]. For this reason, when judging changes before and after treatment, it helps to look at photographs together with findings from the examination.
Types of treatment and the evidence
Microneedling is a minimally invasive method widely used for acne scars [4]. In a 2020 systematic review, all 33 papers reviewed reported that the appearance of scars improved after microneedling [4]. However, this review included not only randomized studies but also case reports and case series, and the evidence comparing microneedling alone with combination treatments or fractional lasers was inconsistent [4].
Radiofrequency technology is also used to improve acne scars and to treat raised (hypertrophic) scars and keloids [6]. Radiofrequency devices are divided into monopolar, bipolar, and multipolar types according to the number of electrodes, and they come in several forms, including fractional devices [6].
Because each type of scar involves different changes in skin structure and tissue, no single method suits every scar [3]. A method is chosen according to the type of scar, or several methods are combined.
The emotional burden of scars
Acne scars are not just a matter of appearance. People with scars have been reported to experience a considerable psychosocial burden, including depression and suicidal thoughts [1]. It has also been pointed out that scars can have a major impact on quality of life [3]. If you are struggling emotionally, it is a good idea to talk about that at your appointment as well as about treating your skin.
Prevention and what to check during your consultation
The first step in reducing scars is getting appropriate treatment in the early stages of acne [2]. For scars that have already formed, the treatment plan and results differ depending on their type and depth and on the condition of your skin, so the method should be chosen after the scars are assessed through an examination. The effects of treatment and the recovery process vary from person to person.
- Whether your acne is currently active, and the plan for treating it
- The type of scar (textural or pigmented) and its depth
- The recovery time and side effects of each treatment being considered
- The expected number of treatments and how results will be assessed
Frequently asked questions
- Can scars form even if my acne was treated well?
- Yes, they can. Acne scars are described as possibly forming even when acne is managed effectively [1]. However, the more severe the acne, the higher the risk of scarring, so early treatment is still important [2].
- Which is better, microneedling or laser?
- In a 2020 systematic review, the evidence comparing microneedling with fractional lasers was inconsistent [4]. Which is better can depend on the type of scar and the condition of your skin [3]. It is a good idea to decide after your scars are assessed through an examination.
References
- Jennings T, Duffy R, McLarney M, et al. Acne scarring-pathophysiology, diagnosis, prevention and education: Part I. J Am Acad Dermatol. 2024.PubMed 35792196DOI
- Liu L, Xue Y, Chen Y, et al. Prevalence and risk factors of acne scars in patients with acne vulgaris. Skin Res Technol. 2023.PubMed 37357642DOI
- Sánchez Viera M. Management of acne scars: fulfilling our duty of care for patients. Br J Dermatol. 2015.PubMed 25597636DOI
- Mujahid N, Shareef F, Maymone MBC, et al. Microneedling as a Treatment for Acne Scarring: A Systematic Review. Dermatol Surg. 2020.PubMed 31356435DOI
- Clark AK, Saric S, Sivamani RK. Acne Scars: How Do We Grade Them? Am J Clin Dermatol. 2018.PubMed 28891036DOI
- Krueger N, Sadick NS. New-generation radiofrequency technology. Cutis. 2013.PubMed 23461058
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.