15 ways to reduce and treat acne scarring: A doctor's guide

Dealing with pimple scars can often feel more frustrating than the breakout itself. While a zit might last a week, the mark it leaves behind can linger for months or even a lifetime. Whether you are seeing red marks, dark spots or indented texture, these are all signs that your skin is trying to heal from inflammation.

The term "acne scarring" is often used to describe two very different things: true atrophic scars (indentations) and post-inflammatory colour changes. Understanding which type you have is the first step to choosing the right treatment. From prescription creams to in-clinic procedures, there are proven ways to smooth texture and fade scars from zits.[1] This guide covers 15 evidence-based strategies to help restore your skin's clarity and texture.

Key takeaways

• Distinguish mark from scar: Red or brown marks (PIE/PIH) are pigment changes, whereas true acne scars like ice pick or boxcar scars involve a change in skin texture and collagen.[2]
• Prevention is powerful: Treating active acne early with retinoids is the single most effective way to prevent permanent scarring from developing.[3]
• Sunscreen is non-negotiable: UV exposure darkens pigmentation and degrades collagen, making scars from pimples look worse and stay longer.[4]
• Combined approach: Most patients get the best results by combining at-home topical treatments for maintenance with professional procedures for deep repair.[5]

Matching the treatment to the scar

A note on prevention:

Before exploring treatments, it is vital to stop new scars from forming. The most common cause of deep, pitted scarring is trauma. Popping pimples ruptures the pore wall deep within the dermis, spreading infection and destroying tissue. If you are tempted to squeeze, remember that this momentary relief is the fastest route to permanent indentation.

Topical treatments for acne scarring

Topical ingredients are your first line of defence. They are excellent for fading discolouration and improving overall skin texture, although they have limitations for deep, indented zit scars.

1. Daily Sunscreen

It might seem simple, but sunscreen is the most critical step. UV rays stimulate pigment cells, causing brown pimple scars to darken and linger. Sun exposure also breaks down collagen, which can make indented scars look deeper and more pronounced. Using a broad-spectrum SPF 50+ daily helps your skin heal efficiently without fighting new damage.[4]

2. Prescription Retinoids

Ingredients like tretinoin and adapalene are gold standards for a reason. By speeding up cell turnover and stimulating new collagen production, prescription retinoids can smooth rough texture and fade pigmentation simultaneously. Studies show that starting retinoids early can even prevent atrophic scars from forming in the first place.[3] You can read more in our guide to retinol vs tretinoin.

3. Azelaic Acid

This powerhouse ingredient is particularly effective for post-inflammatory hyperpigmentation (brown marks). Azelaic acid inhibits tyrosinase, the enzyme responsible for melanin production, while also reducing the inflammation that causes redness. It is a gentle option that is generally safe for use during pregnancy.[6]

4. Niacinamide

For the red marks left behind by acne (known as post-inflammatory erythema), niacinamide is a key ally. It strengthens the skin barrier and has potent anti-inflammatory properties that help calm redness. It also prevents the transfer of pigment to surface skin cells, helping to brighten the overall complexion.[7]

5. Vitamin C

As an antioxidant, Vitamin C protects collagen from environmental damage and is essential for the production of new collagen. It also acts as a brightening agent, helping to fade dark spots and even out skin tone over time.[7]

6. Salicylic Acid (BHA)

While best known for treating active breakouts, salicylic acid is also a chemical exfoliant. It dissolves the bonds between dead skin cells, smoothing the skin's surface and helping to keep pores clear. This resurfacing action helps fade superficial marks faster.[8]

7. Alpha Hydroxy Acids (AHAs)

Acids like glycolic and lactic acid work by exfoliating the top layer of the skin. This can reduce the appearance of shallow acne scars and promote a smoother texture. They are particularly useful for fading pigmentation but should be used with caution to avoid irritation.[9]

8. Tranexamic Acid

A newer hero in skincare, tranexamic acid is gaining popularity for its ability to reduce redness and erythema. It works by interfering with the inflammatory pathways and blood vessel formation that keep red marks visible long after a pimple has healed.[7]

Professional procedures for deep scars

For indented (atrophic) or raised (hypertrophic) scars from pimples, topical creams often need to be paired with professional treatments for significant improvement.

9. Chemical Peels

Professional chemical peels use higher concentrations of acids (like TCA or glycolic acid) to remove the outer layers of skin. This stimulates a healing response and collagen production, which can improve the depth of shallow boxcar and rolling scars.[10]

10. TCA CROSS

This is a specific technique for deep, narrow "ice pick" scars. A high concentration of Trichloroacetic Acid (TCA) is applied precisely into the bottom of the scar. This triggers a strong healing response that causes the scar to close up and become shallower over a series of treatments.[11]

11. Microneedling

Also known as collagen induction therapy, microneedling creates thousands of tiny punctures in the skin. This controlled injury forces the body to produce new collagen and elastin to repair the "wounds," creating a smoother skin surface. It is often safer for darker skin tones than certain lasers.[12]

12. Laser Resurfacing

Lasers come in many forms. Ablative lasers (like CO2) remove outer skin layers for dramatic resurfacing, while non-ablative lasers heat the deeper layers to stimulate collagen without downtime. Pulsed dye lasers (PDL) specifically target the red blood vessels in fresh red scars.[7][12]

13. Subcision

This manual technique is used for rolling scars that are tethered down by fibrous bands. A needle is inserted under the skin to cut these bands, releasing the skin so it can float back up to a level surface. It is often combined with filler for best results.[13]

14. Dermal Fillers

For some depressed scars, injecting a soft tissue filler (like hyaluronic acid) can instantly lift the indentation to match the surrounding skin. While temporary, it provides immediate visual improvement and can stimulate some collagen production over time.[14]

15. Cortisone Injections

Unlike pitted scars, hypertrophic and keloid scars are raised and firm. Injecting them with a corticosteroid helps to soften the scar tissue and flatten the lump. This is often the first line of treatment for raised scars on the jawline or chest.[14]

Start your journey to clearer skin

Treating pimple scars takes time and patience. There is no overnight miracle, but a consistent routine using evidence-based ingredients can make a profound difference. If you are unsure where to start, our Australian doctors can prescribe a personalised formula to target both active acne and the marks it leaves behind.

You can read more about starting a medical routine in our first 8 weeks guide or explore specific treatments for melasma and rosacea.