Acne Scar Treatment in Australia: What Actually Works

If you have ever dealt with acne, chances are the breakouts left behind more than just a memory. Dark marks, uneven texture and small dents in the skin are incredibly common, and for plenty of Australians those reminders hang around long after the pimples have cleared. Acne scar treatment has come a long way, though. Prescription-strength retinoids, niacinamide and vitamin C can all meaningfully improve the look of scars and dark spots when used consistently under medical guidance.

Below we break down the different types of acne scarring, the topical treatments with real clinical evidence, how custom prescription skincare stacks up against shop-bought products, and why getting onto treatment early matters more than most people think.

Key takeaways

• Prescription retinoids (tretinoin, adapalene and trifarotene) have the strongest clinical trial evidence for improving atrophic acne scars and preventing new ones from forming.[1][2]
• Post-inflammatory hyperpigmentation (the dark or red marks left after a breakout) is not true scarring and responds well to topical ingredients like niacinamide, vitamin C and azelaic acid.[3]
• Combination topical regimens (for example niacinamide paired with a retinoid or vitamin C) outperform single ingredients for both texture and pigment.[4]
• A custom prescription formula, like tretinoin with niacinamide and hyaluronic acid in one cream, lets a doctor target your specific scar type at concentrations you cannot get off the shelf.[2]
• Treating active acne early is still the best way to stop scars forming in the first place.[5]

Can pimple scars go away?

It depends entirely on what type of mark you are looking at.

Post-inflammatory hyperpigmentation and erythema

The flat brown, purple or pink marks that linger after a breakout are called post-inflammatory hyperpigmentation (PIH) or post-inflammatory erythema (PIE). Despite how they look, these are pigment or vascular changes rather than actual scars. Many fade on their own over months to years, but topical ingredients speed that up considerably.[3] In one randomised trial, 15 per cent azelaic acid gel twice daily for 12 weeks significantly reduced both PIH and PIE compared to vehicle.[6]

Atrophic (indented) scars

Ice-pick, boxcar and rolling scars are caused by collagen loss during healing. These are permanent structural changes, and topicals alone will not erase deep ones completely. That said, prescription retinoids do stimulate collagen remodelling and measurably improve the look of shallower atrophic scars.[1][7] Deeper scars may need in-clinic procedures, but a good daily topical routine still underpins everything else.

Hypertrophic and keloid scars

Raised, thickened scars are less common with facial acne but can occur, especially on the jawline, chest and back. Silicone-based gels and sheets are considered first-line for preventing and managing these scar types.[3]

Best acne scar treatments: what the evidence says

Plenty of products claim to fix acne scars overnight. Very few have proper clinical trial data behind them.

Retinoids: the strongest evidence

Prescription retinoids have the most clinical data of any topical for acne scars and post-acne marks. They speed up skin cell turnover, push the dermis to produce more collagen, and help break up excess melanin deposits.[2]

A Phase 4 randomised controlled trial (the START study) of 121 patients found that trifarotene 0.005 per cent cream reduced total atrophic acne scar counts by 55.2 per cent over 24 weeks, compared to 29.9 per cent for vehicle, with improvements visible as early as week two.[1] Separately, adapalene 0.3 per cent combined with benzoyl peroxide 2.5 per cent reduced atrophic scar formation by roughly 30 per cent more than vehicle, which is strong evidence that treating acne with a retinoid actively prevents scarring.[5]

Tretinoin, the retinoid prescribed most often by our doctors at Prescription Skin, has been shown to improve superficial acne scars after as little as four months of daily use.[7] A landmark randomised trial in the New England Journal of Medicine demonstrated that 0.1 per cent tretinoin cream significantly lightened post-inflammatory hyperpigmented lesions over 40 weeks.[8] Our retinol versus tretinoin guide explains how prescription retinoids differ from over-the-counter retinol.

Niacinamide: barrier support and pigment control

Niacinamide (vitamin B3) blocks melanosome transfer, which is what darkens post-acne marks, and it shores up the skin barrier so stronger actives like retinoids are better tolerated.[3] At five per cent concentration it is safe for daily long-term use with no notable side effects.[3] Niacinamide is also directly anti-inflammatory. It suppresses interleukin-8 production, calming the redness that can worsen scarring.[9]

Vitamin C: collagen cofactor and brightener

Vitamin C (L-ascorbic acid) is a cofactor in collagen synthesis, and without it your skin cannot build new collagen properly. It also inhibits tyrosinase, the enzyme that drives melanin production, so it pulls double duty on both texture and dark spots.[3] Paired with niacinamide, one study reported an 85 per cent improvement in post-inflammatory hyperpigmentation over 12 weeks.[4]

Azelaic acid: gentle and effective for reactive skin

Azelaic acid is anti-inflammatory, mildly antibacterial and slows excess melanin production. A systematic review of 43 randomised controlled trials found that 20 per cent azelaic acid was more effective than vehicle for acne, and beat two per cent hydroquinone for hyperpigmentation.[10] Side effects are mild, so it suits sensitive skin well, and it is considered safe during pregnancy.[6]

Acne scar treatment at a glance

Custom prescription skincare vs off-the-shelf products vs in-clinic procedures

Most people with acne scars end up weighing three options: a retinol serum from the chemist, in-clinic procedures, or a prescription cream. They overlap less than you might think.

Combination regimens punch well above their weight. A 2025 review found niacinamide plus a retinoid cut inflammatory lesions by 70 per cent and PIH by 60 per cent over 12 weeks; niacinamide with vitamin C hit an 85 per cent improvement in hyperpigmentation over the same period.[4] Custom compounding puts those combinations into a single daily cream, which beats layering three or four separate products and hoping they work together.

Why treating acne early is the best scar treatment

No topical will ever beat not getting the scar in the first place. Scarring is inflammation-driven. The longer a breakout stays inflamed, the more collagen gets destroyed.[2]

A 2025 Australian review in Medicine Today made the point that early acne treatment matters for everyone, not just severe cases, because even mild-to-moderate acne can scar if the inflammation drags on.[7] Retinoids are recommended as first-line partly for this reason: they clear active acne and cut scar risk at the same time.[2]

If you are still breaking out, do not sit on your hands waiting for scars to show up. Our guide to your first eight weeks on prescription skincare walks you through what to expect.

Building a routine for acne-scarred skin

Scar management works best in phases, matching the ingredients to where your skin is in the healing timeline.[3]

Immediately after active breakouts (0–4 weeks)

Keep things simple: gentle cleanser, a moisturiser with hyaluronic acid or niacinamide, and broad-spectrum SPF 50+ every morning. UV exposure darkens post-acne marks and slows healing, so sunscreen is doing more for your scars right now than any active would.

Early recovery (4–12 weeks)

Start adding brightening and anti-inflammatory actives. Niacinamide and vitamin C tackle pigment and support collagen. Azelaic acid works well here too, especially if your skin runs sensitive or you are prone to rosacea.

Remodelling phase (3–12 months)

Prescription retinoids earn their keep over this longer stretch. Collagen remodelling is slow and you will not see dramatic textural changes in a fortnight, but the data consistently shows measurable improvement with daily use over several months.[1][7] Pairing a retinoid with niacinamide and vitamin C appears to outperform any of those ingredients used alone.[4]

How Prescription Skin treats acne scars

Prescription Skin is an Australian telehealth skincare service. Registered doctors assess your skin online and prescribe custom-compounded creams for acne scars, hyperpigmentation, acne, rosacea and fine lines. It is available Australia-wide.

The process runs in four steps:

1. Complete an online skin assessment. Upload photos and answer questions about your history, concerns and goals.
2. A doctor reviews your case. An Australian-registered, AHPRA-credentialed prescriber looks at your photos and history and designs a formula. That might be prescription-strength tretinoin with niacinamide and hyaluronic acid in a single cream, or a different combination depending on your skin.
3. Your formula is compounded. A partner pharmacy makes up the prescription to the doctor's exact specifications.
4. Shipped to your door. Free delivery anywhere in Australia. Formulas can be tweaked over time as your skin improves or your needs shift.

Because everything is compounded to order, your doctor can dial in multiple actives at prescription strength in one cream. You cannot replicate that by stacking shop-bought serums. For acne scars, a typical formula might pair tretinoin (collagen and turnover) with niacinamide (inflammation and pigment) and hyaluronic acid (barrier and tolerability). The specific actives and concentrations depend on your scar type, skin tone, sensitivity and any other conditions you are managing.

Our first eight weeks guide covers what the early weeks look like. For pricing, shipping and follow-up details, see the FAQ page.

Frequently asked questions

Can pimple scars go away completely?

Flat pigmented marks (PIH) usually fade on their own and respond well to topical treatment. True atrophic scars, the indented ones, will not vanish completely with creams alone, but prescription retinoids, niacinamide and vitamin C can noticeably smooth them out over several months.[1][3]

How long does acne scar treatment take?

Allow at least 8 to 12 weeks before expecting visible improvement in pigmented marks, and 12 to 24 weeks or longer for textural changes. Collagen remodelling is gradual, so the people who get the best results are the ones who stick with it rather than switching products every few weeks.

Is it safe to use retinoids on acne-scarred skin?

Yes. Expert consensus guidelines recommend retinoids as first-line for both acne and acne sequelae.[2] Some irritation is normal early on. The standard approach is to start at a lower strength and build up. At Prescription Skin our doctors adjust your formula if your skin reacts.

Can I treat acne scars during pregnancy?

Retinoids are off the table during pregnancy and breastfeeding. Niacinamide, azelaic acid and vitamin C are all considered safe alternatives for keeping post-acne marks in check. Our pregnancy skincare guide goes into more detail.

Do I need a prescription for acne scar treatment?

Not necessarily for mild pigmented marks. Over-the-counter niacinamide and vitamin C can help. But for atrophic scarring and stubborn PIH, prescription-strength retinoids like tretinoin have much stronger clinical trial evidence than cosmetic-grade retinol.[7] With Prescription Skin you can get prescription acne scar treatment without leaving home: fill in an online skin assessment, a doctor reviews your case, and a custom formula is compounded and posted to you.

How does Prescription Skin compare to seeing a dermatologist?

A dermatologist can do things a topical cream cannot, like laser resurfacing, subcision and chemical peels. For the daily prescription skincare that underpins any scar management routine, though, Prescription Skin gives you doctor-prescribed, custom-compounded formulas delivered Australia-wide, usually at a lower cost than repeated specialist visits. Plenty of patients do both: Prescription Skin for the daily routine, and a dermatologist every few months for the deeper scars.