Dermatologists, what are some misconceptions about acne scars and what are some truths? What is the best way to treat acne scars OTC?

First, the easy one, there are no effective over-the-counter treatments for true acne scars. Second, another common misconception is that all marks left by acne are "scars," but many are actually blemishes or hyperpigmentation. This distinction is important because blemishes and hyperpigmentation have different treatments and a much better prognosis than actual scars. True scars have texture—you can feel them with your eyes closed. In contrast, red blemishes have no texture; they’re neither raised nor indented. While these blemishes can be stubborn and long-lasting, they will eventually go away on their own, though this can take up to a year. If acne isn’t controlled, new blemishes may replace the ones fading, making it seem like there’s no improvement. For red blemishes, a V-beam laser is recommended. Hyperpigmentation can be treated with prescription bleaching cream. Treating true acne scars requires procedures like microneedling or CO2 laser resurfacing.

One of the most important topical treatments for acne scars is sunscreen! The reason is that ultraviolet (UV) light exposure breaks down the collagen and elastin fibers in our skin; in turn, acne scars become more prominent as skin becomes lax from chronic UV exposure. Many acne scar treatments are aimed at rebuilding and supporting collagen and elastin in our skin; it's critical to maintain the existing supportive network of collagen by using sunscreen every single day. I recommend SPF 30 or higher and prefer mineral based sunscreens with zinc oxide and/or titanium dioxide as the active sunscreen ingredients. Topical retinols/retinoids are the most clinically proven skincare ingredients to address acne scarring. Deeper, inflammatory acne lesions cause a disruption in the collagen of the skin, which is what leads to acne scars. Retinols and retinoids help strengthen and remodel the damaged collagen that has created the acne scar.

Misconceptions and Truths About Acne Scars: Misconceptions: Acne scars will fade on their own- While some mild discoloration may fade, true acne scars often require targeted treatment. All acne scars are the same- Acne scars vary in type—ice pick, boxcar, and rolling scars—each requiring different treatment approaches for effective results. OTC treatments are always effective- Over-the-counter products can help with mild scars but are often insufficient for deeper, more persistent scars. Once a scar is formed, it's permanent- While eliminating deep scars can be challenging, modern treatments can significantly reduce their appearance. Truths: Early treatment is critical: The sooner you address acne scars, the better your chances of improving their appearance. Multiple treatments may be necessary: Often, a combination of therapies is needed to effectively treat various types of scars. Professional treatments are more effective: Dermatologists offer advanced treatments like laser therapy, chemical peels, and dermal fillers, providing better results than OTC products. Prevention is essential: Proper skincare and treatment are crucial for managing acne outbreaks and preventing new scars. Best OTC Treatments for Acne Scars: Silicone Gel Sheets and Silicone-Based Products: Effective for raised scars, these products hydrate scar tissue, reduce redness, and help flatten scars over time. Alpha Hydroxy Acids (AHAs): Ingredients like glycolic acid exfoliate the skin, promote cell turnover, and gradually fade hyperpigmentation and surface-level scars. Retinoids: OTC retinoids like adapalene gel stimulate collagen production, improve skin texture, and fade pigmentation, helping prevent future breakouts and treat existing scars. Salicylic Acid: This exfoliant removes dead skin cells, unclogs pores, and lessens the appearance of scars, especially for those prone to acne. Vitamin C Serums: A powerful antioxidant, vitamin C lightens dark spots and promotes collagen synthesis, aiding in the healing process of mild scars. Niacinamide: Reduces inflammation, strengthens the skin barrier, and gradually lightens dark spots, making it effective for treating post-inflammatory hyperpigmentation (PIH). Summary: While OTC treatments can help with mild acne scars, consulting a dermatologist for personalized advice is crucial, especially for more severe scarring. Combining OTC products with professional treatments can lead to better, long-lasting results.

One of the biggest misconceptions is that all acne scars should be treated the same, when the reality is they can be very different and require a custom treatment accordingly. Atrophic scars that sit beneath the surface of the skin (commonly called ice pick, crater or boxcar scars) should be treated with collagen-stimulating therapies to boost collagen production to plump up the area. OTC treatments to support collagen production include topical retinol/retinoid, Vitamin C, and peptides. On the flipside a hypertrophic or "raised scars" are the result of the body stimulating too much collagen during the healing process, leaving behind a raised bump at the surface of the skin. Facial massage, silicone patches/sheets and topical niacinamide can help to reduce inflammation and support healing. Regardless of the type of scar, SPF is critical in preventing new scars and protecting existing scars while you're treating them - use a mineral SPF 30+ daily and reapply every 2hrs as well as after swimming or sweating if you're outdoors for an extended period of time. While OTC treatments can improve outcomes, there are also many in-office treatments to consider to boost results.

There are different types of acne scars that can also vary based on skin type and severity of acne. Those with darker skin tend to get post-inflammatory dyspigmentation -- discoloration in areas of previous acne. This is not usually permanent but can take a long time to resolve. Treating the acne as well as sun protection can help skin tone blend in more quickly. Others may get atrophic scars -- areas where the skin is depressed. In many cases, these scars can remodel and fill in with time. Keloid or hypertrophic scars occur when the skin gets thick, firm, and raised. Firm massage with silicone gel or sheets can help, but dermatologists may also treat by injecting these scars with steroids to reduce inflammation and break up the collagen.

Many of us believe that they are permanent and untreatable without professional help; the truth, however, is that while deep scars require clinical treatments, over-the-counter products such as retinoids, AHAs, and BHAs will get your skin texture gradually better. Another misconception people often have is that acne scarring is the same thing as hyper-pigmentation; the thing is that scarring is related to texture, whereas pigmentation means discoloration. Sunscreen must be applied consistently to prevent scars from getting worse. Retinol, salicylic acid, or glycolic acid can be considered for over-the-counter treatment.

There are two types of acne scars, "ice pick" and atrophic. Ice pick scars are small punched out holes that look like large pores. Atrophic scars are shallow depressions that appear like "rolling hills". Dermal fillers help with atrophic scars. Both improve with laser resurfacing and dermabrasion. They also improve with microdermabrasion, though not as much. The latest treatment is RF (Radiofrequency) Microneedling which also improves both. "TCA cross" is very helpful for ice pick scars. Most of the time we use combinations of several treatments to get the best outcomes.