Acne Scars: Treatment Can Ease Pain, Diminish Scars
When acne clears, some people see
raised scars on their skin. With time, these scars may become larger
and more noticeable. Some raised scars itch. They can even be
painful and tender. To ease the discomfort and diminish the
appearance of these scars, dermatologists offer patients a number of
2 Types of Raised Acne Scars
Before treatment begins, a dermatologist will examine the scar to
see type of raised scar you have. Two types of raised scars can form
after acne clears:
keloid is a type of raised scar that grows beyond its
border. Keloids often become extremely thick, rubbery, and
large, such as the keloid on this man’s face and neck.
Keloids are more common in people of African, Asian, or
Keloids can develop anywhere on
the skin, but most form on the earlobe, chest, shoulders, or
upper back. The keloids in this photograph developed on the
chest of a young man after his acne cleared.
Keloid (man’s face) - This photograph was published in the Journal of the American Academy of Dermatology, 1998 Aug; 39(2 Pt 3):S98-103. Halder RM. “The role of retinoids in
the management of cutaneous conditions in blacks.” Copyright
Keloids (chest) and hypertrophic scar – These photographs are used
with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
This type of raised scar does
not grow beyond its border. With time, many hypertrophic
scars become less noticeable.
Treatment Options for Raised Acne Scars
Your dermatologist considers many things before deciding how to
treat a raised scar. Considerations include where the scar appears
on the body, the size of the scar, and how long the scar has been
there. Your dermatologist will use this information to create a
Often a treatment plan will include more than 1 treatment option.
Raised scars, especially keloids, often respond better when treated
this way. Treatments that dermatologists use to treat raised scars
These injections, which your dermatologist may call “intralesional
injections,” help shrink raised scars. Injections of corticosteroids
can soften and flatten thick, raised scars. Interferon can help
soften a keloid and make it feel smoother.
Dermatologists generally give a series of injections. Usually given
every few weeks, the frequency will depend on the type of scar and
many other considerations. Some patients receive an injection every
2 or 3 weeks. Others get an injection once every 3 to 6 weeks. If a
scar does not respond (or stops responding) by the 4th injection,
scar surgery may be recommended.
Acne Scar Surgery
When raised scars do not respond to injections, your dermatologist
may recommend surgery to remove the scar. This surgery can be
performed in a dermatologist’s office, and you can go home
When treating a keloid, dermatologists do not recommend surgery
alone. Most keloids have a high risk (between 45% and 100%) of
returning when surgery is the only treatment. To prevent a keloid
from returning, dermatologists use other treatments before and after
surgery. Many people receive injections of corticosteroids before
The following often are used after surgery:
Surgery, followed by pressure - Applying pressure by wearing a
pressure garment or pressure device can help prevent a keloid from
Surgery, followed by injections – After surgery, dermatologists
often treat raised scars with injections of corticosteroids or
interferon. Combining surgery with these shots remains one of the
most effective treatments for raised scars, especially keloids. Most
patients receive corticosteroid injections once a month for a few
Surgery, followed by radiation – Studies are showing that
radiation can prevent raised scars from returning after surgery.
Lasers and Other Light Therapies
More dermatologists are using lasers to treat raised scars. The
pulsed dye laser (PDL) can be effective for treating some keloids
and hypertrophic scars. Treatment with a PDL can help reduce the
itch and pain, diminish the color, and flatten a raised scar. For
people with lighter skin, intense pulsed light (IPL) also may be a
To help prevent keloids from returning after laser treatment,
injections of corticosteroids or pressure therapy may be used.
This treatment freezes the scar tissue. Freezing the tissue causes
it to die and gradually fall off. To improve the results,
dermatologists may schedule a series of cryotherapy sessions and
corticosteroid injections. This combination often produces the best
results. It can effectively diminish hypertrophic scars and flatten
Cryotherapy, however, can leave the treated skin looking lighter
than the surrounding skin. This limits its use in people with skin
Gels, Creams, and Tapes
Many of these are available without a prescription and can be used
at home to treat raised scars. Products containing silicone may help
reduce the itch and discomfort of both hypertrophic scars and
keloids. One study found that some (34%) keloids actually flattened
a bit when patients applied a silicone gel continuously for 6
Your dermatologist may prescribe a medication that can be applied to
a raised scar. Applying tretinoin (a prescription medication used to
treat acne) twice a day to keloids may help stop the itch and pain.
This medication also may help reduce the size of the keloid.
Sometimes your dermatologist will prescribe a strong corticosteroid
that you can apply to the scar. Applying both tretinoin and a strong
corticosteroid to a keloid seems to improve the results.
To be effective, gels, creams, and tapes must be used continuously.
This can be difficult, especially for scars on the face. Many people
are willing to do this because these treatments have little risk of
side effects. Even so, with continuous use, some people develop
itchy, irritated skin.
None of these gels, creams, or tapes is likely to eliminate a raised
scar, but these can help reduce the discomfort and the size.
What Studies Show About Other Treatments
Raised scars can be especially difficult to treat, so researchers
continue to look for better treatments. They are hopeful that they
will discover a safe, more effective treatment. Some treatments that
have recently been studied for treating raised scars are:
5-Fluorouracil (5-FU) – Injections of this medication have been
effective for treating hypertrophic scars and sometimes keloids.
Combining 5-FU with injections of corticosteroids may be more
effective than either 5-FU or corticosteroids alone.
Imiquimod - One study found that fewer keloids returned when
patients applied imiquimod 5% (a cream approved to treat genital
warts and some skin cancers) after the keloid was removed with
surgery. Another study did not find this to be true.
Radiation therapy (alone) - Dermatologists are finding that
radiation therapy alone can effectively treat some keloids. It seems
most effective for keloids that have been on the skin fewer than 5
Trust Your Dermatologist
Raised scars can be a challenge to treat. With many treatment
options now available, your dermatologist can tailor a treatment
plan to help diminish raised scars and provide you with tips to
reduce your risk of developing new raised scars.
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conditions in blacks.” Journal of the American Academy of
Dermatology August 1998; 39: S98-103.
Halder RM, Nootheti PK. “Ethnic skin disorders overview.” Journal
of the American Academy of Dermatology June 2003; 48: S143-8.
Kelly AP. “Keloids.” In: Kelly AP, Taylor SC editors. Dermatology
for Skin of Color. China, McGraw Hill Medical; 2009. p. 178–194.
Wolfram D, Tzankov A, Pulzl P et al. “Hypertrophic scars and
keloids--a review of their pathophysiology, risk factors, and
therapeutic management.” Dermatologic Surgery February
2009; 35: 171-81.
Zurada JM, Kriegel D, Davis IC. “Topical treatments for hypertrophic
scars.” Journal of the American Academy of Dermatology
December 2006; 55: 1024-31.
content solely developed by the American Academy of Dermatology
are much easier to treat when they first appear. Keloids
that have been around for years can be difficult to
treat and require many appointments with your