Lotions and Creams for Facial Acne Scarring

Atrophic acne scars are pitted scars that occur when fibrous tissue replaces healthy tissue damaged by acne and not enough replacement collagen is formed.

Several treatment options are available for this type of facial acne scarring, depending, on the type and severity of the scarring.

Topical medication (lotions and creams) are a non-invasive option for treating acne scars. They are rarely 100% effective on their own, but can be used in combination with other treatments for optimal results.

The most effective topical treatment are retinoids, a type of medication chemically similar to vitamin A. Retinoids work by increasing cell turnover and stimulating collagen.1 While a complete discussion of retinoids is beyond the scope of this site, there are some great resources out there, including http://www.webmd.com/beauty/aging/retinoid-gel-and-cream-treatments. Retinoids can be very mild and found over the counter (e.g., retinol), or available as more potent prescription-strength products such as tretinoin or tazarotene. Retinoids are most commonly prescribed to treat active acne but have been observed to help the appearance of acne scars as well due to epidermal hyperplasia and increased dermal collagen.2 Retinoids can cause mild dryness, redness and scaling especially during the first few weeks of use.

Another category of topical treatments for improving acne scars includes hydroxyl acids. The acids work by breaking apart the bonds that hold the outermost layer of skin together (the stratum corneum). The skin sloughs and allows newer, younger skin to form and stimulate collagen growth. You can think of hydroxy acid products that are available over the counter as very mild chemical peels. Alpha hydroxy acids include lactic acid, glycolic acid, and many of the fruit-derived acids. Beta hydroxy acid (salicylic acid) can be more effective in penetrating oilier skin and is a favorite for treating acne. Of course, stronger versions of alpha and beta hydroxyl acids are available in a medical professional’s office and are accompanied by side effects that you should discuss with your doctor.

One of the frustrating aspects of acne scarring is hyperpigmentation and redness. Even if the pitting is corrected, the scarred skin may not match the rest of the skin on the face. Most commonly, the scarred skin is a little darker or hyperpigmented. The most effective bleaching agent to address the hyperpigmentation is hydroquinone. It’s available over the counter in concentrations of 2% or less. A higher concentration of up to 4% is only available through a prescription. It needs to be used daily over several months to have a full effect so you will need to be patient.

Hydroquinone can be irritating so always consult with a medical professional. For people who do not like hydroquinone or find it irritating, there are alternatives that can help lighten the skin. Examples of ingredients that can lighten skin include azaleic acid, kojic acid, arbutin, vitamin C, and niacinamide. These are available in many over-the-counter creams. In addition, there are many newer ingredients, often botanical, that claim to lighten the skin. Consult with your physician to understand the latest scientific data on these newer lightening creams.

Remember that topical medications can help treat acne scars but rarely do the whole job by themselves. It is best to seek the opinion of a dermatologist on how best to treat your acne scars before embarking on a course of treatment.

Remember that topical medications can help treat acne scars but rarely do the whole job by themselves. It is best to seek the opinion of a dermatologist on how best to treat your acne scars before embarking on a course of treatment.

NOTE: Always consult with a medical professional to make sure you have a proper diagnosis and plan of action to safely achieve healthy skin.

1 Shalita, Alan R. Update of Topical Retinoid Therapy in Acne. Feb. 1, 2001; 4-6.

2 Harris DW, Buckley CC, Ostlere LS, et al. Topical retinoic acid in the treatment of fine acne scarring.
Br J Dermatol 1991 Jul; 125 (1): 81-2.

SM 1976-17 Rev00

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