Acne scars: what actually helps, and what cannot

Key takeaways

• Dark marks and red marks are not scars; they are pigment and leftover inflammation, and both tend to fade over months with sunscreen and gentle care.
• True scars are dents (ice-pick, boxcar, rolling) or raised bumps (hypertrophic, keloid), and no cream fills a dent.
• Treating inflamed acne early and never picking are the only ways to prevent scars; one trial found an adapalene and benzoyl peroxide gel reduced the number of depressed scars over six months while the untreated side of the face gained more.
• Silicone gel has limited but low-risk evidence for raised scars; rosehip oil and centella have only small or laboratory studies behind them.
• In darker skin, procedures carry higher risks of dark marks and keloids, so an experienced practitioner and conservative settings matter.

A spot heals and leaves something behind: a brown mark, a pink one, a small dent or a raised bump. They can look alike in the mirror, but they are different things, and what helps one does nothing for another. This guide sorts them out, is honest about what gentle care can and cannot do, and walks through the professional options, including what matters most in brown or Black skin.

Marks, redness and scars are three different things

A dark mark is post-inflammatory hyperpigmentation: extra pigment made by the skin in response to inflammation. It is flat, tan to brown or sometimes grey, and it usually fades over months, more slowly when the pigment sits deep⁴. A red or pink mark is post-inflammatory erythema, the leftover redness of inflammation and the small blood vessels it leaves widened. Two dermatologists proposed the term in 2013 precisely to separate it from pigment; like dark marks, and unlike true scars, it tends to resolve with time³. A scar is a change in the skin's structure. Depressed scars form when too little collagen is laid down as a deep spot heals; raised scars form when too much is^{1, 11}.

Ice-pick scars make up roughly 60 to 70% of depressed acne scars; boxcar and rolling scars are wider and shallower². In skin of colour, both dark marks and keloids are more common after acne². Keloids are more common in Black and Latin American people, the risk peaks between ages 10 and 30, about a third of people with keloids have a close relative who gets them, and acne is one of the usual triggers¹⁰.

Prevention is the one lever you fully control

Scars form when inflammation reaches deep into the skin and the repair goes wrong. The known risk factors are moderate to severe acne, acne that lasts a long time, more inflamed spots, picking or squeezing, and smoking². The practical message is simple: treat inflamed acne promptly, because the longer and angrier a spot is, the more likely it is to scar, and keep your hands off it².

There is direct evidence that treating acne prevents scars. In a 24-week trial, 67 people with moderate to severe acne applied an adapalene 0.3% and benzoyl peroxide 2.5% gel to one half of the face and a plain gel to the other. By the end, the treated side had 15.5% fewer depressed scars than at the start, while the untreated side had 14.4% more. The study was funded by the manufacturer, which is worth knowing, but the design was sound⁵. If gentle care has not calmed your acne within three months, or you have painful deep lumps, moving to prescription treatment is itself the best scar prevention there is. Our natural acne care guide covers the first steps.

What gentle care can do

Gentle and natural approaches can fade marks, support healing and slightly improve texture. Here is what each one has behind it.

Sunscreen

Evidence: strong for fading marks. Ultraviolet light darkens pigment and prolongs redness.

Daily broad-spectrum SPF 30 or higher is a first-line recommendation in reviews of post-inflammatory marks in skin of colour⁴. A tinted sunscreen with iron oxides also blocks visible light, which matters in darker skin. See sun protection for every skin tone.

Niacinamide, vitamin C and azelaic acid for dark marks

Evidence: moderate for azelaic acid and niacinamide; limited for vitamin C.

These three target pigment, not scar tissue. A randomised trial of 20% azelaic acid cream in 52 people showed more lightening than the plain base by 24 weeks; vitamin C at 5 to 10% is well tolerated but mostly studied in melasma; niacinamide at 2 to 5% has small trials in melasma and sun-induced pigmentation, mostly in lighter-skinned and Asian participants, but has not been tested specifically for marks in darker skin⁴. Over-the-counter azelaic acid is around 10%; 15 to 20% is prescription. Our dark spots guide covers each in detail.

Gentle retinol

Evidence: limited for over-the-counter retinol; moderate for prescription retinoids.

Retinoids speed cell turnover and encourage collagen, and the American Academy of Dermatology lists topical retinoids among options for mild scarring¹. The strong evidence belongs to prescription strengths: tretinoin 0.1% lightened marks in a 40-week trial of 54 Black patients, though half developed retinoid irritation⁴, and the adapalene and benzoyl peroxide trial above reduced scar counts⁵. Over-the-counter retinol is gentler and weaker. Start with 0.1 to 0.3% two nights a week, build slowly, wear sunscreen, and avoid it in pregnancy.

Silicone gel or sheets for raised scars

Evidence: limited. Many small trials, but a Cochrane review rated them poor quality and prone to bias.

A Cochrane review of 20 trials with 873 people found weak evidence that silicone sheeting reduces the chance of abnormal scarring in people at high risk, and that it improved the thickness and colour of existing hypertrophic and keloid scars, while warning that the trials were poor and prone to bias⁶. It is safe and cheap to try: apply gel or a sheet to a closed, healed bump for most of the day, every day, for at least two to three months.

Rosehip oil

Evidence: limited. Two small human trials, both on surgical scars.

A 2024 review found only two clinical trials of rosehip oil, which suggested it may reduce the size and redness of post-surgical scars, and concluded there is not enough evidence to recommend it for wounds⁸. Nothing has tested it on acne scars. It is a pleasant, low-risk moisturising oil for red marks, but oils can be heavy for acne-prone skin, and it will not fill a pit. See rosehip oil.

Centella asiatica

Evidence: limited. Mostly laboratory and animal work.

Centella's compounds, asiaticoside and madecassoside, increase collagen production in cell and animal studies, and a review describes a protective effect on surgical and burn scars, but the human trials it cites are small and mostly about photoageing and stretch marks, with no large trials for acne scars or keloids⁷. It is soothing and well tolerated, which makes it a good partner for stronger actives. See centella asiatica.

What gentle care cannot do

No cream, oil or serum fills a pitted scar, because the missing tissue is below the surface. Even professional treatment makes scars less noticeable rather than gone; scars can fade but rarely disappear entirely¹. A product that promises to remove scars is describing marks, or describing nothing at all.

A simple routine for healing skin

1. Morning: gentle cleanser; niacinamide or vitamin C serum; moisturiser; tinted SPF 30 or higher.
2. Evening: cleanse; azelaic acid on marks, or retinol two or three nights a week once skin tolerates it; moisturiser, with centella or rosehip oil if you like them.
3. Raised bumps: silicone gel or a sheet during the day, every day, for months.
4. Active acne: keep treating it, because every new inflamed spot is a new chance to scar.
5. One new product at a time, two weeks apart.

Professional options, and what matters for darker skin

Dermatologists usually wait until acne is under control before treating scars, and match the method to the scar¹. For depressed scars the main tools are chemical peels (mild peels may take three to five sessions), microneedling, laser resurfacing, radiofrequency, fillers that lift a dent for three months to two years, subcision to release the tether under a rolling scar, and punch techniques for single ice-pick scars^{1, 2}. For raised scars and keloids, options include corticosteroid injections, silicone, laser, cryotherapy and surgery, often combined, and keloids frequently return². Most need several sessions, some involve downtime, and insurance does not usually cover them¹.

In brown and Black skin the stakes are higher because any injury can cause dark marks or keloids. A review of laser and energy treatments in skin of colour found that both ablative and non-ablative lasers work, that the risk of post-treatment darkening depends on skin type, device and especially the density and energy settings, and that non-ablative fractional lasers are considered first choice for darker skin because of their safety record, even though they need more sessions. Radiofrequency microneedling looked promising with limited data⁹. Microneedling and radiofrequency are described as safe for all skin tones¹.

What to avoid

• Picking, squeezing and extracting at home. It drives inflammation deeper and raises the risk of a pit or a dark mark².
• Home dermarollers and high-strength peels bought online. Unsterile needles spread bacteria, and professional peels are dosed and neutralised for a reason.
• Lemon juice, toothpaste and baking soda on healing skin. Irritation means more pigment.
• "Scar removal" creams that promise to fill pits. They cannot.
• Tanning to "even out" marks. It darkens them and delays their fading.

More in DIY remedies to avoid.

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How long it takes

Mild dark marks usually fade over 6 to 12 months, deeper ones over years¹², and sunscreen and gentle actives speed that up⁴. Red marks typically settle over a few months. Prescription acne treatment showed its effect on scar counts over 24 weeks⁵, silicone needs months of daily use, and procedures are measured in sessions, often with touch-ups later¹. Judge progress with same-light photos every month, not daily mirror checks.

When to get professional help

Not everyone wants scars treated, and that is a reasonable choice¹. If you do, early acne control and experienced hands give the best result.

Our page on when to see a dermatologist explains what to bring and how to find someone experienced with skin of colour, and our free weekly skin care tips can keep you company through the slow months.

Common questions

Will my acne scars go away on their own?

Dark marks and red marks usually fade over months, sometimes a year or more, without being true scars. Genuine pitted or raised scars are changes in the skin's structure and do not fill in by themselves, although they often soften and become less noticeable with time. Professional treatments can make them less visible, but even the best rarely remove a scar completely.

Does rosehip oil fade acne scars?

The evidence is thin. A 2024 review found only two small human trials, both on surgical scars, which suggested less redness and smaller scars, and concluded that there is not yet enough evidence to recommend it. It is a gentle moisturising oil, so there is little harm in trying it on marks, but it will not fill a pitted scar, and oils can be too heavy for acne-prone skin.

Is microneedling safe for dark skin?

The American Academy of Dermatology describes microneedling as safe for all skin tones, and reviews of darker skin suggest it carries a lower risk of pigment problems than aggressive resurfacing. Risk still depends on the practitioner's experience and the settings used, so ask how often they treat people with your skin tone and whether they will start conservatively.

What is the difference between a keloid and a hypertrophic scar?

Both are raised scars made of excess collagen. A hypertrophic scar stays within the borders of the original spot and often flattens slowly over time. A keloid grows beyond the original wound, can keep growing, and tends to return after removal. Keloids are more common in Black and Latin American people and often run in families.

Sources

1. American Academy of Dermatology — Acne scars: diagnosis and treatment www.aad.org/public/diseases/acne/derm-treat/scars/treatment
2. DermNet — Acne scarring dermnetnz.org/topics/acne-scarring
3. Bae-Harboe YSC, Graber EM (2013). Easy as PIE (postinflammatory erythema). Journal of Clinical and Aesthetic Dermatology. jcadonline.com/easy-as-pie-postinflammatory-erythema
4. Davis EC, Callender VD (2010). Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. Journal of Clinical and Aesthetic Dermatology. pmc.ncbi.nlm.nih.gov/articles/PMC2921758
5. Dréno B et al. (2018). Prevention and reduction of atrophic acne scars with adapalene 0.3%/benzoyl peroxide 2.5% gel in subjects with moderate or severe facial acne. American Journal of Clinical Dermatology. pmc.ncbi.nlm.nih.gov/articles/PMC5978908
6. O'Brien L, Jones DJ (2013). Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database of Systematic Reviews. pubmed.ncbi.nlm.nih.gov/24030657
7. Bylka W et al. (2013). Centella asiatica in cosmetology. Postepy Dermatologii i Alergologii. pmc.ncbi.nlm.nih.gov/articles/PMC3834700
8. Belkhelladi M, Bougrine A (2024). Rosehip extract and wound healing: a review. Journal of Cosmetic Dermatology. pubmed.ncbi.nlm.nih.gov/37605366
9. Teymour S et al. (2023). Energy-based devices in the treatment of acne scars in skin of color. Journal of Cosmetic Dermatology. pubmed.ncbi.nlm.nih.gov/36575886
10. American Academy of Dermatology — Keloids: who gets and causes www.aad.org/public/diseases/a-z/keloids-causes
11. American Academy of Dermatology — Acne scars: who gets and causes www.aad.org/public/diseases/acne/derm-treat/scars/causes
12. American Academy of Dermatology — How to fade dark spots in darker skin tones www.aad.org/public/everyday-care/skin-care-secrets/routine/fade-dark-spots