The best acne scar treatment is preventing scars in the first place, which means treating acne early and effectively, especially the deep, painful kind. Topical retinoids and benzoyl peroxide handle mild to moderate acne. Spironolactone works well for adult women. Isotretinoin (Accutane) is the most powerful option and can cure severe acne.
Once scars exist, the treatment depends on the scar type. Red and brown marks fade with time and skincare. Rolling scars respond to subcision, boxcar scars to lasers and microneedling, and ice pick scars to TCA CROSS or punch excision. Most people need a combination over several sessions. Copper peptides like GHK-Cu are studied for wound healing and collagen, but have no strong acne scar trials. Here is the complete guide.
How acne forms
Acne develops in hair follicles and their oil glands through four overlapping steps:
- Excess oil (sebum), driven largely by androgens
- Clogged pores from skin cells that don’t shed properly, forming blackheads and whiteheads
- Bacteria (Cutibacterium acnes) multiplying in the clogged follicle
- Inflammation, producing red papules, pus-filled pustules and deep nodules or cysts
The deeper and more inflamed a lesion, the more it damages the surrounding collagen, and the more likely it is to scar. Picking and squeezing add to the damage.
Treatment by acne severity
The Canadian clinical practice guideline on acne matches treatment to severity (Asai et al., 2016):
| Severity | Looks like | First-line approach |
|---|---|---|
| Mild (comedonal) | Blackheads, whiteheads | Topical retinoid; benzoyl peroxide |
| Mild to moderate (inflammatory) | Red bumps and pustules | Combination topicals: retinoid + benzoyl peroxide, or clindamycin + benzoyl peroxide |
| Moderate to severe | Many inflamed lesions, some nodules | Combination topicals + oral antibiotic (limited duration) or hormonal therapy |
| Severe, nodular or scarring | Deep painful nodules, cysts, scarring | Isotretinoin |
Rule of thumb: if acne is leaving scars, it’s severe enough to warrant stronger treatment, whatever it looks like on a given day.
Topical treatments
- Retinoids (adapalene, tretinoin, tazarotene, trifarotene) unclog pores, reduce inflammation and, over time, improve skin texture and mild scarring. Expect dryness and irritation early; start a few nights a week. Not for use in pregnancy.
- Benzoyl peroxide kills acne bacteria without causing antibiotic resistance. Can bleach fabrics.
- Topical antibiotics (clindamycin) should always be combined with benzoyl peroxide to limit resistance.
- Azelaic acid reduces acne and fades brown marks; gentle enough for pregnancy and sensitive skin.
- Salicylic acid helps with mild comedonal acne.
Fixed combination products in one tube improve adherence. Results take 8 to 12 weeks.
Antibiotics, the pill and spironolactone
Oral antibiotics
Doxycycline or minocycline for moderate to severe inflammatory acne, combined with topical treatments and limited to about three months where possible to reduce antibiotic resistance.
Combined oral contraceptives
For people who also want contraception, combined pills reduce androgen-driven oil production and are effective for acne, especially along the jaw and chin. They take 3 to 6 months for full effect.
Spironolactone
An inexpensive anti-androgen pill widely used for adult women with acne. In the UK SAFA trial, spironolactone improved acne-related quality of life and reduced acne compared with placebo, with benefits building over 12 to 24 weeks (Santer et al., 2023). It must be used with reliable contraception because it can affect a male fetus. Not used in men because of hormonal side effects.
Hormonal acne connects to conditions like PCOS; see our PCOS treatment guide.
Isotretinoin (Accutane)
Isotretinoin is the only acne treatment that targets all four causes of acne, shrinking oil glands dramatically. A course of about 5 to 8 months produces long-term remission in most people, and it is the most effective way to stop ongoing scarring.
| Consideration | Details |
|---|---|
| Who | Severe, nodular or scarring acne, or acne that fails other treatments |
| Pregnancy | Causes severe birth defects; strict pregnancy prevention and testing are mandatory |
| Common side effects | Very dry lips, skin and eyes; nosebleeds; muscle aches; temporary flare at start |
| Monitoring | Blood tests for lipids and liver enzymes; mood check-ins |
| Mood | Rare reports of depression and suicidal thoughts; acne itself also affects mood. Report any mood changes promptly |
| Access in Canada | Prescribed by dermatologists and many family physicians; generics available |
Scar procedures are often delayed until a few months after finishing isotretinoin, although recent evidence suggests some procedures may be safe sooner; follow your dermatologist’s advice.
Red and brown marks are not scars
| Mark | What it is | Who gets it | Treatment |
|---|---|---|---|
| Post-inflammatory erythema (PIE) | Red or pink flat marks from dilated blood vessels | Lighter skin tones | Fades over months; vascular lasers speed it up |
| Post-inflammatory hyperpigmentation (PIH) | Brown or dark flat marks from excess pigment | More common in medium and darker skin | Sunscreen, azelaic acid, retinoids, vitamin C; fades over months |
These flat marks are not permanent changes to skin texture and fade on their own, faster with daily sunscreen and the right topicals. True scars change the texture of the skin.
The four types of acne scars
| Scar type | Looks like | Depth |
|---|---|---|
| Ice pick | Narrow, deep holes, like large open pores | Deep, narrow |
| Boxcar | Round or oval depressions with sharp edges | Shallow to medium, wider |
| Rolling | Wave-like undulations; skin looks uneven in side lighting | Tethered by fibrous bands underneath |
| Hypertrophic / keloid | Raised, firm scars, often on chest, back, shoulders and jaw | Raised |
Most people have a mix, which is why combination treatment works best.
Scar treatments, one by one
Microneedling
Fine needles create micro-injuries that stimulate collagen remodelling. Good for rolling and shallow boxcar scars, with low downtime and a lower risk of pigment problems in darker skin. Usually 3 to 6 sessions spaced weeks apart. RF microneedling adds heat for more collagen stimulation.
Fractional lasers
- Ablative fractional lasers (CO2, erbium) remove microscopic columns of skin and give the strongest results for boxcar and rolling scars, with about a week of downtime.
- Non-ablative fractional lasers heat the skin without removing it: more sessions, less downtime, more modest results.
Subcision
A needle or blunt cannula is passed under the skin to cut the fibrous bands tethering rolling scars down. One of the most effective treatments for rolling scars; often combined with fillers or microneedling.
TCA CROSS
High-strength trichloroacetic acid applied precisely into individual ice pick scars causes them to fill in with collagen over several sessions.
Punch excision or punch elevation
Deep ice pick or boxcar scars are cut out and stitched closed, or the scar base is lifted to skin level.
Fillers
Hyaluronic acid or biostimulatory fillers lift depressed rolling scars immediately; results are temporary to semi-permanent.
Chemical peels
Medium-depth peels improve shallow scarring and pigmentation; superficial peels mainly help marks rather than true scars.
For raised scars
Steroid injections, silicone sheets and gels, vascular lasers and sometimes cryotherapy flatten hypertrophic and keloid scars.
Matching treatment to scar type
| Scar type | Best options |
|---|---|
| Ice pick | TCA CROSS, punch excision |
| Boxcar (shallow) | Microneedling, fractional laser, peels |
| Boxcar (deep) | Punch elevation, ablative laser |
| Rolling | Subcision, fillers, RF microneedling |
| Hypertrophic / keloid | Steroid injections, silicone, vascular laser |
| Red marks (PIE) | Time, vascular laser |
| Brown marks (PIH) | Sunscreen, azelaic acid, retinoids |
Expect improvement, not perfection. A realistic goal is often 50% to 80% improvement over a series of treatments.
Darker skin tones: special considerations
- Higher risk of post-inflammatory hyperpigmentation after aggressive lasers and peels.
- Microneedling, RF microneedling and subcision are generally safer choices.
- Lasers can be used with careful settings by experienced practitioners; ask about their experience with your skin type.
- Pre- and post-treatment skincare, and strict sun protection, reduce pigment risk.
- Keloid tendency is more common in some people with darker skin; mention any personal or family history.
Costs in Canada
| Treatment | Covered? |
|---|---|
| Doctor or dermatologist visits | Covered by provincial plans (dermatology by referral) |
| Prescription acne medications | Often covered by private plans; generics are inexpensive |
| Scar procedures (lasers, microneedling, subcision, fillers) | Cosmetic: not covered; priced per session at private clinics |
| Keloid treatment | Sometimes covered when symptomatic (painful or itchy) |
Ask for a treatment plan with the expected number of sessions and the total cost. Package pricing is common.
What you can do at home
- Don’t pick or squeeze.
- Use a retinoid nightly once tolerated: it treats acne and slowly improves texture.
- Daily sunscreen: reduces dark marks and protects collagen.
- Gentle, non-comedogenic products.
- Avoid at-home “dermarollers” with long needles: infection and scarring risk; professional microneedling is safer.
- Be patient: skin remodels over months.
GHK-Cu and peptide research
GHK-Cu is a naturally occurring copper peptide first studied for wound healing. In laboratory studies it stimulates collagen and elastin production, supports remodelling of damaged tissue, and has antioxidant and anti-inflammatory effects (Pickart & Margolina, 2018). Because scar treatments rely on collagen remodelling, copper peptides are a logical research area, and they appear in some post-procedure skincare.
KPV, a three-amino-acid fragment of alpha-melanocyte-stimulating hormone, is studied for its anti-inflammatory effects, including in skin and gut inflammation models. See our KPV guide.
There are no strong clinical trials showing copper peptides or KPV treat acne or acne scars. The proven treatments above should come first. These are research compounds.
| Research compound | Research area | From |
|---|---|---|
| GHK-Cu | Collagen and wound repair (lab) | $49 |
| GLOW70 | GHK-Cu + BPC-157 + TB-500 | $130 |
| KPV | Anti-inflammatory peptide (animal and lab) | $36 |
For laboratory research only, with reports in our COA library. More on copper peptides in retinol vs vitamin C vs copper peptides.
Acne myths
- “Acne is caused by dirty skin.” It’s driven by hormones, oil, pore clogging and inflammation; over-washing irritates skin.
- “Toothpaste dries out pimples.” It irritates skin and can worsen marks.
- “Sun clears acne.” It may temporarily hide redness, but it darkens marks and some treatments make skin more sun-sensitive.
- “You’ll grow out of it, so don’t treat it.” Untreated severe acne can leave permanent scars.
- “Accutane is too dangerous.” It requires monitoring and strict pregnancy prevention, but it is highly effective and widely used safely.
Adult acne in women
Acne doesn’t always end with adolescence. Many women experience acne in their twenties, thirties and forties, often with a typical pattern:
- Deeper, tender bumps along the jawline, chin and neck
- Flares before periods
- Persistence despite good skincare
- Sometimes links to PCOS, stress or stopping hormonal contraception
Hormonal treatments work particularly well here: combined oral contraceptives and spironolactone, alongside topical retinoids and azelaic acid. Adult skin is often more sensitive and drier, so gentler formulations and slower introduction help.
Back and chest acne
- Benzoyl peroxide washes left on the skin for a minute or two before rinsing are practical for large areas.
- Topical retinoids can be used on the body, though covering large areas takes more product.
- Oral antibiotics or isotretinoin are often needed for extensive or scarring body acne.
- Sweat and friction: shower after workouts, wear breathable fabrics, avoid tight straps.
- Fungal acne (Malassezia folliculitis), with uniform itchy bumps, mimics acne and needs antifungal treatment instead.
Body acne is more prone to hypertrophic and keloid scarring, especially on the chest and shoulders, so early, effective treatment matters.
Does diet affect acne?
| Factor | Evidence |
|---|---|
| High-glycemic diet (sugary foods, refined carbs) | Modest evidence of worsening acne in some studies |
| Milk, especially skim | Observational links in some studies; not consistent |
| Whey protein supplements | Case reports of flares |
| Chocolate | Weak, mixed evidence |
| Greasy food | No good evidence it causes acne |
Diet changes may help some people but rarely replace medical treatment. If you suspect a trigger, try changing one thing for 8 to 12 weeks and track results.
A simple routine that works
| Step | Morning | Evening |
|---|---|---|
| 1 | Gentle cleanser (or benzoyl peroxide wash) | Gentle cleanser |
| 2 | Azelaic acid or treatment gel if prescribed | Topical retinoid (pea-sized amount for the whole face) |
| 3 | Light non-comedogenic moisturizer | Moisturizer (apply before retinoid if very dry) |
| 4 | Sunscreen SPF 30+ | — |
Simple and consistent beats complex. Introduce one new active at a time, and give each 8 to 12 weeks.
Acne treatment in pregnancy
| Generally avoided | Generally considered options (discuss with your provider) |
|---|---|
| Isotretinoin (strictly contraindicated) | Azelaic acid |
| Topical retinoids | Benzoyl peroxide |
| Spironolactone | Topical clindamycin with benzoyl peroxide |
| Tetracycline antibiotics | Some oral antibiotics in specific situations |
Many scar procedures are postponed until after pregnancy and breastfeeding.
How long each treatment takes
| Treatment | First improvement | Full effect |
|---|---|---|
| Topical retinoids | 6–8 weeks | 3–6 months |
| Benzoyl peroxide | 4–6 weeks | 2–3 months |
| Oral antibiotics | 4–6 weeks | About 3 months |
| Birth control pill | About 3 months | About 6 months |
| Spironolactone | About 6–12 weeks | About 6 months |
| Isotretinoin | 1–2 months (after initial flare) | End of course (5–8 months) |
| Scar procedures | After 1–2 sessions | 3–6 months after the last session |
Choosing a scar treatment clinic
- Who treats you? Look for a dermatologist or a physician-supervised clinic, especially for lasers and subcision.
- Assessment first: a good clinic identifies your scar types before recommending a device.
- Combination plans: be wary of one-machine-fits-all approaches.
- Before-and-after photos of patients with similar skin tone and scar types.
- Experience with your skin tone, particularly for lasers on medium and darker skin.
- Clear total cost and number of sessions.
- Active acne controlled first: treating scars during active breakouts wastes money.
Acne and mental health
Acne is often dismissed as cosmetic, but studies consistently link it to anxiety, depression, social withdrawal and lower self-esteem, sometimes out of proportion to how severe it looks to others. Scarring can have lasting effects on confidence.
- Treating acne effectively often improves mood and quality of life substantially.
- Check in on mood during treatment, especially with isotretinoin, and tell your prescriber about any changes.
- Avoid compulsive picking; if you can’t stop, habit-reversal approaches can help (it’s a recognized condition called excoriation disorder).
- Get support if acne is affecting daily life; see our anxiety treatment guide.
Mask, helmet and sports acne
Acne mechanica is triggered by friction, pressure and heat under masks, helmets, chin straps, backpack straps and sports equipment. Tips:
- Wear a clean, breathable layer between skin and equipment.
- Shower and change out of sweaty gear promptly.
- Wash masks and pads regularly.
- Use non-comedogenic moisturizers and avoid heavy products under masks.
- Treat as usual with benzoyl peroxide and retinoids.
Ingredient glossary
| Ingredient | What it does | Best for |
|---|---|---|
| Adapalene, tretinoin, tazarotene, trifarotene | Retinoids: unclog pores, reduce inflammation, remodel skin | Most acne; texture and mild scarring |
| Benzoyl peroxide | Kills acne bacteria without resistance | Inflammatory acne |
| Clindamycin | Topical antibiotic | Inflammatory acne, always with benzoyl peroxide |
| Azelaic acid | Anti-inflammatory, antibacterial, fades pigment | Acne with dark marks; sensitive skin; pregnancy |
| Salicylic acid | Exfoliates inside pores | Blackheads and whiteheads |
| Niacinamide | Calms redness, supports barrier | Sensitive, red skin |
| Glycolic / lactic acid | Surface exfoliation | Texture, dullness |
| Spironolactone | Oral anti-androgen | Hormonal acne in women |
| Isotretinoin | Oral retinoid that shrinks oil glands | Severe or scarring acne |
FAQ
Tap a question to reveal the answer.
What is the best treatment for acne scars?
It depends on the scar type: subcision for rolling scars, fractional lasers or microneedling for boxcar scars, and TCA CROSS or punch excision for ice pick scars. Most people need a combination.
Can acne scars go away on their own?
Red and brown flat marks usually fade over months. True textured scars improve only slightly on their own and usually need treatment.
Does microneedling work for acne scars?
Yes, especially for rolling and shallow boxcar scars, over several sessions. RF microneedling adds heat for stronger collagen stimulation.
Is spironolactone good for acne?
Yes, for adult women. In the SAFA trial it reduced acne compared with placebo, with benefits building over 12 to 24 weeks. It requires reliable contraception.
Is Accutane worth it?
For severe, nodular or scarring acne, isotretinoin is the most effective treatment and can produce long-term remission. It requires blood tests, mood monitoring and strict pregnancy prevention.
Are acne scar treatments covered in Canada?
Medical acne treatment is covered by provincial plans and often by private drug plans, but scar procedures like lasers and microneedling are considered cosmetic and paid privately.
Does GHK-Cu help acne scars?
GHK-Cu stimulates collagen in lab studies and is used in some skincare, but there are no strong clinical trials showing it treats acne scars.
Does diet cause acne?
Diet isn’t the main cause, but high-glycemic diets and, in some people, dairy and whey protein may worsen acne. Medical treatment remains the foundation.
How long does it take to see results from acne treatment?
Most treatments take 6 to 12 weeks for first improvement and several months for full effect. Isotretinoin works over a 5 to 8 month course.
Can acne affect mental health?
Yes. Acne is linked to anxiety, depression and lower self-esteem, and effective treatment often improves quality of life. Report mood changes to your prescriber, especially during isotretinoin treatment.
Related reading
- Retinol vs vitamin C vs copper peptides
- PCOS treatment in Canada
- Loose skin after weight loss
- KPV peptide guide
References
- Asai Y, Baibergenova A, Dutil M, et al. Management of acne: Canadian clinical practice guideline. CMAJ. 2016;188(2):118–126. PubMed
- Santer M, Lawrence M, Renz S, et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA). BMJ. 2023. PubMed
- Pickart L, Margolina A. Regenerative and protective actions of the GHK-Cu peptide in the light of the new gene data. Int J Mol Sci. 2018;19(7):1987. PubMed
This article is general information, not medical advice. See a doctor or dermatologist for acne treatment and scar procedures. TrueLabs research compounds are sold for in vitro and laboratory research use only and are not intended for human or veterinary use.