Cystic Acne Scars – How To Get Rid Of Them

Posted in  Acne  on  April 19, 2023 by  Jessica Gremley0 comments

Cystic acne is a severe form of acne. It can usually be treated, if going the dermatology route, with antibiotics or if going a more natural route with topical skin products and herbal supplements. However, if left untreated, cystic acne can cause long-term damage to the skin, leading to permanent scars. 

In fact, if you have experienced severe cystic acne, scars may still develop despite doing everything you could to treat it properly.  If your cystic acne has left you with deep, dark scars, don’t despair. There are ways to effectively treat acne scars and restore your skin’s original appearance.

What Is Cystic Acne?

Cystic acne is first and foremost caused by the genetic condition called retention hyperkeratosis- which means that your skin cells turn over 5 times the average rate of a normal functioning skin cell. Cystic acne is a kind of inflammatory acne that is triggered by factors such as hormones, stress, acne triggering foods and gut imbalance. These triggers cause inflammation and bacteria, sebum (skin oil), and dead skin cells are trapped in the pores . 

For example, hormonal imbalances, such as those caused by certain types of birth control or onset of high stress, can increase sebum production and contribute to clogged pores, increasing the risk of cystic acne. 

Additionally, stress can trigger cystic acne flare-ups, and certain medications may worsen existing cystic acne, for example thyroid medications which are high in iodine.

Cystic acne is characterized by large, painful bumps on the face, chest, back, and upper arms. The most common symptoms of cystic acne include painful, deep red lesions that can be filled with pus or fluid.

In some cases, the lesions may form a head (a white cap that forms on the top of the lesion) if they are near the surface of the skin. While less common, other signs and symptoms may include persistent itching, discoloration, and burning around the affected area.

The most effective way to treat cystic acne is to prevent it from developing in the first place. This can be done by avoiding any triggers, such as hormonal imbalances, stress, or certain products. 

However, if a flare-up does occur, it is vital to seek help right away. Natural Skincare & Acne Clinic offers their award winning Holistic Acne Program that has clear 1,000’s from active acne.. We will help you in numerous ways, such as recommending products and treatments, advise you on diet, and a proven skincare routine.

Why Is Cystic Acne More Prone To Leaving Scars?

All types of acne can cause scarring, particularly if the acne is severe. However, compared to other types of acne, cystic acne, in particular, is known for leaving scars due to its deep and wide lesions. Cystic acne affects the deeper layers of tissue. This damage can disrupt the natural healing process in the skin, resulting in scarring and discoloration. 

The size and depth of the lesions can also contribute to the risk of scarring. For example, large, deep cystic acne lesions are more likely to cause scarring, as they cause more damage to the dermis (the inner layer of skin). Additionally, cystic acne lesions can cause a large amount of pus to build up, leading to further damage and scarring.

Types Of Scars Caused By Cystic Acne

Not only is cystic acne more likely to lead to severe scarring than other types of acne, but it can also leave behind several different types of scars on the skin. The following are the main types of scars left behind by cystic acne:

Ice Pick Scars

Ice pick scars are small, deep, pitted scars that look like an ice pick caused them. They form when the inflammation caused by acne results in a loss of collagen, which is a protein that keeps your skin firm and elastic and is necessary for the skin to heal. As a result, the overlying skin will collapse, causing a narrow depression in the skin.

Rolling Scars

Rolling scars are wide, shallow depressions in the skin that give it a rolling or “wave-like” appearance. They are typically caused when bands of scar tissue form underneath the skin. Rolling scars are usually found on the face, chest, and back.

Boxcar Scars

Boxcar scars are known for their round or oval depressions and sharp edges, giving them a box-like appearance. When a cyst develops beneath the skin, it will destroy the surrounding fat. As a result, once the acne disappears, the loss of fat in that area causes indentation. 

The depression left behind has hidden scar tissue that pulls the scar downward, thereby leading to boxcar scars. Boxcar scars tend to form in the lower cheeks and jaw.

Keloid Scars

Keloid scars are raised, reddish-purple lesions that form when the body produces too much collagen in an attempt to heal a wound. They are more common on the chest and back but can also develop on the face. 

Keloids may not appear until several months after the initial cystic acne has cleared and they can continue to grow even after the skin has healed. They are more likely to form in those with darker skin tones.

Treatment For Cystic Acne Scars 

Proactively treating and preventing breakouts helps safeguard from scaring, but it can only take you so far. Even if you do everything you can to clear your acne, it can still cause long-term scarring. Fortunately, there are plenty of treatment options that can help you remove acne scars. The following are some of the available solutions:

Acne Scar Surgery

For more severe scarring, surgery might be recommended. Although invasive, acne scar surgeries tend to be minor procedures that can be done in-office while the patient is conscious (but under local anesthesia). However, it’s important to note that, like all surgical procedures, there’s always a risk of complications, such as infection. 

That being said, there are several types of surgeries available for acne. For example, punch excision is a surgery that involves removing the scarred area and stitching the surrounding skin together. Another of the more common and effective types of surgical procedure is acne scarring subcision.

Acne Scarring Subcision

Acne scarring subcision is a type of surgery performed on depressed scars, such as ice pick scars, boxcar scars, and rolling scars. During the procedure, a needle is used to break up the fibrous tissue that is responsible for the scarring. 

As a result, the scar tissue is released, allowing the skin to be filled in with the body’s natural collagen production. It’s a quick and safe procedure that can improve the texture and appearance of scars.

Laser Skin Resurfacing

Laser skin resurfacing, ie Fractional CO2, is another treatment option for cystic acne scars. It can be helpful for those with shallow scars and is also sometimes used to remove other skin blemishes, like age spots and wrinkles. There are two kinds of laser skin resurfacing treatments: ablative and non-ablative. 

Ablative lasers remove the epidermis (top layer of skin). The clinician heats the deeper layers of the skin, thereby promoting the growth of collagen to improve skin firmness and texture. As the epidermis regrows, it will become smoother and tighter than before.

Non-ablative laser skin resurfacing is less aggressive but can also stimulate collagen growth. Although the recovery time is shorter, it does not provide the same level of results as ablative laser treatments and is more suitable for those with mild scarring.


Microneedling is another treatment option for those with shallow scars. It involves using tiny needles to puncture the scar. By creating “controlled wounds,” microneedling helps stimulate the skin to break down the existing scar tissue, heal the area, and produce more collagen, making the skin tighter and smoother. 

It’s a minimally invasive procedure with little to no side effects. At worst, it can cause a little redness and swelling, which will typically resolve within a day or two.

The Most Innovative Treatments For Cystic Acne At Natural Skincare Clinic

Here at the Natural Skincare & Acne Clinic, we treat cystic acne scarring using two of the most effective, medically proven treatment solutions: Fractional CO2 and microneedling.

Fractional CO2

Fractional CO2 is a type of laser resurfacing treatment used for various purposes, including reducing cystic acne scarring, wrinkles, age spots, sun damage, and other skin blemishes. It involves using a carbon dioxide (CO2) laser to remove the outer layer of damaged skin, which can then be replaced by new and healthy skin. 

The Fractional CO2 laser is precise and can target the specific area of scarring while also treating the surrounding skin to promote collagen growth and healing. The procedure only takes -30 to -45 minutes, is safer than other types of laser treatments, and results in less downtime (meaning, it takes less time to fully recover afterward).


Microneedling is considered one of the safest and most effective options available for treating cystic acne scarring. Because it helps stimulate collagen production, microneedling is especially effective on depressed cystic acne scars. In addition to removing acne scars, it’s also an effective treatment option for sun damage, melasma, surgical scars, burn scars, and more. 

Although there are some minor side effects, such as redness and inflammation, these typically clear up after a day or two. At Natural Skincare & Acne Clinic, we recommend at least four to eight microneedling sessions, with one every four to six weeks, for optimal results.

Treat Your Acne Scars. Get Expert Guidance For Your Skin.

Cystic acne scars can cause both physical and emotional distress. It can be a difficult journey to find the proper treatment solution that works best for your skin. At the Natural Skincare & Acne Clinic, we specialize in providing expert guidance and personalized treatment plans to help patients reduce their acne scars and achieve healthier, smoother skin. 

Our experienced practitioners use the most innovative treatments available, including Fractional CO2 laser treatment and microneedling, to target scarring on any skin type. Our goal is to help you restore your confidence and reclaim your skin health.

Looking for the best treatment for your acne scars? Let’s discuss your needs.

About the Author

Jessica has been a Medical Esthetician, Certified Acne Specialist and Healing Diets Coach since 2003. After struggling with acne for more than a decade, she became determined to find a way to clear acne without pharmaceuticals for herself and eventually, future clients. Today, she offers a complete acne regimen that combines proven non-comedogenic skincare products, natural supplements, lifestyle coaching, and support from trained acne specialists to achieve lifelong clear skin. She and her staff serve locally at Natural Acne Clinic in Wheat Ridge, Colorado and nationally via NAC’s Online Acne Program.

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