Acne Scars
Lasting marks and texture changes left behind by acne
Quick Facts
- Type: Skin scarring
- Cause: Inflammation from acne damaging the skin
- Main types: Depressed (pitted), raised, and discoloration
- Best approach: Prevent by treating acne early
Overview
Acne scars are lasting changes in the skin that remain after acne lesions heal. When a pimple or deeper cyst becomes inflamed, it can damage the skin and the tissue beneath it. As the body repairs the damage, it may produce too little or too much collagen, leaving an uneven texture or a mark that does not fully fade. Acne scars most often affect the face but can also appear on the back, chest, and shoulders.
It is helpful to separate true scars from temporary marks. Many people develop flat red, brown, or dark spots after a breakout; these are post-inflammatory discoloration and usually fade over months without treatment. True scars involve a change in the skin's texture, such as a pit or a raised bump, and tend to be permanent. While scars cannot always be erased completely, a range of treatments can make them noticeably less visible, and treating acne early is the best way to prevent them.
Types and Appearance
Acne scars vary in shape and color. The main types include:
- Atrophic (depressed) scars: Pits or depressions caused by loss of tissue. These include narrow, deep "ice pick" scars, wider "boxcar" scars with sharp edges, and shallow, sloping "rolling" scars.
- Hypertrophic and keloid scars: Raised, firm scars caused by too much collagen, more common on the chest, back, and shoulders.
- Post-inflammatory discoloration: Flat red, pink, brown, or dark marks left after a breakout; these are not true scars and usually fade over time.
Scars may feel rough or uneven to the touch and can affect a person's confidence, which is an important reason many people seek treatment.
Causes
Acne scars form when inflammation from acne damages the skin and the healing process is uneven. Key contributors include:
- Deep or severe acne: Cysts and nodules are far more likely to scar than small surface pimples.
- Inflammation: The more inflamed and prolonged a breakout, the greater the chance of scarring.
- Picking or squeezing: Popping or picking at pimples increases inflammation and tissue damage, making scars more likely.
- Delayed treatment: Acne that is left untreated for a long time has more opportunity to cause permanent damage.
During healing, the skin may lose collagen, producing a depressed scar, or overproduce it, producing a raised scar. Genetics also influence how a person's skin heals and how prone they are to scarring.
Risk Factors
- Severe, deep, or long-lasting acne, especially cystic acne
- Frequently picking, squeezing, or popping pimples
- Delayed or inadequate treatment of active acne
- A family history of acne scarring
- Inflammation that lasts a long time before the acne clears
Diagnosis
Acne scars are diagnosed by appearance, and no special tests are usually needed. A dermatologist will:
- Examine the skin to identify the type of scarring, since different scars respond to different treatments.
- Distinguish true scars from temporary discoloration, which often resolves on its own.
- Assess whether any active acne is still present, because that needs to be controlled first.
- Consider skin tone, since some treatments carry a higher risk of pigment changes in darker skin and must be chosen carefully.
Treatment
Treatment is tailored to the type and depth of scarring, and several approaches are often combined:
- Topical treatments: Retinoids and other creams can improve mild scarring and discoloration over time, and sunscreen helps dark marks fade and prevents them from worsening.
- Resurfacing procedures: Chemical peels, microneedling, and laser treatments stimulate new collagen and smooth uneven texture.
- Filling and lifting: Dermal fillers can temporarily plump depressed scars, while a technique called subcision releases tethered scars from below.
- Procedures for raised scars: Steroid injections, pressure therapy, or specialized treatments can flatten hypertrophic and keloid scars.
Results vary, and improvement is usually gradual and partial rather than complete. A dermatologist can recommend the safest, most effective plan for your skin type and scar pattern.
Prevention
- Treat acne early and consistently to limit inflammation and prevent deep lesions
- See a dermatologist for severe or cystic acne, which is most likely to scar
- Avoid picking, squeezing, or popping pimples
- Use sunscreen daily to keep dark marks from worsening
- Follow your prescribed acne routine even after the skin begins to clear
Because true scars are difficult to remove completely, preventing them by controlling acne is the most effective strategy.
When to See a Doctor
Consider seeing a dermatologist if:
- You have deep, cystic, or persistent acne that is not improving, to reduce the chance of scarring
- You already have scars that bother you and want to explore treatment options
- Marks left after breakouts are not fading or are getting worse
- Raised or keloid scars are growing, itching, or causing discomfort
Early professional care for active acne offers the best chance of preventing lasting scars.
Frequently Asked Questions
Are acne scars permanent?
True acne scars, which involve a change in skin texture such as pits or raised bumps, tend to be permanent. However, many post-acne marks are just temporary discoloration that fades over months, and treatments can make true scars much less noticeable.
What is the difference between an acne scar and a dark mark?
A dark or red mark left after a breakout is post-inflammatory discoloration, which is flat and usually fades on its own over time. A true scar involves a change in the skin's surface, such as a pit or a raised area, and generally does not disappear without treatment.
Does picking pimples cause scars?
Yes. Picking, squeezing, or popping pimples increases inflammation and damages the skin, making scarring more likely. Leaving breakouts alone and treating them properly helps prevent scars.
Can acne scars be removed completely?
Most treatments improve the appearance of scars rather than erase them entirely. Options such as laser resurfacing, microneedling, chemical peels, fillers, and subcision can produce noticeable improvement, and combining methods often works best.
How can I prevent acne scars?
Treat acne early and consistently, avoid picking at pimples, and see a dermatologist for severe or cystic acne, which is most likely to scar. Daily sunscreen also helps prevent dark marks from worsening.
References
- American Academy of Dermatology Association. Acne scars: Overview and treatment.
- Mayo Clinic. Acne — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Acne.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Acne.