Acne Scars and Marks
Most of what people call scarring is not scarring. How to tell in one second with your eyes shut, and why that changes everything you should do next.
Part of the Complete Acne Guide.
Key fact: Most of what people call acne scarring is not scarring. Flat brown or red marks are pigment and blood vessels, and they fade on their own — slowly. A true scar is a change in the texture of the skin, and that does not fade.
Marks are not scars
This distinction changes what you should do, and almost nobody is told it. Run a finger over the area with your eyes shut.
Flat to the touch
It is a mark — pigment or dilated blood vessels left behind after the inflammation settled. The skin's structure is intact. It will fade, over months, and there are things that speed it up.
You can feel a dip or a raised area
It is a scar — collagen was lost or overproduced while the spot was healing. The structure has changed. It will not fade, and treating it means resurfacing or rebuilding.
The overwhelming majority of what worries people after acne is the first kind. That is good news, and it also explains why creams marketed for scars sometimes appear to work: they were applied to marks that were going to fade anyway.
Brown marks
Post-inflammatory hyperpigmentation is a flat brown, grey or black mark left where a spot has healed. It happens when inflammation stimulates pigment-producing cells, and it is considerably more common and more persistent in darker skin tones — often the main reason someone seeks treatment, ahead of the acne itself.
Left alone, it fades over three to twenty-four months. Two things speed it up and one thing dramatically slows it down.
- Treat the acne. Every new spot creates a new mark. Nothing fades faster than the marks of someone who has stopped producing them.
- Sunscreen, daily, all year. Ultraviolet light drives the same pigment cells that produced the mark. This is the single most effective thing available and it is free of side effects.
- Do not pick. Picking extends the inflammation, which deepens the pigment and prolongs it.
Azelaic acid and topical retinoids both act on pigmentation as well as on acne, which makes them a sensible choice when marks are the main concern — our azelaic acid guide covers the detail.
Red and purple marks
Post-inflammatory erythema is a flat pink, red or purple mark, and it is dilated blood vessels rather than pigment. It is more visible on lighter skin and it behaves slightly differently: it blanches if you press it, and it tends to fade faster than brown pigment, usually over three to six months.
Sunscreen helps here too, and time does most of the work. Aggressive treatment of a red mark is generally unnecessary and risks producing the inflammation that caused it.
The three true scar types
Atrophic scars — where tissue was lost — account for the great majority of acne scarring, and they come in three shapes. Most people have a mixture, which matters because they respond to different things.
| Type | What it looks like | Responds best to |
|---|---|---|
| Ice pick | Narrow, deep, steep-sided pits, as though the skin had been pricked. Often on the cheeks | The hardest to treat. Targeted techniques rather than general resurfacing |
| Boxcar | Wider depressions with sharp, defined edges, like a shallow crater | Resurfacing and filling approaches |
| Rolling | Broad, shallow undulations that give the skin a wavy surface; most visible in raking light | Releasing the tethering beneath, plus collagen stimulation |
Less commonly, acne heals with raised scars — hypertrophic or keloid — where too much collagen is laid down. These occur most often on the chest, shoulders and back, and are covered alongside the other reasons those sites behave differently in our guide to back, chest and body acne.
What actually prevents scarring
This is the part worth acting on, because prevention is straightforward and treatment is not. Scarring is a consequence of how deep and how prolonged the inflammation was.
| Factor | Why it matters |
|---|---|
| Treating early | The strongest predictor of scarring is how long active inflammatory acne went untreated. Months of deep spots produce scars; the same acne treated promptly often does not |
| Treating deep acne properly | Nodules and cysts scar; surface whiteheads rarely do. Deep, painful lesions are the ones that justify escalating treatment rather than waiting |
| Not picking or squeezing | Forces inflammation deeper into the skin and widens the area of damage |
| Family history | A tendency to scar runs in families. If a parent or sibling scarred, treat your acne more assertively and earlier |
The case for not waiting. Acne is often left untreated because it is expected to pass. It usually does — but the scars it leaves do not, and no treatment for established scarring is as effective, as cheap or as painless as preventing it.
Why picking matters more than anything else
Almost everyone picks, and almost everyone knows they should not. It is worth being specific about what it does, because “don't pick” on its own has never stopped anyone.
A spot is a follicle whose contents are inflaming the surrounding tissue. Squeezing ruptures the follicle wall and pushes those contents sideways and downwards into the deeper layer of the skin, spreading inflammation into tissue that was uninvolved. A lesion that would have resolved in five days with a flat mark becomes a two-week lesion with a bigger mark and a real chance of a scar.
If picking has become compulsive — time lost to it, picking at skin that has no spots, distress afterwards — that is skin picking disorder, it is recognised and treatable, and it is worth mentioning to a clinician. It is far more common than people assume, and it is not a failure of willpower.
What treats what
| Problem | Where to start |
|---|---|
| Brown marks | Daily sunscreen, treating active acne, and a topical retinoid or azelaic acid |
| Red marks | Sunscreen and time. Usually needs nothing else |
| Rolling or boxcar scars | Clinic procedures — microneedling, resurfacing, subcision, fillers. Assessment first, because the mix of scar types determines what is worth doing |
| Ice pick scars | Specialist assessment. General resurfacing does little; targeted techniques are needed |
| Raised or keloid scars | Dermatology assessment. Treated quite differently from depressed scars, and easily made worse by the wrong approach |
| Still getting new spots | Treat the acne first. Scar treatment on active acne is premature and generally wasted |
That last row is the one that saves money. Procedures for scarring are typically done once the acne has been quiet for several months, because new lesions produce new scars and repeat the problem.
When to get advice
Speak to a clinician if you are getting deep, painful spots rather than surface ones; if marks are accumulating faster than they fade; if you can feel changes in skin texture developing; if there is a family history of scarring; or if picking has become difficult to control. Options are set out on our acne treatment page.
Frequently Asked Questions
Is my acne mark a scar?
Close your eyes and run a finger over it. If the skin feels flat, it is a mark — pigment or dilated blood vessels left behind after inflammation — and it will fade over months. If you can feel a dip, a pit or a raised area, the texture of the skin has changed and that is a true scar, which will not fade on its own. Most of what people call acne scarring is actually marks.
How long do brown marks from spots take to fade?
Post-inflammatory hyperpigmentation typically fades over three to twenty-four months, and it lasts longer in darker skin tones. Daily sunscreen makes the biggest difference, because ultraviolet light drives the same pigment cells that produced the mark. Treating the active acne matters just as much, since each new spot creates a new mark, and topical retinoids and azelaic acid act on pigmentation as well as on acne.
Does squeezing a spot really cause scars?
It substantially increases the risk. Squeezing ruptures the follicle wall and pushes inflammatory material sideways and downwards into deeper skin that was not previously involved. A spot that would have settled in a few days becomes a larger, longer-lasting lesion with a bigger mark and a real chance of leaving a scar. If picking has become compulsive, that is a recognised and treatable condition worth mentioning to a clinician.
Can acne scars be removed completely?
True scars can usually be improved substantially but not erased. Rolling and boxcar scars respond reasonably well to clinic procedures such as microneedling, resurfacing, subcision and fillers; ice pick scars are the most resistant and need targeted techniques rather than general resurfacing. Most people have a mixture of types, which is why assessment before treatment matters — the right approach depends on which you have.
Should I treat my scars or my acne first?
The acne, every time. Scar treatments are generally carried out once acne has been quiet for several months, because active spots produce new scars and repeat the problem. Treating scarring while acne is still inflammatory is premature and usually wasted money. Preventing scars by treating acne early is also far more effective than any treatment for established scarring.
References
- National Institute for Health and Care Excellence. Acne vulgaris: management (NG198). nice.org.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Acne vulgaris. cks.nice.org.uk
- NHS. Acne. nhs.uk
- British Association of Dermatologists. Patient information leaflets and isotretinoin guidance. bad.org.uk
- Medicines and Healthcare products Regulatory Agency. Isotretinoin: Pregnancy Prevention Programme and safety review. gov.uk
- DermNet. Acne and acneiform eruptions. dermnetnz.org
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Several acne treatments, including oral retinoids and the tetracycline antibiotics, must not be used in pregnancy or when there is any chance of becoming pregnant. Acne treatment takes weeks to months to work and a short-lived worsening at the start is common. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.