Acne Scars

Acne scars are external exhibits of damage that one or more types of acne can leave on the skin. Doctors find it easy to treat some types of scars, but other types are more difficult to treat successfully.

Last Modified: September 5, 2023
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What Are Acne Scars?

Acne scars may develop as a complication of acne. Acne scars can be small and shallow bumps or ridges. Scars can also become deeper, larger and more difficult to heal such as pits and pockmarks.

About 80% of people between the ages of 11 and 30 deal with acne. Of that group, 95% experience at least minor acne scarring.

Types of Acne Scarring

The three types of acne scarring include atrophic, hypertrophic and keloid. Each type varies depending upon the cause. How effective treatment is depends upon the type.

  • Atrophic: Atrophic acne scars can appear sunken or flat and look like holes in your skin. An inflammatory process leading to collagen fiber dilapidation likely causes this type of scarring. These are the most common.
  • Hypertrophic: Hypertrophic acne scars appear as raised lumps at the site of the acne because of scar tissue build-up. These scars are the same size as the acne that caused them. They’re common on the shoulders, jawline, back and chest.
  • Keloid: Keloid acne scars form because of an overgrowth of scar tissue and tend to be bigger than the acne that caused it. These scars are thick, raised and lumpy.

Scars result from severe acne and can form after popping the pimple or removing a mole. Three are three types of scars: boxcar, ice pick and rolling.

Boxcar Scars

Boxcar scars are rounded or oval dents in your skin. They can appear dark brown or red, but sometimes they have the same skin pigmentation as your skin.

Researchers don’t know why some people get boxcar scars while others don’t. Doctors primarily associate them with cystic acne or a nodule. Cystic acne is painful, and when it heals, your skin may not replace lost collagen. It’s the collagen that makes the skin look filled out, so the absence of it leads to the skin depressions.

Ice Pick Scars

Ice pick acne scars have a pitted, or sunken, appearance. Your skin will look as if a small ice pick has punctured it, hence the name of this type of scarring.

Ice pick scars appear after acne goes away, and they look like tiny craters over your cheeks. They are narrow and deep and measure less than 2mm wide.

When an acne outbreak damages your skin, the body will try to produce collagen to speed up the repair. But when the body produces too little collagen, ice pick scars develop, leaving behind depressions or pits.

Rolling Scars

Rolling scars develop because of dermal tethering and give your skin an uneven rolling appearance. They’re about 4 to 5 mm wide and provide an undulating skin look. They are among the easiest scars to treat and manage.

Treating post-acne scars is a therapeutic challenge that requires a combination of techniques. The deeper the acne, the more challenging the healing process. Successful treatment of rolling scars depends on your age, your reaction to medications and therapies and your overall health.

What Causes Acne Scars?

Acne scars are caused by the severity of skin inflammation, which can be traced to genetic predisposition or untreated acne. Popping and picking blemishes also account for significant acne scars. The brown and red marks are not harmful to your physical health, but they can affect self-esteem.

For some people, scarring is genetic. There are families with a genetic predisposition to scarring, pointing to hereditary nature. See a dermatologist for acne treatment, especially if your family has a history of struggling with scarring or post-inflammatory hyperpigmentation.

Risk Factors for Acne Scars

A risk factor for acne scars is significant skin inflammation. The risk of developing scars increases when collagen production malfunctions. The risk of scarring is greater in cases of cystic acne than comedonal acne.

Risk factors include:
  • Genetics: Acne and scarring often runs in families. Although there’s no one gene specifically responsible for acne, research shows that genetics play a role. Genetics can determine how your immune system fights acne.
  • Untreated inflammatory acne: Inflammatory acne occurs deeper in the skin, and it can cause permanent scarring. Inflamed acne affects children, teens and adults. While there is no cure, early acne treatment can help prevent scarring.
  • Pimple popping: Popping pimples can force debris deeper into the follicle. As a result, the follicle wall can rupture and spill the infected material into the dermis. This can cause more inflammation, increased swelling and redness. Dermatologists advise against popping any pimples.

Scars may take time to heal, and treatment of acne scars may not start until the acne clears. Consult a dermatologist for the best plan for you.

Acne Scars vs. Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation (PIH) is a broad term referring to spots on the skin caused by irritation or damage to the skin cells. This skin condition can show up as brown, tan or dark brown patches on your skin. Eczema, impetigo or acne can cause it, but any skin irritation can lead to PIH.

Acne scarring, however, is a change in your skin texture. For PIH, the texture remains the same. Seek medical help to treat your acne as early as possible.

Acne Scars vs. Skin Cancer

Sometimes people mistake skin cancer for acne and acne scars. Basal cell carcinoma can sometimes look like pimples. In the early stages of skin cancer, you might see tiny bumps or spots on the skin.

If skin cancer bumps are scratched, picked or otherwise opened, they may appear like a popped pimple. But unlike acne, these cancerous sores will return to the same spot bigger and more painful.

If you are at risk of skin cancer or suspect sores or scars may be more serious than acne or acne scars, a dermatologist can examine your skin and properly diagnose your condition. It’s imperative that skin cancer be treated as soon as possible.

When Should You See a Doctor for Acne Scars?

Treating acne scars starts with treating acne. Consult a dermatologist if you have severe acne and over-the-county treatments have not worked. Stubborn breakouts can persist even with the best skincare routine. Treatments are available for acne scarring including microneedling, chemical peels, laser resurfacing and more.

If you’re unsure if your acne scars may be connected to a more serious health condition, it’s important to see a dermatologist as soon as possible.

Please seek the advice of a medical professional before making health care decisions.