Acne Scarring: Understanding the Different Types of Acne Scars

Acne Scarring: Understanding the Different Types of Acne Scars

For many people, acne doesn't simply end when the spots disappear. In some cases, acne leaves lasting changes in the skin's texture known as acne scars. Unlike the flat red or dark marks that often fade over time, true acne scars involve permanent structural changes within the skin.

Understanding the different types of acne scars is important because it helps explain what you're seeing in the mirror, why scars develop and why preventing them while acne is still active is one of the most important parts of acne management.

What is an acne scar?

A true acne scar is a lasting change to the skin's texture caused by inflammation damaging the deeper layers of the skin during the healing process.

Unlike Post-Inflammatory Hyperpigmentation (PIH) or Post-Inflammatory Erythema (PIE), which are flat colour changes, acne scars affect the structure of the skin itself.

Scars may appear as:

  • Small pits.
  • Depressions.
  • Indentations.
  • Raised areas.
  • Uneven skin texture.

Because they involve changes beneath the surface of the skin, they behave very differently from flat marks.

What's the difference between a scar and a mark?

This is one of the most common areas of confusion.

Acne marks

Acne marks are:

  • Flat.
  • Changes in colour only.
  • Brown, grey, red or pink.
  • Usually improve gradually over time.

Acne scars

Acne scars are:

  • Changes in texture.
  • Pits or depressions.
  • Raised areas.
  • Much longer-lasting.

Understanding this distinction is reassuring because many people who believe they have scarring are actually seeing flat marks that will continue to improve naturally.

What causes acne scarring?

Scars develop when inflammation extends deep into the skin.

As the body repairs damaged tissue, the healing process may not completely restore the skin's original structure.

The likelihood of scarring increases when acne is:

  • Deep.
  • Painful.
  • Cystic.
  • Nodular.
  • Left untreated for prolonged periods.

Picking or squeezing spots can also increase inflammation and significantly raise the risk of permanent scarring.

What are the different types of acne scars?

There are two main categories of acne scars.

Atrophic scars

These are the most common acne scars.

They develop when tissue is lost during healing, leaving small depressions in the skin.

This group includes:

  • Rolling scars.
  • Boxcar scars.
  • Ice-pick scars.

Each has its own appearance and characteristics, which are explained in more detail in our dedicated guide.

Raised scars

Raised scars occur when the skin produces too much collagen during healing.

These include:

  • Hypertrophic scars.
  • Keloid scars.

They appear as firm raised areas above the surface of the skin and are more commonly found on the:

  • Chest.
  • Back.
  • Jawline.
  • Shoulders.

Not everyone develops raised scars, and they are considerably less common than pitted scars following acne.

Why does identifying the scar type matter?

Different scar types develop for different reasons and affect the skin in different ways.

Recognising the type of scarring helps provide realistic expectations about your skin and ensures discussions about treatment are based on the correct diagnosis.

Perhaps more importantly, identifying early scarring is a reminder that active acne should be managed promptly.

The earlier inflammatory acne is brought under control, the lower the risk of additional scars developing.

Can acne scarring be prevented?

While not every scar can be prevented, the risk can often be reduced by:

  • Treating inflammatory acne early.
  • Avoiding picking or squeezing spots.
  • Following a consistent skincare routine.
  • Seeking assessment if acne is deep, painful or beginning to scar.

Preventing scars while acne is active is far more effective than trying to improve established scars later.

Frequently Asked Questions

What is the difference between an acne mark and an acne scar?

Acne marks are flat colour changes that usually fade with time. Acne scars involve permanent changes in skin texture, such as pits or raised areas.

Are acne scars permanent?

Acne scars are generally long-lasting because they involve structural changes within the skin. This is why preventing scars during active acne is so important.

What are the main types of acne scars?

The main types include atrophic (pitted) scars and raised scars. Atrophic scars include rolling, boxcar and ice-pick scars.

Why do some people scar while others don't?

Scarring depends on several factors, including the severity of inflammation, genetics, skin healing and whether acne is picked or squeezed.

When should I seek professional assessment?

If you notice changes in skin texture, deep acne or early signs of scarring, early assessment is worthwhile to reduce the risk of further permanent scars.

Reviewed by Dr Tara Treacy, GP with a special interest in dermatology (IMC 411337).

Last reviewed: 16/07/2026.

General information only. It does not replace an individual medical assessment.