Acne marks are flat color changes without texture change, while true acne scars create dents or raised tissue from collagen damage. Marks often fade over months with protection and topicals, but scars rarely resolve alone and usually need procedures that rebuild collagen.
Post-inflammatory hyperpigmentation (PIH) means dark spots from excess melanin after inflammation. Post-inflammatory erythema (PIE) means pink or red marks from dilated vessels during healing. According to AEDIT, that flat-versus-textured difference decides what needs treatment AEDIT's acne scar guide.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- What do marks and scars look like?
- How can you check texture at home?
- What helps flat marks fade?
- What treats indented or raised scars?
What do marks and scars look like?
PIH appears as brown, grey or dark spots. PIE appears as pink, red or purple marks. Both sit flat with the skin surface. True atrophic scars form dents with three shapes.
According to Dermatology Times, they include narrow deep icepick scars, broad sharp-edged boxcar scars, and wide wavy rolling scars from fibrous tethering Dermatology Times scar review. Raised hypertrophic and keloid scars form bumps instead. Color alone does not prove a scar. A dark or red spot can still be a flat mark. A skin-colored dent can still be a true scar.
How can you check texture at home?
Wash hands, use good light, and feel the spot with a clean fingertip. Look from the side as well as straight on. Flat marks stay flat from every angle. Try the stretch test.
Flat PIH or PIE does not change shape when nearby skin is gently stretched. Dents may look deeper when stretched, while raised bumps stay raised. Do not press hard, scratch, or pick during the check. Picking prolongs healing and can darken marks. If texture is unclear, ask a dermatologist rather than guessing.
What helps flat marks fade?
Daily sunscreen and not picking matter most. Sun protection limits further darkening while healing continues.
Early control of new breakouts also reduces new marks. Topical care may include: According to WebMD, red PIE may also respond to vascular laser in addition to sunscreen and gentle topical care WebMD PIE overview. Expect gradual fading over months, not days.
- sunscreen every morning, reapplied for longer sun exposure
- no picking, squeezing, or harsh scrubbing
- azelaic acid, niacinamide, vitamin C, or retinoids as directed
- vascular laser for persistent red PIE, done by a professional
What treats indented or raised scars?
Depressed scars are treated with fractional lasers, microneedling, chemical peels, fillers, subcision, or excision. According to a 2023 PubMed evidence review, the strongest support is for lasers and microneedling PubMed review of atrophic scarring. Raised scars need different treatment, so correct typing matters. A dermatologist matches the method to scar type, depth, and skin tone.
Icepick, boxcar, and rolling scars often need different tools. Combination treatment is common for mixed scarring. People with Fitzpatrick skin types III-VI develop PIH more often. They also face higher risk that lasers or inflammation worsen pigmentation. For these skin types, sun protection and early inflammation control matter most, and any energy procedure needs careful planning.