Acne scars form when severe inflammation from acne damages the deeper layers of your skin, leading to an abnormal healing process where the body produces too much or too little collagen. This damage disrupts the skin’s normal repair, leaving behind dents, raised areas, or uneven texture that do not fade on their own.
The main trigger is inflammation from types of acne like cysts, pustules, or nodules. These breakouts push deep into the dermis, the skin’s middle layer, where they harm collagen and elastin, the proteins that keep skin firm and smooth.[1][2][3][4] When the skin tries to heal, it often gets the collagen amount wrong. Too little collagen results in indented scars, while too much leads to raised ones.[1][2][3][8]
Picking or squeezing pimples makes things worse. This action drives bacteria and pus deeper into the skin, ramps up inflammation, and destroys more tissue, raising the chance of permanent marks.[1][9] Leaving acne untreated for too long has a similar effect. Ongoing inflammation eats away at more skin structure before healing can start.[1][2]
Your genes play a role too. Some people inherit a tendency for strong inflammatory responses or poor healing, making scars more likely if family members have had bad acne.[2][3] In adults, scars form easier because skin heals slower. Age cuts collagen production, cell turnover lags, and past sun damage weakens the skin’s repair power.[5][7][8]
Sun exposure adds to the problem. UV rays boost pigment in dark spots after acne and break down collagen, slowing recovery and making scars last longer.[3][5] Other factors like stress, poor sleep, pollution, or certain medicines can heighten inflammation and impair healing in adults.[5]
Not all marks after acne are true scars. Red or pink spots come from broken blood vessels, not collagen loss, and dark spots happen from extra melanin. These fade over time but can worsen with sun or irritation.[2][3]
Indented scars, the most common type, include ice pick scars that look like deep narrow pits from follicle damage, boxcar scars with sharp edges from big collagen loss, and rolling scars from bands of tissue pulling skin down into waves.[1][3][8] Raised scars grow from excess collagen but are less common.
Sources
https://syraaesthetics.com/treatments/acne-scar-treatment-nyc/
https://sozoclinic.sg/acne-scars/
https://www.kins-clinic.com/blogs/what-are-the-main-acne-scar-types-a-skin-friendly-guide-with-treatment-options
https://elosklinik.com/en/sivilce-tedavisi/sivilce-cukurlari-nasil-gecer/
https://www.london-dermatology-centre.co.uk/blog/adult-acne-scarring/
https://www.oreateai.com/blog/the-journey-of-acne-scars-understanding-their-formation/2680dcb2bfbfb7caed166aeace40ddc4
https://glojasaesthetic.com/skin-blog/reasons-acne-scars-persist/
https://labelleviemedicalcare.com/acne-scar-repair-treatment/
https://shi.org/acne-scars/fillers-and-filler-injections/
