When Acne Marks Turn Into Scars
Understanding the difference between acne marks and acne scars is important because they are two very different skin conditions that require different approaches to treatment. Many people use these terms interchangeably, but they are medically distinct and understanding the difference can help you set realistic expectations for your skin.
Acne marks are flat areas of discoloration that remain after an acne lesion has healed. These marks are either brown spots from post-inflammatory hyperpigmentation or red and pink areas from post-inflammatory erythema. If you run your finger gently over an acne mark, it will feel smooth and level with the surrounding skin because the skin’s surface texture has not changed. The mark is purely a color issue involving either melanin pigmentation or vascular changes in the skin.
Acne scars, by contrast, involve permanent structural changes to the skin’s texture and appearance. Scars develop when healing from deep inflammatory acne lesions such as cysts or nodules affects the dermis, which is the deeper structural layer of skin. Unlike marks, scars create visible depressions or raised areas on the skin’s surface. When you run your finger over a scar, you can feel the texture change because the skin’s physical structure has been altered.
The key factor that determines whether acne will leave marks or scars is how deep the inflammation goes. Shallow acne lesions typically heal without scarring and may only leave temporary marks. Deep inflammatory acne that damages the dermis is what creates scars. The severity of the acne breakout itself is not the main predictor of scarring. Instead, how your skin heals after the inflammation is what matters most.
Your skin’s healing ability depends on several factors. Teenagers often have aggressive breakouts but develop few scars because their skin has thicker, healthier collagen and a fast healing response. Adult skin heals differently. It has reduced collagen, slower cellular turnover, lower elasticity, more accumulated sun damage, and weaker structural support. These changes make it harder for the skin to recover fully after inflammation, which means adults are more susceptible to scarring even from smaller breakouts.
There are different types of acne scars. Boxcar scars are characterized by sharp, well-defined edges and a crater-like appearance. They form when inflammation destroys a block of collagen beneath the skin, leaving a noticeable depression. Hypertrophic scars are firm, raised areas of scar tissue that remain confined within the boundaries of the original acne lesion. Keloid scars grow beyond the original wound boundaries and expand into surrounding healthy tissue. Both hypertrophic and keloid scars reflect an overactive healing response with excessive collagen deposition.
Adult skin is more prone to developing boxcar scars because the dermis is thinner, providing less structural support. Inflammation in adult skin tends to penetrate deeper and last longer, which damages collagen more extensively. Collagen loss is more severe in adults because stronger or prolonged inflammation can break down larger areas of collagen, creating sharper and deeper scars. Additionally, the ability to rebuild tissue is weaker in adult skin because fibroblast activity is slower and collagen production is reduced.
The good news is that acne marks and acne scars respond differently to treatment. Acne marks are flat discolorations that may fade gradually over time, particularly with appropriate topical ingredients or professional treatments. Acne scars involve permanent structural changes to skin texture and typically require professional procedures for improvement. Understanding whether you have marks or scars will help you choose the right treatment approach and have realistic expectations about what can be achieved.
Your skin type also influences how likely you are to develop marks or scars and how they will appear. People with naturally higher melanin levels often experience darker, more persistent marks. Those with lighter skin tones may see red marks that fade more quickly. Oily skin types typically experience more intense inflammatory responses due to excess sebum mixing with bacteria, which can lead to deeper, more severe acne lesions. Dry skin often struggles with slower collagen synthesis, leading to longer healing times and potentially more visible scarring.
Sources
https://www.london-dermatology-centre.co.uk/blog/adult-acne-scarring/
https://worldofasaya.com/blogs/skin-types/skin-type-acne-marks-what-you-must-know
