Acne scars form even without picking because deep inflammation from pimples damages the skin’s lower layers, leading to uneven collagen repair during healing.[1][2] When severe acne like cysts or nodules breaks out, it affects the dermis, the skin’s structural layer beneath the surface.[1][2][4] This damage triggers the body to produce collagen to fix the injury, but the process often goes wrong.[1][2][6]
In many cases, the skin makes too little collagen. This creates atrophic scars, which look like pits or depressions on the face.[1][2][4][7] Common types include ice pick scars that are narrow and deep like tiny holes, boxcar scars with sharp edges, and rolling scars that give a wavy texture.[1][2][4][7] These happen because the healed area loses tissue and cannot bounce back fully.[2][4]
Sometimes the skin overproduces collagen instead. This leads to raised hypertrophic scars that stay within the original spot or keloids that grow beyond it.[1][2] Either way, the imbalance comes from the inflammation itself, not from touching the pimple.[1][5][8]
Factors like how long the inflammation lasts play a big role. Deeper, longer-lasting breakouts cause more harm to collagen fibers.[1][3] Genetics, skin type, and repeated acne in the same spot can make healing uneven too.[1][3] For example, oily skin often has stronger inflammation from excess oil and bacteria, while dry skin heals slower with less collagen.[3]
Even flat dark spots after acne, called post-inflammatory hyperpigmentation, are not true scars but can look like them. These form from extra melanin during healing and last longer in darker skin tones.[2][3][4] Sun exposure can make them worse.[1]
Early treatment of active acne helps limit deep damage and reduces scar risk.[1][7] The skin’s natural repair just does not always match the injury perfectly.
Sources
https://heartaestheticshobart.com.au/skin-concerns/acne-scarring/
https://www.kins-clinic.com/blogs/acne-marks-or-acne-scars-understanding-the-difference-and-management-options
https://worldofasaya.com/blogs/skin-types/skin-type-acne-marks-what-you-must-know
https://drhaach.com/treatments/acne-scars/
https://urbanskinhairclinic.com/acne-scars/
https://labelleviemedicalcare.com/acne-scar-repair-treatment/
https://slmdskincare.com/blogs/learn/the-5-kinds-of-acne-scars-how-to-treat-each-type
https://rawbeautyaesthetics.com/education/how-do-you-get-rid-of-an-acne-scar/
https://glojasaesthetic.com/skin-blog/reasons-acne-scars-persist/
