Atrophic acne scars are sunken or indented marks on the skin that form when the body does not produce enough collagen to fully repair damage from severe acne.[1][2][6] These depressed scars happen because inflammation from deep acne lesions destroys collagen and tissue in the skin’s deeper layers, leaving pits or dips that sit below the normal skin level.[1][4][5]
Unlike raised scars, which come from too much collagen, atrophic scars result from a shortage of this key protein during healing.[1][2][4] The skin tries to fix itself after acne breaks the pore wall and spills bacteria and oil into surrounding areas, but fibroblasts, the cells that make collagen, do not work well enough.[1][6] This leads to thin, weak skin that cannot bounce back.
There are three main types of atrophic acne scars. Ice pick scars are narrow, deep holes that look like they were poked by an ice pick; they often form from cystic acne.[1][2] Boxcar scars are wider pits with sharp edges, like shallow craters.[2] Rolling scars create wavy, uneven skin because fibrous bands pull the surface down toward deeper layers.[1][2][4]
Severe acne is the top cause, especially cystic or nodular types that go deep into the skin.[1][2][3] Other triggers include chickenpox, injuries, or surgery where healing fails.[1] Factors like genetics, picking at pimples, delayed treatment, or thicker skin on the back and chest make scarring worse.[2][3] Smoking or alcohol can raise the risk too.[2]
These scars often show up on the face, like cheeks and jawline, but also on the back and chest where acne hits harder due to more oil glands and friction.[3][4] They can make skin feel rough and affect how people feel about their looks, but knowing what they mean is the first step to handling them.[1]
Sources
https://sozoclinic.sg/acne-scars/atrophic/
https://shi.org/acne-scars/fillers-and-filler-injections/
https://www.london-dermatology-centre.co.uk/blog/acne-scarring-back-chest-treatment/
https://www.kins-clinic.com/blogs/what-are-the-main-acne-scar-types-a-skin-friendly-guide-with-treatment-options
https://www.shumailas.com/conditions/acne-scars
https://www.michelegreenmd.com/laser-vs-microneedling-for-acne-scars
https://shi.org/injectable-scar-treatments/
https://eyelidcenterutah.com/ultraclear-acne-scarring/
