Acne scars: Signs and symptoms

How do you get acne scars?

These scars appear after a pimple or other acne breakout clears. Acne scars are more likely to develop when you have a deep breakout like a cyst or nodule. Picking or scratching at an acne breakout can also damage your skin and cause scarring.

Are there different types of acne scars?

Yes. These scars come in different shapes and sizes. The following describes the different types of acne scars that develop.

Depressed acne scars

When acne clears, your skin heals by making collagen. If your skin makes too little collagen to fill the area where the acne was, a depressed scar appears.

Most people who get acne scars develop depressed acne scars and often develop more than one type of depressed acne scar. Here are the different types of depressed scars that can form.

Ice pick scars

This is the most common type of acne scar. It looks small but goes deep into the skin.

Rolling scars

This type of scar is wide and shallow. When someone has many rolling scars, the skin can have a rolling or wavy appearance.

Boxcar scars

These scars cause a round or oval-shaped depression in the skin. They are wider than ice pick scars but not as wide as rolling scars.

Raised acne scars

If your skin makes too much collagen when healing after a breakout, you develop raised scars. This type of acne scar is more common in people who have darker skin tones.

There are three types of raised acne scars.

Hypertrophic scar

This raised scar feels firm. It usually develops on the jaw line or areas of the trunk like the chest or back. You’re likely to see this scar appear 1 to 2 months after an acne breakout clears.

Keloid

It takes time for this raised scar, which grows larger than the acne breakout, to appear. The first sign is thickening skin, which usually begins 3 to 12 months after the acne clears. Sometimes, keloids take longer to appear. If you notice thickening skin, wearing a pressure garment can prevent (or reduce the size of) a keloid.

Papular scar

The raised bumps on this man’s nose are papular acne scars. This type of scar is skin colored or lighter than the person’s natural skin tone. It usually develops on the nose, chin, jawline, or back and can be mistaken for acne.

Flat spots can appear after acne clears

When a pimple or other acne breakout clears, you may see a flat, pigmented spot where you had the acne. These flat spots are usually not scars. A common type of flat spot that’s not a scar is called post-inflammatory hyperpigmentation (PIH).

The color of PIH tends to vary with your skin tone.If you have a lighter skin tone, this spot is usually red or pink. People who have a medium or darker skin tone often see a spot that is brown, but it can be bluish gray.

Post-inflammatory hyperpigmentation (PIH)

Appearing after acne clears, these flat spots are not scars. PIH usually fades over time. Treatment can clear the spots more quickly.

Some people develop flat spots that are white, or lighter than their skin tone. Doctors call this hypopigmentation. These spots also aren’t scars either.

Unlike scars, these flat spots usually fade, leaving no trace. Fading can take time.

If the discoloration bothers you, a board-certified dermatologist can recommend treatment to help these spots fade more quickly.

Acne scars can by itchy or painful

You may notice that a scar itches or feels painful. This is more likely to occur if you have a raised scar.

Some people are more likely than others to develop acne scars. To see if you have an increased risk, go to Acne scars: Causes.

Images

• Images 1,2,4,5,7,8: Reproduced with permission from ©DermNet www.dermnetnz.org 2023.

• Image 3: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2010;63:274-83.)

• Image 6: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2021;84:e259-60).

References
Gan S, Graber E.“Papular scars: An addition to the acne scar classification scheme with an exemplary case report.” Presented at: American Academy of Dermatology Annual Meeting 2014; March 21 - 25, 2014; Denver, Colorado. Poster P8043. J Am Acad Dermatol. 2014;5(suppl 1):AB9. [Commercial support: None identified.]

Heath CR, Gathers RC, et al. “Postinflammatory hyperpigmentation/periorbital hyperpigmentation.” In: Taylor and Kelly’s Dermatology for Skin of Color. (second edition). McGraw Hill, USA, 2016:360-2.

Jennings T, McLarney M, et al. “Acne scarring-pathophysiology, diagnosis, prevention and education – Part 1.” J Am Acad Dermatol (2022) [journal pre-proof].

Leung AK, Barankin B, et al. “Dermatology: How to manage acne vulgaris.” Drugs Context. 2021 Oct 11;10:2021-8-6.

Patra S, Kaur M, et al. “Intralesional radiofrequency with a thin hypodermic needle in the management of papular acne scars.” J Am Acad Dermatol. 2021 Jun;84(6):e259-e260.

Waibel JS, Waibel H, et al. “Scar therapy of skin.” Facial Plast Surg Clin North Am. 2023 Nov;31(4):453-62.

Written by:
Paula Ludmann, MS

Reviewed by:
Kesha Buster, MD, FAAD
Sandy Marchese Johnson, MD, FAAD
Desmond Shipp, MD, FAAD

Last updated: 12/8/23