How can you tell the difference?
Look at whether the area is flat, sunken or raised, rather than judging by color alone. Scars can also be pink, red, brown or darker than surrounding skin. The word 'mark' is doing a lot of unpaid work here: a flat patch of color and a dent are different problems.14
| What remains after acne | What it looks like | What to expect |
|---|---|---|
| Dark mark | A flat patch darker than surrounding skin, called postinflammatory hyperpigmentation, or PIH | Often fades after the cause is controlled |
| Depressed scar | An indentation: a deep ice pick hole, a sharply edged boxcar dent or a rolling dip | Rarely disappears completely on its own |
| Raised scar | Firm scar tissue above the surrounding surface | A hypertrophic scar stays within the original wound; a keloid grows beyond it |
Flat red marks can also remain after acne. Redness, dark pigmentation and scarring are not interchangeable descriptions, and you can have pigmentation and scars together. A new scar can be discolored as well as indented or raised; the color usually fades over time, but the scar remains.167
Why does acne leave different kinds of marks?
Dark marks develop when inflammation triggers extra melanin, the pigment that gives skin its color. This is particularly relevant in medium to dark skin tones. Scars develop during repair of inflamed acne: lost tissue leaves an indentation, while too much collagen, the skin's repair tissue, creates a raised scar. Not every breakout causes scarring.123
Will they go away on their own?
Once the cause is stopped, a dark spot a few shades darker than your usual skin color typically fades within 6 to 12 months. Deeper pigmentation can take years and often looks slate blue, gray or much darker brown. Acne scars can fade, but rarely disappear completely without treatment. Hypertrophic scars usually flatten over time; keloids usually do not.34
What should you do about flat dark marks?
- Treat ongoing acne first so new breakouts do not keep creating marks.
- Before going outside, apply tinted sunscreen containing iron oxide, with SPF 30 or higher, broad spectrum protection and water resistance. Reapply every two hours outdoors and after swimming or sweating.
- A dark spot product containing azelaic acid, glycolic acid, kojic acid, a retinoid or vitamin C can help fade pigmentation.
- Use gentle skincare and stop a product if it burns or stings. Irritation can create more dark spots.
What helps dents or raised scars?
A dermatologist can identify the scar type and match treatment to its shape and location. Options include laser resurfacing, chemical peels and microneedling; fillers can lift depressed scars, while steroid injections can flatten raised scars. More than one procedure or repeated sessions can be needed. Control active acne before starting scar procedures, because acne treatments and scar treatments can interfere with each other.2
Skin camouflage can disguise color but cannot change texture, because pigment is not a building material.4
When should you get help?
Seek treatment early for deep, painful acne, particularly if a parent or sibling has acne scars. Avoid picking, squeezing or scratching breakouts: these increase inflammation, scarring, infection and discoloration. See a dermatologist if dark spot treatment is not helping or you want to improve persistent texture changes. See a doctor for a suspected keloid that bothers you, grows beyond the original breakout, or becomes itchy or painful; early treatment can help limit growth.135
Where this answer comes from
- 1Acne scars: Overviewaad.org
- 2Acne Scars: Causes, Diagnosis, Types & Treatmentmy.clevelandclinic.org
- 3How to fade dark spots in darker skin tonesaad.org
- 4Scar Management Servicebwc.nhs.uk
- 5Keloid scarsnhs.uk
- 6Acne Management Guidelines by the Dermatological Society of Singaporepmc.ncbi.nlm.nih.gov
- 7Acne Scarring Imagesdermnetnz.org
