Acne marks vs acne scars: what is the difference?

Key takeaways

• Marks are about colour. Scars are about texture. Run your finger over it: if it is flat, it is most likely a mark.
• In brown skin, most of what people call "acne scars" are actually dark marks (post-inflammatory hyperpigmentation).
• Marks often fade over six to twelve months with sun protection and the right creams. Deeper pigment takes longer.
• True scars rarely go away by themselves, but they can be improved with procedures.
• Many people have both, and the order of treatment matters.

How can I tell if it's a mark or a scar?

People come to me and say, "Doctor, I have acne scars." I'm happy to treat scars, but first I check, because very often they have marks, not scars. And the treatment is completely different.

Try this at home in good daylight: 1. Touch it. Close your eyes and run a fingertip over the spot. Flat means a mark. A dip or a bump means a scar. 2. Look from the side. Stand next to a window and turn your face. Scars cast small shadows. Marks do not. 3. Stretch the skin gently. Some shallow rolling scars soften when stretched. Colour stays the same. 4. Note the colour. Brown or dark grey flat patches are pigment. Pink or red flat patches are redness left by inflammation, more common in lighter skin.

Why does Indian skin get so many dark marks after pimples?

See, what happens is, brown skin has active pigment cells. When a pimple inflames the skin, those cells respond by making extra melanin, and that leaves a brown patch after the pimple is gone. Doctors call it post-inflammatory hyperpigmentation, or PIH. DermNet notes it is more common, more intense and often longer-lasting in darker skin.

The American Academy of Dermatology describes it simply: a flat patch of colour after acne clears is usually PIH, not a scar. It also says a spot a few shades darker than your skin usually fades within six to twelve months once the cause has stopped, while pigment deeper in the skin, which looks slate-grey or very dark brown, can take years.

Two things make marks last longer in Mumbai: daily sun on the commute and constant picking. Both keep switching the pigment back on. My article on dark marks after pimples goes into treatment in detail.

What types of acne scars are there?

True scars happen when inflammation damages the collagen layer underneath. DermNet describes these main types:

• Ice-pick scars. Narrow, deep, like a small puncture.
• Boxcar scars. Wider, round or oval dips with sharp edges.
• Rolling scars. Wide, gentle dips with sloping edges that make the skin look wavy. They often soften when the skin is stretched.
• Raised scars (hypertrophic and keloid). Firm bumps from too much collagen, more common on the jawline, chest and upper back.

Most people have a mixture. The type matters because each responds to a different procedure. For example, a 2024 Indian split-face study found rolling and boxcar scars responded better than ice-pick scars to both laser and microneedling.

Can I have both marks and scars at the same time?

Yes, and this is very common. A scar can have a brown mark sitting on top of it. DermNet calls these hybrid scars.

The order I follow is usually: 1. Control active acne first. There is no point treating scars while new pimples keep forming. DermNet also advises treating active acne before scar treatment. 2. Settle the pigment. Fade marks and get sun protection right. Treating a dark, inflamed face aggressively can create new pigment. 3. Then treat texture. Once the skin is calm, procedures for scars work better and carry less pigment risk.

Basically, I treat it like the endgame in chess. I decide where we need to end up, then work backwards, so each step makes the next one safer.

What helps marks, and what helps scars?

For marks - Broad-spectrum sunscreen every day, ideally a tinted one with iron oxide, which also protects against visible light - Prescription or over-the-counter ingredients such as azelaic acid, retinoids, vitamin C, glycolic acid or kojic acid, as advised - Superficial chemical peels in suitable skin - Time, and no picking

For scars - Laser resurfacing - Chemical peels, including focal peels for deep pits - Microneedling - Subcision for rolling scars - Fillers for some depressed scars - Punch techniques for deep ice-pick scars - Steroid injections and other options for raised scars

My article on acne scar treatments compares these in detail.

Why is prevention so important?

The American Academy of Dermatology says acne scars rarely disappear on their own and that the indent or raised texture usually stays, even when the colour fades. DermNet notes that treating inflamed acne early reduces the risk and severity of scarring, that picking and squeezing make scarring more likely, and that smoking is linked to worse scarring.

So my practical advice is: - Treat acne early, especially deep, painful, cystic spots. - Do not squeeze or pick, however tempting it is in the bathroom mirror. - Do not apply toothpaste, lemon or undiluted home remedies. Irritation adds pigment.

How we approach this at Dr Tvacha

At my centres in Thane, Andheri, Bandra and Dahisar, the first step is to separate marks from scars, under good light, and to check whether acne is still active. That decides the order of treatment. The Rs 499 skin consultation includes this assessment, and the plan, with fees, is written down before you pay. Treatments available at our centres include acne treatment, chemical peels, laser therapy and PRP. You can read about the Second Layer Skin Plan or find a centre near you.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.