Acne Scars vs Dark Marks: Telling Them Apart

After acne heals, the skin can be left with two very different things. True scars change the skin's texture, leaving dips, pits or raised bumps. Marks are flat changes in colour, either red-purple or brown, with smooth skin underneath. Marks usually fade on their own over months, while scars tend to be lasting and are the ones that may benefit from in-clinic treatment. Knowing which you have saves time, money and frustration.

A simple way to check at home

Stand by a window or use a light from the side, so it falls across your face at an angle rather than straight on. Run a clean fingertip over the area.

• If you can feel or see a dip, a sharp pit or a raised bump, and it casts a small shadow, it is a textural scar.
• If the area is completely smooth and only the colour is different, it is a mark.

Many people have both. A mark can also sit on top of a shallow scar, which can make the scar look worse until the colour settles. A clinician can help you sort out which is which, especially on skin that is still actively breaking out.

Red and purple marks

Pink, red or purplish flat spots that linger after a pimple are often called post-inflammatory erythema. They come from small blood vessels that widened during inflammation and have not yet settled. They are more noticeable in lighter skin tones.

One clue is that red marks often blanch, or fade briefly, when you press on them with a clear glass. They typically improve gradually over several months. Daily sunscreen, gentle skincare and avoiding picking all help. Some ingredients, such as azelaic acid and niacinamide, may support fading. For marks that persist, vascular laser treatment that targets red pigment in blood vessels is an option for some people.

Brown and dark marks

Brown, grey-brown or very dark flat spots are post-inflammatory hyperpigmentation. Inflammation triggers pigment cells to produce extra melanin, which is deposited in the skin. They are more common and often more persistent in medium and darker skin tones.

These marks usually fade over months, but sometimes take a year or more, especially if the pigment sits deeper in the skin. Sun exposure darkens them and slows fading, so daily broad-spectrum sunscreen is the most important step. Ingredients with reasonable evidence include azelaic acid, retinoids, niacinamide and vitamin C. Superficial peels and some laser treatments may help selected people, though aggressive treatment can create new pigment, particularly in darker skin. Our article on hyperpigmentation covers this in more depth.

Textural acne scars

Scars form when deep or inflamed acne damages the collagen in the deeper layers of skin. The body's repair is imperfect, leaving either too little tissue (a depressed scar) or too much (a raised scar).

• Ice pick scars: narrow, deep pits that look like large pores.
• Boxcar scars: broader depressions with sharp edges.
• Rolling scars: wider, soft dips that give skin a wavy look, often caused by bands of tissue pulling the surface down.
• Hypertrophic scars and keloids: raised, firm scars, more common on the chest, back and jawline. Keloids grow beyond the original spot.

Unlike marks, textural scars do not usually fade much with time or skincare. Retinoids may slightly improve shallow scars over a long period, but treatment for noticeable scarring is generally in-clinic. Options can include microneedling, fractional laser resurfacing, chemical peels for shallow scars, targeted procedures for individual pits, and filler for some rolling scars. Raised scars are treated differently, often with steroid injections from a physician. Results vary from person to person, usually need several sessions, and improvement rather than complete removal is a realistic goal. See our article on microneedling for acne scars for one example.

Why the difference changes the plan

Treating a mark as if it were a scar can lead to unnecessary, more intensive procedures, and in some cases more irritation and more pigment. Treating a scar as if it were a mark can mean months of creams with little change. Getting the diagnosis right first is the most important step.

The other key step is controlling active acne. Every new breakout can create new marks and scars, so treating acne effectively, often with help from your family doctor, comes before or alongside any scar work.

Who should wait before scar treatment

In-clinic scar treatments injure the skin in a controlled way, so timing matters. People are usually advised to wait if they have active, inflamed acne in the area, a skin infection or cold sore, or a recent tan. People who have recently taken isotretinoin may be asked to wait before certain procedures, based on their physician's advice. Pregnancy, a history of keloids, poorly controlled diabetes and some autoimmune conditions also need to be discussed beforehand.

The main risks of scar treatments include redness, swelling, temporary darkening or lightening of skin, infection and, uncommonly, new scarring. Darker skin tones carry a higher risk of pigment changes, so settings and treatment choice need care.

Patience with fading

It can be discouraging to see a mark linger long after the pimple has gone. Try taking photos in the same light once a month; gradual fading is easier to see in photos than in a daily mirror check. Protect your skin from the sun and resist the urge to scrub or pick, both of which slow healing.

Frequently asked questions

Will my dark marks become permanent scars?

No. Flat marks are a colour change, not a scar, and usually fade. They do not turn into textural scars, though they may sit over one.

Does popping pimples cause scars?

It can. Squeezing pushes inflammation deeper and increases the chance of both marks and scars.

When can I start treating scars?

Ideally once acne is under control. Your clinician can advise on timing for your skin.

If you are not sure whether you are dealing with scars, marks or both, a consultation at HealthPark Medical Aesthetics can assess your skin and talk through realistic options, including simply waiting for marks to fade.