Types of Acne Scars: How to Identify Them and Choose the Right Treatment

Acne scars fall into two main groups: depressed scars that sit below the skin, and raised scars that sit above it. Depressed (atrophic) scars include ice pick, boxcar, and rolling scars, while raised scars include hypertrophic and keloid scars. Flat brown or red marks left after a pimple are not true scars but post-acne marks, which fade over time. These differences matter because the right treatment depends entirely on the type of scar you have. Scars form when acne inflammation damages collagen during healing, with too little collagen causing depressed scars and too much causing raised ones. This guide helps you identify your scar type and choose the treatment that actually works.

Key Takeaways

• Acne scars are either depressed (ice pick, boxcar, rolling) or raised (hypertrophic, keloid).

• Flat dark or red marks are post-acne marks, not true scars, and fade with time.

• True scars are a change in skin texture you can feel; marks are only a colour change.

• Deep scars usually need professional treatment, while marks respond to skincare.

• Treating acne early and never picking are the best ways to prevent scars.

The Main Types of Acne Scars

There are five main types of acne scars, plus flat post-acne marks that are often mistaken for scars. Knowing the different types of scars on the face and body helps you choose the right treatment. The simplest way to tell a true scar from a mark is to feel it: a scar changes the skin's texture, so you can feel a dip or a raised bump, while a mark is flat and only changes colour.

Ice Pick Scars

Ice pick scars are narrow, deep scars that look like small puncture holes, as if the skin was pricked with a fine tool. They are usually less than 2 mm wide but extend deep into the skin, which makes them the hardest type to treat. They most often appear on the cheeks, forehead, and temples, where the skin is thinner.

Boxcar Scars

Boxcar scars are round or oval depressions with sharp, well-defined vertical edges, like small craters. They are wider than ice pick scars, usually 1.5 to 4 mm across, and can be shallow or deep. Boxcar scars commonly form on the cheeks, jaw, and temples, often after cystic or inflamed acne.

Rolling Scars

Rolling scars are wide, shallow depressions with soft, sloping edges that give the skin a wavy, uneven look. They are caused by bands of tissue pulling the skin down from underneath. Rolling scars appear most on the lower cheeks and jaw, and they tend to become more noticeable with age as skin loses firmness.

Hypertrophic Scars

Hypertrophic scars are raised scars that form when the skin produces too much collagen while healing. They stay within the boundary of the original acne spot and feel firm and slightly raised. They are more common on the jawline, chest, back, and shoulders than on the face.

Keloid Scars

Keloid scars are also raised, but they grow larger than the original acne spot and can feel firm, shiny, and sometimes itchy or tender. They may look pink, red, or darker than the surrounding skin. Keloids are caused by an overgrowth of scar tissue and are more common in deeper skin tones.

Post-Acne Marks (PIH and PIE)

Post-acne marks are flat and are not true scars, because they change only the skin's colour, not its texture. Post-inflammatory hyperpigmentation (PIH) shows as brown or dark marks from excess melanin, more common in deeper skin tones, while post-inflammatory erythema (PIE) shows as pink or red marks from damaged blood vessels. If you are unsure whether you have marks or true scars, the touch test helps. Both marks usually fade on their own over weeks to months, especially with sun protection.

Quick Identification Table

Use this table to quickly identify your scar type by how it looks, how it feels, and where it appears.

How to Choose the Right Treatment for Each Type

The right treatment depends on whether your scar is depressed, raised, or actually a flat mark. Because each type behaves differently under the skin, matching the treatment to the type is what delivers real results. The table below shows the treatments most commonly used for each.

A key point is that raised scars like keloids should never be treated with aggressive resurfacing, as this can make them worse. Depressed scars respond best to treatments that rebuild collagen or release the tethered tissue underneath. Flat marks are the easiest to improve and often clear with the right skincare, which we cover next.

What Can Skincare Realistically Do at Home?

At home, skincare works best on flat post-acne marks and for supporting prevention, but it cannot fix deep, structural scars. For true depressed or raised scars, creams can only make a small difference to surface texture, and professional treatment is needed for real change. Where skincare genuinely helps is with discolouration. To treat dark spots left after pimples, brightening ingredients like niacinamide, vitamin C, kojic acid, and alpha arbutin fade dark spots and even out tone, while gentle exfoliating acids like glycolic acid improve texture and retinoids support skin renewal. A dark spot removal cream that combines niacinamide and kojic acid in a hydrating, hydroquinone-free base is a practical way to fade post-acne marks, especially when used consistently. Above all, daily broad-spectrum sunscreen is essential, as sun exposure darkens marks and slows their fading.

How to Prevent Acne Scars

The best way to prevent acne scars is to treat acne early and never pick at your skin, so inflammation does not damage the deeper layers. A few consistent habits make the biggest difference:

• Never pick, pop, or squeeze pimples. Pressing on a pimple pushes bacteria and inflammation deeper into the skin, which greatly increases the risk of scarring and leaves darker marks behind. If a pimple is painful or stubborn, let it heal or see a professional rather than forcing it.

• Treat acne early and consistently. The sooner you calm a breakout, the less damage it does to the collagen underneath. Managing acne quickly with suitable products like salicylic acid, and getting help for cystic or inflamed acne, reduces the chance of permanent scars.

• Be gentle with your skin. Harsh scrubbing, over-exfoliating, and strong products can irritate active acne and worsen inflammation. A mild, simple routine helps skin heal cleanly without extra damage.

• Wear sunscreen every day. Sun exposure darkens healing skin and makes any marks or scars more noticeable. A daily broad-spectrum SPF 30 or higher protects the area while it recovers.

• See a dermatologist for severe acne. If you have frequent, deep, or cystic breakouts, professional treatment can control the acne before it scars. Early medical care is one of the most effective ways to prevent long-term scarring.

When to See a Dermatologist

You should see a dermatologist for any true acne scar that has changed your skin's texture, or if you have deep, widespread, or raised scarring. Because true scars usually cannot be removed with creams, a professional assessment is the only way to match the right procedure to your scar type and skin tone. This is especially important for keloid scars, which need specialist care, and for choosing safe options if you have a deeper skin tone. A dermatologist can also help control ongoing acne, which is the first step to preventing new scars from forming.

The Bottom Line

Treating acne scars starts with correctly identifying what you have. First, feel the area: a texture change means a true scar, while a flat colour change is a post-acne mark. Depressed scars like ice pick, boxcar, and rolling respond best to professional treatments that rebuild collagen, raised scars need careful specialist care, and flat marks fade with brightening skincare and daily sunscreen. Creams help most with marks and prevention, not deep scars. With the right approach, patience, and professional guidance where needed, smoother and clearer skin is achievable.