Types of acne scars

Types of acne scars
First, some good news about the healing process. As an acne blemish heals, the inflamed area flattens, leaving behind a reddish spot. Though it may look like an acne scar, it’s actually a macule — the final stage of an acne lesion. Macules may last for up to six months, but leave no permanent acne scar.

The same holds true for post-inflammatory hyperpigmentation, a darkening of the skin at the site of a healing acne lesion. Most prevalent in African-American, Asian and Latino populations, these spots can last up to 18 months — but may disappear more quickly if you stay out of the sun. Both macules and post-inflammatory hyperpigmentation are considered "pseudo-scarring" because they eventually disappear completely.

There are two kinds of true scars left behind by acne: acne scar caused by increased tissue formation, and acne scars caused by tissue loss. The former, called keloid or hypertropic scars, are less common and appear to be hereditary. These are found primarily in African-American, Asian and Latino patients. Keloid scarring occurs when the skin cells respond to injury by producing an excess of collagen, which forms into lumpy fibrous masses most frequently along the jaw line and on the back or chest. These acne scars appear firm and shiny, and may persist for years.

Acne Scars caused by tissue loss are much more common, and may take many forms:


Soft acne scars have gentle sloping rolled edges that merge with the surrounding skin. They are usually small, circular or linear in shape, and soft to the touch.

Ice-pick acne scars. Most often found on the cheek, ice-pick scars are usually small but deep, with a jagged edge and steep sides. If they are soft to the touch, they may be improved by stretching the skin; hard ice-pick scars are difficult to treat.

Depressed fibrotic acne scars. Over time, ice-pick scars may evolve into depressed fibrotic scars. These also have sharp edges and steep sides, but are larger and firm at the base.

Atrophic macules, a form of acne scarring most common in Caucasians, are soft with a slightly wrinkled base. Blood vessels just below the surface of the scar may make them appear purplish when they are recent, but this discoloration may fade over time to a pale ivory. Atrophic macules are usually small when they occur on the face, but may be a centimeter or larger elsewhere on the body.

Follicular macular atrophy is more likely to occur on the chest or back of a person with acne. These small, soft white lesions resemble whiteheads that didn’t fully develop; they may persist for months or years.