Acne Scars vs Acne Marks (PIH): What’s the Difference and How Are They Treated?
Acne Marks and Acne Scars Are Not the Same
You've finally got your acne under control, but now you're left with brown spots or uneven skin texture.
You may call both of them "acne scars," but medically, they can be very different.
Acne marks, particularly post-inflammatory hyperpigmentation (PIH), mainly affect skin colour. Acne scars change the texture or structure of the skin.
Knowing the difference is important because the treatment for pigmentation isn't necessarily the same as the treatment for scars.
What Are Acne Marks or Post-Inflammatory Hyperpigmentation?
Post-inflammatory hyperpigmentation (PIH) occurs when the skin produces excess pigment after inflammation.
Key Clinical Distinguishing Clue: After a pimple heals, it can leave behind a brown, greyish or darker patch. If the skin feels completely smooth when touched, you are dealing with an acne mark (PIH) rather than a structural scar.
What Are Acne Scars?
Acne scars are permanent or long-lasting changes in the texture of the skin caused by damage during the healing process. They are broadly classified into atrophic scars and hypertrophic or keloid scars.
Ice-Pick Scars
These are narrow, deep scars that extend into the skin. They can look like small holes or punctures and are often more difficult to treat than superficial acne marks.
Boxcar Scars
Boxcar scars are wider depressions with relatively defined edges. They can be shallow or deeper and are commonly seen on the cheeks and temples.
Rolling Scars
Rolling scars create an uneven, wave-like appearance because of tethering beneath the skin. They usually have softer, rounded edges.
Hypertrophic and Keloid Scars
Unlike atrophic scars, these scars are raised above the skin surface. They occur when excess scar tissue develops during healing.
How Can You Tell the Difference?
A simple way to think about it:
- Brown or dark but smooth skin: More likely an acne mark / PIH.
- Indentation, depression or raised texture: More likely an acne scar.
Sometimes a person can have both PIH and acne scars at the same time.
How Is Acne PIH Treated?
Treatment depends on the depth and severity of pigmentation. A dermatologist may consider:
- Medical skincare
- Chemical peels
- Pigmentation-focused procedures
- Selected laser treatments
- Sun protection
The goal is to gradually improve uneven pigmentation while avoiding unnecessary irritation.
How Are Acne Scars Treated?
Acne scar treatment depends heavily on the type of scar. Depending on the individual, treatments may include:
- Microneedling
- MNRF (Microneedling Radiofrequency)
- Fractional CO₂ laser
- Subcision (for tethered rolling scars)
- TCA-based scar treatments (TCA CROSS)
- Combination procedures
Deep scars often require a combination approach rather than a single treatment.
Why Should You Treat Acne Before Treating Acne Scars?
If active acne is still causing frequent inflammation, treating the scars alone may not solve the problem.
A dermatologist may first focus on controlling active acne and then plan scar treatment once new breakouts are under better control. This approach can also help reduce the formation of new marks and scars.
Final Thoughts
Acne marks and acne scars may look similar at first, but they are different skin concerns. PIH mainly changes skin colour, while acne scars change skin texture.
Getting the correct diagnosis helps your dermatologist choose a more suitable treatment instead of treating every post-acne change in the same way.
Accurate Diagnosis Matters For Scar Recovery
If you're unsure whether you're dealing with acne marks, PIH or true acne scars, consult Dr. Yaksh Oza, M.D. Dermatology for a personalized skin assessment.
Consult Dr. Yaksh Oza (MD DVL) →