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Acne Marks vs Acne Scars: Differences & Treatments

Acne marks and acne scars are very common consequences after getting pimples (also known as acne). This is especially common if the pimple outbreak was serious or if the pimples were big.

It is important to know the differences between acne marks and acne scars because the treatments are different.

Treating scars and acne marks is as much a science as it is an art. It requires accurate diagnosis followed by precise treatment to deliver optimal improvements and results.


What's the Difference Between Acne Marks and Acne Scars?

Acne marks are typically brown acne marks (post-inflammatory hyperpigmentation) or red marks (post-inflammatory erythema).

red flat scar
brown pigmented scar

Acne scars, on the other hand, tend to be either atrophic (indented) or hypertrophic scars (raised scars).

Atrophic acne scars can be further divided into 3 sub-types: Boxcar scars, rolling scars and icepick scars.

These are examples:

boxcar scar

It is possible to have both scars and acne marks after pimples too.

What Causes Acne Marks and Scars?

Skin injury and inflammation due to the pimple is one of the main causes of acne marks and acne scars.

Severe acne and adult acne like cystic acne tends to cause more acne scarring.

This can be worsened by squeezing the pimple or incorrect use of creams/ treatments for the acne. Not all acne treatments work well. Some may even worsen the pimples.

Acne Marks

Brown marks is due to melanin production. These dark spots tend to happen more commonly in patients with darker skin tones. Brown marks may persist for more than 1 year after the pimple has healed.

Red marks are due to damaged blood vessels and growth of blood vessels at the area of injury. Red marks may persist even several months after the initial acne outbreak.

Acne Scars

Acne scars occur due to skin inflammation and injury that leads to skin atrophy (indentation) and scar tissue formation. This is seen as dents or “holes” in your skin.

It is possible to have acne scars and acne marks at the same pimple spot due to the concurrent disease processes.

How to Treat Acne Marks?

Treatment options for acne marks vs acne scars differ. There are specific treatments for each type of acne mark.

Red marks are typically treated with vascular laser and micro-needling radio frequency while brown marks require pico laser treatment.

It is not uncommon to have a mix of red and brown marks which means that you might require a range of treatments to treat both types of acne marks.

Micro-needling Radiofrequency

Fractional radiofrequency treatments like INFINI can help the healing process by reducing inflammation and reducing blood flow so that the redness improves. This treatment also stimulates collagen production.

Vascular Laser Treatment

Gold Toning vascular laser treatments help to contracted blood vessels relax. This reduces the red acne marks. Pulsed dye laser can also help.

Pico Laser Treatment

Pico laser helps to reduce dark spots by reducing melanin production in your skin. It might also help superficial skin scars. This is a very popular treatment as there is almost no downtime.

Pico Laser can also improve sun-damage, freckles and sunspot too.

Vitamin C

Vitamin C helps to lightening dark spots by reducing pigmentation and melanin production for clear skin. It is a common ingredient in many skin care brands.

How to Treat Acne Scars?

The difference between acne scars and raised scar is an important difference to make before starting treatment.

In order to treat scars effectively, it is also important to identify the types of acne scars first followed by instituting the appropriate treatment for the type of scar.

For example, box-car scars will require subcision and filler followed by fractional laser whereas icepick scars can be treated slightly differently with TCA chemical peel and fractional lasers.

Everyone is unique. The most suitable treatments for your scar and skin will differ amongst individuals depending on your skin type, hydration, pain tolerance and ability to handle downtime.

Scar treatments should also be flexible to accommodate how your skin changes during the course of treatment.

Chemical Peel

Chemical peels can treat acne scars. For mild acne scar, chemical peel can help to reduce acne inflammation (increased white blood cells), help with fighting acne and treat mild depressed scars. Examples include azelaic acid and exfoliating hydroxy acids.

More aggressive chemical peels like TCA cross can be used for ice-pick scars.

Fractional Laser

Fractional laser therapy helps to resurface your skin for acne scar remodelling. After laser resurfacing for treating acne scars, your skin heals with new skin cells and more even toned skin underneath. This treatment also helps to rejuvenate surrounding tissue.

Fractional laser can be combined with other treatments like Infini and Subcision to achieve better scar improvement results. This is why it is important to see a doctor who has a wide range of treatment options to offer you.

INFINI

Infini is one of the best treatment options for acne scar. Infini delivers radio frequency using tiny needles to the deeper layers of the skin to stimulate collagen production.

Another benefit of Infini is the minimal downtime and fast recovery of typically only 1-2 days.

Infini also has a lower risk of hyper-pigmentation as it is a non-ablative treatment.

Subcision

Subcision works best for tethered scars and stubborn scar tissue.

Subcision is performed using a needle to gently free up the scar tissue under the skin. It is a laborious process but the results obtained are often unparalleled. Not many doctors in Singapore offer this treatment.

Subcision works best with dermal fillers to support scar recovery and remodelling.

Dermal Fillers

Dermal fillers are often used together with subcision of acne scars to enhance scar remodelling and recovery.

There are several type of dermal fillers for acne scars, ranging from hyaluronic acid fillers to collagen stimulators like Rejuran, Profhilo and Ellanse. Each has its own strengths and weaknesses.

This is a highly technical treatment that requires dexterity and experience.

How to Prevent Acne Marks and Acne Scars?

The best way to prevent acne scars and acne marks is to prevent acne lesions from forming. This can be done using good skin care, exfoliation to remove dead skin cells and avoid squeezing the pimples that form. However, do note that genetics also play a role in determining how easily you scar.

Knowing the difference between acne and acne scars is also important. Remember to treat acne immediately so that less scars form. This is especially important for patients who have dark skin (darker skin types).

Conclusion

Knowing the difference between acne scars and acne marks will help you to get the most suitable treatment for your skin concern.

Apart from effectiveness of the treatment, the other key considerations that you should have include: recovery time, risk and price.

If in doubt, please speak to an acne scar expert for advice.

Author

Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.