Acne is an inflammatory skin disorder that usually appears in adolescence but can last well into adulthood. It’s fairly common, affecting about 50% to 80% of teenagers and young adults. It shows up in all sorts of ways — blackheads, cysts, whiteheads, papules, pustules, nodules — and can leave behind scars that damage the confidence and social life of the people it affects. Dealing with acne can take a toll on mental health and overall well-being. In this article, I’ll explain the differences between acne marks vs acne scars to help you make decisions about your skincare journey.

The signs of acne

Acne can result in lasting blemishes and damage to the skin, which may persist permanently or for varying durations after the initial outbreak. Seeking professional guidance and sticking to a consistent skincare regimen can help treat and prevent the long-term effects of acne on your skin.

Acne bumps

Cystic acne, often referred to as acne bumps, is a skin condition where nodules, cysts, pustules and papules grow on the skin. Areas dense in oil glands, such as the face, neck, chest, upper arms, back and shoulders, are the most common locations for these bumps to appear.

Main causes

• Overabundance of sebum (oil)
• Blocked hair follicles
• Bacteria
• Hormonal changes
• Inflammation
• Genetics

Treatment options

The options for acne bump treatment depend on the condition and severity. To unclog pores and decrease inflammation, common options include topical treatments with chemicals like salicylic acid, benzoyl peroxide or retinoids. In more severe cases, dermatologists may recommend oral antibiotics, hormonal therapies, or isotretinoin. Corticosteroid injections can be used to treat acne bumps by injecting a small, dilute amounts of solution directly into the inflamed lesion. In cases where acne bumps are large, painful and filled with pus, a dermatologist may opt for incision and draining.

Complications

Popping or picking at acne cysts opens them up, which can lead to scarring and bacterial skin infections. After the acne clears up, some people may see patches near the cyst location that are different in color, either light or dark. They usually disappear after a while; however, it can take more than a year.

Acne marks and post-inflammatory hyperpigmentation

After acne lesions heal, they can leave behind flat, discolored blotches called acne marks. The intensity of the inflammation and the person’s skin tone determine the color or hue, which can range from red and pink to purple and brown. Post-inflammatory hyperpigmentation (PIH) occurs when the body produces pigmentation (excess melanin) in reaction to inflammation, leading to the appearance of dark spots or patches on the skin. Acne marks and PIH occur after the resolution of acne bumps, serving as reminders of past acne flare-ups.

Main causes

• Excess melanin production
• Darker skin tones
• Damaged blood vessels
• Prolonged inflammation
• Picking or popping acne lesions
• Sun exposure
• Genetics

Treatment options

The methods differ for dealing with acne marks vs acne scars. Every kind of acne mark has its own unique therapy. While brown marks may require laser therapy, red marks may require a vascular laser or micro-needling radio frequency. When you have a combination of red and brown spots, as is typical, you may require many treatments.

Complications

Treatment of acne scars and post-inflammatory hyperpigmentation may have side effects such as redness, irritation and a transient darkening of the treated region. In addition, if the underlying causes, such as acne, are not adequately treated, some people may see a return of hyperpigmentation. A dermatologist’s advice is crucial for deciding on the best course of therapy and reducing the likelihood of side effects.

Acne scars

Acne scars are the lasting marks left behind on the skin after the healing of severe acne bumps, acne marks and PIH. Scarring may be the result of tissue loss, which manifests as skin indentations or pits. They result from the destruction of collagen in the skin during the healing process, leading to permanent changes in texture and appearance. Scarring also may result from the production of too much collagen.

Most common types

• Ice pick scars. Deep, narrow scars that resemble small punctures in the skin.
• Boxcar scars. Broad, depressed scars with well-defined edges, resembling a box-like shape.
• Rolling scars. Shallow, undulating scars that create a wave-like appearance on the skin’s surface.
• Keloid scars. These form when excessive collagen production during the healing process extends beyond the boundaries of the original wound, often resulting in scars larger than the initial injury.

Despite the different origins of acne scars, cosmetics and skincare treatments can help improve their appearance over time.

Treatment options

• Home skin care. Consists of topical treatments such as retinoids, alpha-hydroxy acids and vitamin C serums to promote skin turnover and collagen production, reducing the appearance of acne scars.
• Soft tissue fillers. Injectable substances like hyaluronic acid or collagen fill in depressed scars, providing temporary improvement in appearance.
• Steroid injections. Corticosteroids injected directly into hypertrophic or keloid scars help reduce inflammation and flatten raised scars.
• Laser resurfacing. High-energy laser beams remove damaged skin layers, stimulating collagen production and improving overall skin texture.
• Fine needles create controlled micro-injuries in the skin, stimulating collagen production and enhancing scar remodeling.
• Surgical removal of individual acne scars, particularly for deep or isolated scars.

Complications

Scarring might be mild or severe, depending on your individual body’s reaction to a trauma. Collagen production plays a crucial role in the healing process, but an imbalance in collagen synthesis can lead to the formation of raised scars. It’s also possible that some treatments may inadvertently lead to the development of new scars.

The healing process

Dermatologists play a key role in addressing acne concerns. They perform assessments and may run tests to develop personalized treatment plans and prescribe the appropriate medications and treatments. At Florida Medical Clinic Orlando Health, our Dermatology Department offers comprehensive care for skin conditions, including acne and acne scars. Call us today at 813-712-5702 to schedule an appointment or request an appointment online.

About Ellen Lockwood, PA-C

Ellen was born in Columbus, Ohio and raised in Naples, Florida. She received her Master of Medical Science Degree in Physician Assistant Studies from Charleston Southern University. Ellen has a passion for dermatology and providing patient-centered care.

Outside of medicine, she enjoys golfing, reading, boating, and exploring Tampa’s many new restaurants.