The 3 Types of Acne Scars (And What Topical Skincare Can Realistically Do)
By Simon MitchellYou've tried the serums. You’ve layered the acids. You've followed the routine religiously for months.
And yet, the indentations remain. The marks persist. The texture hasn’t smoothed.
Here’s what most brands won't tell you: not all acne scars are created equal. Treating them as if they're all the same condition is exactly why most topical routines fail to deliver the results you're hoping for.
Some scars respond beautifully to consistent topical support. Others need professional intervention. The difference lies in understanding which type you’re dealing with and what realistic improvement actually looks like.
What's Happening Under the Skin
Acne scars form when inflammatory acne damages the skin's deeper layers - specifically the dermis, where collagen and elastin live. When your skin attempts to heal this damage, the process doesn't always go to plan.
Sometimes, your skin produces too little collagen during healing, which can create depressions. At other times, it overproduces collagen, causing raised areas. The result is often long-lasting structural change that sits beneath the surface layer most skincare products can reach.
Understanding this distinction is critical. Surface treatments work on surface problems. Structural damage requires a different conversation entirely.
Important note: This article provides general information only and should not replace professional medical advice. If you have concerns about acne scarring, please consult your GP or dermatologist. If you're post-procedure, always follow your surgeon's specific aftercare instructions.
Quick Self-Check: How to Tell What Type of Acne Scars You Have
Use this as a guide - a clinician can confirm.
- Indented texture you can feel: Likely atrophic scarring (ice pick, boxcar, rolling)
- Raised, firm area: Hypertrophic scarring
- Flat red/pink mark: PIE (post-inflammatory erythema)
- Flat brown/dark mark: PIH (post-inflammatory hyperpigmentation)
Type 1: Atrophic Scars (Indented Scars)
These are the most common types of acne scars -the ones that create shadows and texture because they sit below the surrounding skin surface. These are also the scars most likely to need in-clinic support for significant structural improvement.
Ice Pick Scars
Deep, narrow indentations that look like the skin has been punctured with a sharp tool. Ice pick scars extend into the deeper dermis and appear as small but noticeable pits, most commonly on the cheeks.
Boxcar Scars
Wider depressions with sharply defined edges, creating a box-like appearance. Boxcar scars vary in depth but tend to be broader than ice pick scars and can appear angular or U-shaped.
Rolling Scars
Wave-like indentations that create an uneven, undulating texture across the skin surface. Rolling scars occur when fibrous bands pull the skin downward, creating broader, shallow depressions.
What topical skincare CAN do:
- Improve the quality of skin around the scar
- Support collagen synthesis and barrier function
- Strengthen overall skin health and resilience
- Improve tone and reduce discolouration
- Make scars appear less prominent as the surrounding skin improves
Look for collagen-supporting and barrier-strengthening actives that work with your skin's natural remodelling process over time.
What it CANNOT do:
- Fill deep structural collagen loss
- Resurface deep indentations on its own
- Fully replace lost structure in deep atrophic scars
Topicals can support collagen function, but cannot rebuild tissue that's been permanently damaged in the dermis.
For deeper atrophic scarring, procedures such as microneedling, subcision, laser resurfacing, or dermal fillers are typically required to achieve visible structural change.
Type 2: Hypertrophic Scars (Raised Scars)
Unlike atrophic scars, hypertrophic scars form when your body produces too much collagen during the healing process. The result is a raised, thickened area that sits above the surrounding skin.
These scars often feel firm or rope-like to the touch. They're more common on the jawline, chest, back, and shoulders - areas where skin tension is higher and acne tends to run deeper.
What topical skincare can do:
- Create an environment that supports more balanced skin remodelling
- Reduce redness and inflammation over time
- Improve texture slightly with consistent barrier support
- Help soften the appearance with silicone-based formulations
Realistic expectations:
Topical products rarely flatten established hypertrophic scars completely. Significant raised scarring often requires professional intervention such as steroid injections, laser therapy, or pressure therapy.
Type 3: Post-Inflammatory Marks (Not True Scars)
Here's where things get clearer - and more hopeful.
Post-Inflammatory Erythema (PIE) – Red Marks
Post-inflammatory erythema appears as pink or red marks caused by broken capillaries and lingering inflammation. PIE marks often blanch (turn white temporarily) when you press on them, indicating they're vascular rather than pigment-based.
Timeline: PIE often improves in 12–24+ weeks with consistency, and faster when inflammation is actively controlled through barrier support and sun protection.
Post-Inflammatory Hyperpigmentation (PIH) – Brown Marks
Post-inflammatory hyperpigmentation appears as flat brown or dark spots caused by excess melanin production triggered by inflammation. PIH is more common in medium to deeper skin tones.
Timeline: PIH often improves in 8–12+ weeks with consistent use of appropriate ingredients and strict sun protection.
Look for pigment-supporting and anti-inflammatory actives that help fade discolouration without compromising barrier function.
The good news: PIE and PIH are not true scars. There's no structural damage to the dermis, which means they respond extremely well to topical skincare. If your "scarring" is predominantly discolouration without texture change, topical support can deliver visible, often significant results.
What Topical Skincare Can Realistically Do for Acne Scars
- Fade post-inflammatory marks (PIH and PIE) – often significantly with consistent use
- Gradually refine surface texture – smoothing fine irregularities
- Support collagen health and synthesis – creating a stronger foundation
- Calm lingering inflammation – reducing redness and preventing further damage
- Strengthen barrier function – essential for allowing any treatment to work effectively
- Improve tone and overall skin quality – making scars less prominent even when structure remains unchanged
What Topical Skincare Cannot Do
- Replace professional procedures for deep structural scarring
- Instantly resurface damaged dermis
- Rebuild significant collagen loss in deep indented areas
- Deliver overnight transformation
- Fully eliminate deep ice pick or boxcar scars on its own
Understanding this boundary is empowering, not discouraging. It allows you to set realistic expectations and invest your time and money wisely.
A Barrier-First Approach to Supporting Acne Scars
In our clinic-style approach, we prioritise barrier repair first. When skin is irritated or compromised, scar treatments stall, and pigmentation lingers. An inflamed barrier often tolerates actives poorly, which can slow progress in marks and texture.
This is especially critical if you've been over-exfoliating or layering multiple acids in pursuit of faster results.
The Framework: Cleanse → Repair → Protect
Morning:
- Gentle, non-stripping cleanser
- Barrier-supportive serum or essence
- Targeted treatment (if tolerated in AM—otherwise PM only)
- Broad-spectrum SPF 50+ (non-negotiable)
Evening:
- Gentle cleanser
- Barrier repair product
- Targeted treatment (choose 1–2 actives, not 5)
- Nourishing moisturiser or occlusive layer
What to avoid:
- Over-exfoliating (more acids don't mean faster results)
- Aggressive layering of potent actives
- Chasing every trending ingredient without a strategy
- Skipping sun protection
Starting point for sensitive or reactive skin:
If your skin is easily irritated, start with barrier repair for 2–3 weeks before introducing stronger actives. Let your skin stabilise first. Consistency beats intensity every time.
Strategic focus:
Choose one target initially: fading marks OR supporting texture - not both at once in week one. Introduce one new active at a time and keep it consistent for at least 8–12 weeks before judging results. Let your skin adapt, then gradually layer in additional support.
Timeline Expectations: What "Working" Looks Like for Acne Scars
2 weeks:
Improved hydration, reduced inflammation, calmer overall appearance. No texture or pigment change yet—this is foundation work.
4 weeks:
Surface texture begins to refine slightly. Very early fading of post-inflammatory marks may become noticeable, particularly PIH.
8–12 weeks:
Visible improvement in tone and brown discolouration (PIH). Subtle smoothing of fine texture. Atrophic scars remain structurally unchanged, but the surrounding skin quality improves noticeably.
12–24 weeks:
Continued fading of red marks (PIE) as inflammation resolves. Texture continues refining. Deep structural scars show improved tone but minimal change in depth.
Patience isn't optional here. Skin remodelling takes time, and rushing the process through aggressive exfoliation often sets progress back.
Troubleshooting: 5 Common Mistakes When Treating Acne Scars
- Over-exfoliating in pursuit of faster results - damages barrier function, increases inflammation, and worsens both scars and marks
- Treating all marks as scars – missing that PIH and PIE need different support than atrophic scarring
- Skipping sunscreen – UV exposure darkens pigmentation, degrades collagen, and undoes months of progress
- Expecting topicals to replace procedures – setting unrealistic goals based on marketing hype rather than skin biology
- Switching products too quickly – not allowing enough time (minimum 8–12 weeks) to assess what's actually working
FAQs About Acne Scars and Topical Treatment
Can skincare remove acne scars completely?
For true atrophic scars with structural indentations, no. Skincare can improve tone, texture, and surrounding skin quality, but cannot rebuild lost collagen in deep depressions. Post-inflammatory marks (PIH and PIE), however, often fade significantly with consistent topical support.
How long does it take to see improvement in acne scars?
For discolouration, 8–12 weeks for PIH and 12–24 weeks for PIE typically show visible fading. Texture improvement takes longer - expect 3–6 months for subtle refinement. Deep structural scars require professional treatment for significant change.
Are acne marks the same as scars?
No. Post-inflammatory hyperpigmentation (brown marks) and erythema (red marks) involve no structural damage and respond well to topicals. True scars involve collagen damage in the dermis and may require professional intervention.
Do retinoids help acne scars?
Retinoids support collagen synthesis and cell turnover, which can improve skin quality around scars and help fade post-inflammatory marks over time. They cannot fill indented scars or flatten raised scars on their own.
Does sunscreen matter for treating acne scars?
Absolutely. UV exposure worsens pigmentation, degrades existing collagen, and can darken both scars and marks. Daily SPF 50+ is essential for any scar-focused routine—without it, you're working against yourself.
When should I consider in-clinic treatment for acne scars?
If you have moderate to severe ice pick scars, boxcar scars, or rolling scars that impact your confidence, or if topical skincare hasn't delivered the improvement you hoped for after 6 months of consistent use, consult a dermatologist about procedures.
Final Word
If your scarring is mostly discolouration or early texture change, topical support can make a visible difference. You may be surprised by how much improvement is possible with the right ingredients, realistic timelines, barrier-first thinking, and consistent application.
But if you're dealing with significant structural scarring, the kindest thing you can do for yourself is acknowledge that topical skincare has limits - and that seeking professional guidance isn't giving up. It's choosing the most effective path forward.
If you're unsure what type of scarring you have, consider a professional skin consultation. A trained practitioner can assess your specific concerns and recommend the most appropriate combination of topical support and in-clinic options.
Focus on consistent, barrier-supportive routines. Protect your skin from further damage. And remember: improvement doesn't always mean perfection. Sometimes, it means healthier, calmer skin that you feel more comfortable in—and that's absolutely worth pursuing.
