Acne scarring occurs when inflammation from blocked follicles destroys collagen and skin tissue. Severe inflammatory acne, genetics, and behaviors like picking increase risk. Scars fall into atrophic (ice-pick, boxcar, rolling) and raised (hypertrophic, keloid) categories. Prevent scarring by treating acne early and avoiding manipulation of lesions. Existing scars can be improved with procedures such as microneedling, laser resurfacing, chemical peels, fillers, subcision, or steroid injections under a dermatologist's care.

What acne scarring is and why it happens

Acne scarring results when the skin's normal repair process responds to inflammation inside hair follicles (pilosebaceous units). When sebum, dead skin cells, and bacteria such as Cutibacterium acnes clog a pore, the follicle can become inflamed or infected. That inflammation can damage surrounding collagen and skin structure and lead to permanent changes - scars.

Cystic or severe inflammatory acne causes the most scarring because deep nodules and cysts destroy tissue. Individual factors such as genetics, skin type, and how someone manages active acne (for example, picking or squeezing) also affect whether scars form.

Common types of acne scars

Atrophic (lost tissue)

Atrophic scars are caused by loss of collagen and skin tissue. The three common shapes are:
  • Ice-pick scars: narrow, deep indentations.
  • Boxcar scars: wider, with well-defined edges.
  • Rolling scars: broad, sloped depressions that give skin an uneven appearance.
Atrophic scars are the most common result of inflammatory acne on the face.

Hypertrophic and keloid scars (excess tissue)

Hypertrophic scars are raised, firm scars that stay within the original injury area. Keloids are an overgrowth of scar tissue that extends beyond the original wound. Both types are more common on the chest, back, and shoulders and can affect people with a tendency to form raised scars.

How to reduce the risk of scarring

Early and appropriate treatment of active acne is the best way to prevent scars. Strategies include:


  • Avoid picking, popping, or squeezing pimples.


  • Use topical treatments (retinoids, benzoyl peroxide) as recommended by a clinician.


  • Treat moderate-to-severe inflammation with prescription options: topical or oral antibiotics, hormonal therapy (for people assigned female at birth), or oral isotretinoin for severe, resistant acne.


  • See a dermatologist early if acne is nodular, cystic, or not responding to over-the-counter care.


Promptly reducing inflammation limits the tissue damage that causes scarring.

Treatments for existing acne scars

Several effective procedures can improve acne scars; choice depends on scar type and skin tone. Common options include microneedling, chemical peels, fractional laser resurfacing, dermal fillers for depressed scars, subcision for tethered scars, and steroid injections or surgical excision for hypertrophic/keloid scars. A board-certified dermatologist can recommend a tailored plan and discuss risks, expected improvement, and downtime.

Bottom line

Acne scars arise when inflammation damages skin structure. You can reduce risk by treating acne early, avoiding picking, and consulting a dermatologist for persistent or severe acne. For established scars, multiple medical and procedural options can significantly improve appearance.

FAQs about Acne Scarring

What causes acne scars?
Scars form when inflammation from blocked, infected, or ruptured hair follicles damages surrounding collagen and skin tissue. Severe inflammatory lesions such as nodules and cysts are most likely to scar.
Can acne scarring be prevented?
Many scars can be prevented by treating acne early, controlling inflammation with appropriate medications, and avoiding picking or squeezing pimples. See a dermatologist for nodular or cystic acne.
What are the main types of acne scars?
The main categories are atrophic (lost tissue) - including ice-pick, boxcar, and rolling scars - and hypertrophic/keloid (raised, excess tissue) scars.
How are existing acne scars treated?
Treatment depends on scar type and skin tone. Options include microneedling, fractional laser resurfacing, chemical peels, fillers, subcision, steroid injections, and surgical techniques. A dermatologist can design a combined approach.
When should I see a dermatologist?
See a dermatologist if you have moderate-to-severe acne, nodules or cysts, or if over-the-counter treatments fail. Early specialist care reduces the risk of permanent scarring and provides targeted treatments.