Acne Cut

Scarring & Marks

Scar or dark mark? How to tell the difference after acne

Drafted with AI assistance · not reviewed by a dermatologist · Published August 2, 2026 · Last updated October 5, 2026

Short answer

A dark or red mark is a flat change in color left after an inflamed spot, and it often fades, though slowly [3]. A scar changes the skin's surface, usually as a small pit or dent, and does not go away on its own [1][6]. Sunscreen and treating acne early help with both [2][4].

How settled

Well established

What we read

  1. NHS, Acne
  2. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Acne: diagnosis, treatment and steps to take
  3. Lopez-Estebaranz JL, Am J Clin Dermatol 2026
  4. Davis EC, J Clin Aesthet Dermatol 2010
  5. Jacob CI, J Am Acad Dermatol 2001
  6. Kim EY, Arch Dermatol Res 2023
  7. Bansal A, Indian J Dermatol Venereol Leprol 2026
  8. Tobiasz A, Pharmaceuticals (Basel) 2026
  9. Williams HC, Lancet 2012
An amber dropper bottle standing on folded white towels against white tiles
An amber bottle on folded towels. AI-generated illustration.

The quick test: flat or not?

A folded white cloth, a small glass vial and a drop of liquid on a tiled surface
A folded cloth and a small glass vial. AI-generated illustration.

After a spot heals, what is left falls into two groups. Marks are flat: the skin's surface is unchanged and only its color is different. Scars change the texture of the skin; the NHS describes acne scars as shallow holes, such as ice-pick or boxcar scars [1].

If you run a finger over the area and it feels level with the skin around it, it is most likely a mark rather than a scar [1][3]. That distinction matters, because marks often fade with time while scars generally need a procedure to improve [3][6].

Cross-section diagram: a dark mark and a red mark sit flat in the skin; icepick, boxcar and rolling scars dip below the surface, with icepick the deepest at about 1.9 millimeters.
Flat marks compared with sunken scars. The shapes are schematic; the depths are the averages measured in source 7. Drawn for Acne Cut.
Dark or red markScar
SurfaceFlat; only the color has changed[3]Sunken pits or dents in most acne scars[1][6]
CauseExtra pigment, or changes in small blood vessels, after inflammation[3]Damage to the skin's structure from severe inflammation[5]
Who it affects mostDark marks: people with darker skin[3][4]People with severe or picked spots[1][5]
Does it fade?Often, though it can take months or years[3]No; acne scars are permanent, though treatments can improve them[5][6]
What helpsTreating the acne, sunscreen, topical lightening agents[2][4]Procedures such as lasers, peels, fillers and microneedling[2][6]

Dark marks

Dark marks are post-inflammatory hyperpigmentation: the inflammation of a spot triggers extra production and deposit of melanin, the skin's pigment [3]. They are especially common in darker skin; one 2026 review reports that up to 85 percent of people with darker skin types (Fitzpatrick types IV to VI) develop them after inflamed acne [3], and a 2010 review notes that they affect darker-skinned people more often and more severely [4].

Risk factors include being female, darker skin, severe acne, spots on the face, a lot of sun exposure, and spots that have been picked or otherwise injured [3]. Dark marks can last for months or even years, and for some people they are more distressing than the acne itself [3].

Red marks

Red or pink marks are a separate thing: they reflect changes in the small blood vessels of the skin rather than extra pigment, and they can also persist for months or years [3]. Like dark marks, they are flat.

Scars

Acne scars form when severe inflammation damages the skin permanently [5]. A widely used classification from 2001 sorts the sunken scars of acne into three types: icepick, rolling and boxcar [5], and a 2023 review notes that these sunken, or atrophic, scars are the most common type [6].

A small 2026 study that examined 49 sunken scars under the microscope found that icepick scars were the deepest, about 1.9 millimeters on average, with boxcar and rolling scars at about 1.3 to 1.4 millimeters [7]. The study was small and looked only at darker skin, so the figures are a guide rather than a rule [7].

How common is scarring? A review in The Lancet estimates that facial scarring from acne affects up to 20 percent of teenagers [9].

What helps dark and red marks

The first step is treating the acne itself; a 2010 review describes managing the underlying inflammation as where treatment of dark marks begins, and advises starting early [4]. Sunscreen comes next: NIAMS calls it especially important for treating and preventing dark spots, and reviews of dark marks put sun protection at the center of treatment [2][3][4].

Topical lightening agents can help. Reviews list azelaic acid, retinoids, hydroquinone and several others, and note that chemical peels and lasers may help marks that do not respond [3][4]. Because irritation can itself make dark marks worse, these need to be used carefully [4]. A doctor can suggest a plan for fading existing dark spots [2].

What helps scars

Scars usually need procedures. NIAMS lists laser and other light treatments, superficial chemical peels, fillers, microneedling and surgery [2]. A 2023 review of the evidence found the strongest support for lasers, chemical peels, hyaluronic acid fillers and microneedling, with weaker evidence for microdermabrasion and subcision, a technique that releases scar tissue under the skin [6].

The type of scar shapes the choice. The authors of the 2001 classification built their treatment plan around it, using techniques such as punch excision, punch elevation, subcision and laser resurfacing depending on which type a scar is [5], which is why an assessment by a dermatologist comes before any procedure.

Topical retinoids may help too: a 2026 review concluded they can improve the appearance of sunken scars and slow the progression of scarring, though much of the evidence on newer products comes from small studies [8].

Preventing both

The surest prevention is treating inflamed acne early and well, and leaving spots alone. Picking or squeezing can cause scars [1], and injured spots are a risk factor for dark marks [3]. If spots are deep, painful or already leaving scars, the NHS advises seeing a doctor [1].

The four evidence labels used on Acne Cut, with “Well established” highlighted for this article.
This article's label: Well established. The labels describe the research, not how likely something is to work for you.

Sources

  1. NHS. Acne. Page last reviewed September 22, 2026; accessed October 5, 2026. Read it
  2. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne: diagnosis, treatment and steps to take. NIH, last reviewed July 2023; accessed October 5, 2026. Read it
  3. Lopez-Estebaranz JL, Lopez-Pando M, Mitsunaga K. Practical therapeutic strategies for acne-induced hyperpigmentation across all skin types. Am J Clin Dermatol. 2026;27(4):697–707. PubMed 42234395
  4. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3(7):20–31. PubMed 20725554
  5. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45(1):109–117. PubMed 11423843
  6. Kim EY, Wong JH, Hussain A, Khachemoune A. Evidence-based management of cutaneous scarring in dermatology part 2: atrophic acne scarring. Arch Dermatol Res. 2023;316(1):19. PubMed 38059974
  7. Bansal A, Sardana K, Paliwal P, Khurana A, Sharath S. A cross-sectional pilot study evaluating the histopathology of atrophic acne scars with a focus on the vertical depth of ice pick, boxcar, and rolling scars and its implications in skin of colour. Indian J Dermatol Venereol Leprol. 2026;92(1):14–21. PubMed 40826840
  8. Tobiasz A, Jankowska-Konsur A, Nowicka D. Topical retinoids in acne vulgaris and acne scars: from monotherapy to combining regimens. Pharmaceuticals (Basel). 2026;19(4):620. PubMed 42075875
  9. Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. 2012;379(9813):361–372. PubMed 21880356

Read next