Acne Scars vs Pigmentation: How to Tell the Difference and Which Treatment Is Right for You

Acne scar treatments in London

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By Dr Hiba Injibar | Consultant Dermatologist, Dermasurge Harley Street

Introduction

If you’ve been dealing with marks left behind after a breakout, you’re not alone. Post-acne skin changes are one of the most common concerns we see at Dermasurge — and one of the most frequently misunderstood. Many patients come in describing “acne scars,” when what they’re actually experiencing is post-inflammatory pigmentation. Others assume their dark spots will fade on their own, not realising they’re dealing with a structural scar that requires a different approach entirely.

The distinction matters — because the right treatment depends entirely on what you’re actually treating. Understanding your skin is the first step to lasting results.

In this guide, we’ll walk through how to identify whether you’re dealing with acne scarring or pigmentation, what causes each, and the evidence-based treatment options available at a specialist dermatology clinic in London.

What Are Acne Scars?

Acne scars are structural changes to the skin. They form when a breakout — particularly a deep, inflamed one — damages the dermis, the deeper layer of skin beneath the surface. As the skin attempts to repair itself, it may produce too little collagen (leading to a depressed scar) or too much (leading to a raised one).

There are several distinct types of acne scars:

• Ice pick scars — Deep, narrow channels that extend into the skin. Often seen on the cheeks and are among the most difficult to treat.
• Boxcar scars — Broad, box-shaped depressions with defined edges, typically on the cheeks or temples.
• Rolling scars — Shallow, undulating depressions that give the skin a wavy or uneven texture.
• Hypertrophic or keloid scars — Raised, thickened scars that sit above the skin surface. More common in individuals with darker skin tones.

The key characteristic of a true acne scar is that it involves a change in the texture or structure of the skin. Run your finger across the area — if the surface feels uneven, pitted, or raised, you are most likely dealing with a scar rather than a colour change alone.

Acne scars do not fade with time in the same way pigmentation can. They are permanent unless treated directly.

What Is Post-Acne Pigmentation?

Post-inflammatory hyperpigmentation (PIH) is a flat, discoloured mark left on the skin after inflammation — in this case, after a spot has healed. It is not a scar. The skin’s texture remains smooth; only the colour has changed.

PIH occurs because inflammation triggers the skin’s melanocytes — the cells responsible for producing pigment — to go into overdrive. The result is a patch of skin that appears darker than the surrounding area, ranging from pink or red in lighter skin tones to brown or deep purple-brown in medium and darker complexions.

Post-inflammatory pigmentation is extremely common and, importantly, it can fade over time — particularly with appropriate treatment and sun protection. However, without intervention, some marks can persist for months or even years, especially in those with higher levels of natural melanin.

It’s also worth distinguishing PIH from a separate but related condition: post-inflammatory erythema (PIE). PIE presents as pink or red flat marks and reflects vascular changes rather than excess pigment. It’s more commonly seen in lighter skin tones and generally responds well to specific laser treatments.

Acne Scar vs Dark Spots: A Practical Way to Tell the Difference

When patients ask about the difference between an acne scar and a dark spot, we often suggest a simple self-assessment:

1. Look at the texture. Stand near a light source and examine the area from the side. Does the skin sit flat, or are there dips, pits, or raised areas? If the texture is altered, it’s more likely a structural scar.
2. Assess the colour. If the skin is smooth but discoloured — darker or redder than the surrounding skin — this points more towards pigmentation or erythema.
3. Consider how long it’s been there. Fresh marks from a breakout that healed within the last few months are more likely to be pigmentation. Long-standing marks that haven’t changed are more likely to be scars.
4. Think about how the original spot presented. Deep, cystic, or nodular acne is more likely to leave structural scars. Superficial spots are more likely to leave pigmentation.

In practice, many patients present with both — areas of pitting or textural change alongside overlying discolouration. This is why a professional assessment is so important before committing to any treatment pathway.

Evidence-Based Treatment Options

At Dermasurge, our approach to both acne scar treatment in London and pigmentation treatment is grounded in clinical evidence and tailored to your individual skin type, concern, and goals. There is no one-size-fits-all solution, and our team prioritises patient safety and outcomes above all else.

Treatments for Acne Scars

Structural acne scars require treatments that stimulate collagen remodelling or physically alter the scar tissue. Clinically proven options include:

Dermal filler — In some cases, hyaluronic acid filler can be used to temporarily elevate depressed scars, improving the appearance of the skin surface. Performed by experienced practitioners.

Microneedling (Collagen Induction Therapy) — Fine needles create controlled micro-injuries in the skin, stimulating the body’s natural collagen and elastin production. Particularly effective for rolling and boxcar scars. Multiple sessions are typically recommended for optimal results.

Fractional laser resurfacing — Medical-grade laser energy targets the dermis to promote collagen regeneration and improve overall skin texture. Suitable for a range of scar types and can be adjusted based on skin tone and scar depth.

Subcision — A minor in-clinic procedure in which a fine needle is used to release fibrous tissue tethering a depressed scar to the deeper skin layers, allowing it to lift. Often combined with other treatments for enhanced results.

TCA cross (chemical reconstruction of skin scars) — A precise application of trichloroacetic acid into ice pick scars to stimulate collagen formation from within the channel. A highly targeted treatment for this specific scar type.

Dermal filler — In some cases, hyaluronic acid filler can be used to temporarily elevate depressed scars, improving the appearance of the skin surface. Performed by experienced practitioners.

Treatments for Pigmentation

Pigmentation treatment in London typically involves either inhibiting melanin production, accelerating cell turnover, or using targeted energy to break down pigment. Options include:

• Topical prescription agents — Medical-grade formulations containing ingredients such as azelaic acid, tranexamic acid, retinoids, or hydroquinone can effectively reduce pigmentation over time when used consistently under clinical guidance.
• Chemical peels — Controlled application of exfoliating agents to remove the surface layers of skin, reducing the appearance of pigmentation and improving overall skin tone. Different peel depths are available depending on the severity of the concern.
• Laser treatment — Certain laser wavelengths target melanin directly, breaking down pigment so it can be cleared by the body. Particularly useful for stubborn or deep pigmentation.
• IPL (Intense Pulsed Light) — Broad-spectrum light therapy that can address both redness and pigmentation. Most suitable for lighter skin tones and requires careful patient selection.

Sun protection is non-negotiable throughout any pigmentation treatment programme. UV exposure stimulates melanin production and will actively counteract any clinical treatment, so daily use of a broad-spectrum SPF 30 or higher is a core part of every plan we recommend.

How to Treat Acne Scars and Pigmentation Together

When both structural scarring and pigmentation are present — which is common — treatment is typically sequenced rather than delivered simultaneously. In most cases, pigmentation is addressed first, as it can make the skin appear more even and allow for more accurate assessment of the underlying texture. Once pigmentation is better controlled, resurfacing or collagen-stimulating treatments can be introduced.

The best treatment for acne scars in the UK is not a single modality but a tailored combination protocol, adjusted based on your skin type, Fitzpatrick classification, the types of scars present, and your lifestyle. A thorough consultation with a qualified dermatology team is essential before beginning any treatment programme.

At Dermasurge, we never recommend a treatment without first understanding the full picture. Every plan is individual, evidence-based, and delivered with your long-term skin health in mind.

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Frequently Asked Questions

Can acne scars be fully removed?

Full removal isn’t always possible, but significant improvement is achievable with the right treatment approach. The aim of most acne scar treatment is to reduce the depth and visibility of scarring, improve skin texture, and create a more even complexion. Results vary depending on scar type, skin tone, and treatment method. A realistic assessment of expected outcomes is always part of our consultation process.

Will my dark spots fade on their own?

Post-inflammatory hyperpigmentation can fade naturally over time, particularly in lighter skin tones. However, the process can take anywhere from a few months to over a year, and is significantly slowed by sun exposure. Clinical treatments can accelerate fading considerably. Without treatment or adequate sun protection, some marks may persist indefinitely.

Is acne scar treatment suitable for darker skin tones?

Yes, but the approach requires careful consideration. Some laser and light-based treatments carry a higher risk of post-inflammatory pigmentation in medium to dark skin tones if not properly selected and calibrated. At Dermasurge, we have experience treating a full range of skin types and will always select the safest and most appropriate treatment for your individual skin. Patient safety and outcomes are prioritised in every decision we make.

How many treatment sessions will I need?

This depends on the type and severity of scarring or pigmentation, the treatment selected, and how your skin responds. Most patients see meaningful improvement over a course of three to six sessions, though some concerns may require more. We will give you a realistic expectation of timelines at your consultation — and we won’t recommend more treatments than are clinically indicated.

Can I treat acne scars and active acne at the same time?

Generally, active acne should be stabilised before beginning resurfacing or collagen-stimulating treatments. Treating active breakouts alongside scar treatment can increase the risk of further inflammation and new scarring. Our team will assess your skin holistically and may recommend a period of medical management for active acne before proceeding with scar or pigmentation treatments.

Conclusion

Acne scars and pigmentation are two distinct concerns that are frequently confused — and for good reason. They often appear together, share similar origins, and are both deeply personal to the people who experience them. But they respond to different treatments, and using the wrong approach can lead to frustration, wasted time, and occasionally, worsened results.

Getting clarity on what you’re dealing with is the foundation of any effective skin treatment plan. Whether you’re seeking acne scar treatment in London, pigmentation treatment, or a combination of both, a thorough clinical assessment is the right place to start.

Understanding your skin is the first step to lasting results — and you don’t have to navigate it alone.

Ready to take that first step? Book a consultation with our dermatology team at Dermasurge. We’ll assess your skin thoroughly, explain your options clearly, and build a treatment plan that’s right for you — book your appointment here.

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