"They are mostly cystic lesions that feel painful underneath the skin and they don't really connect with the surface easily," said Dr. Bowe. "The inflammation gets trapped in there."

Cystic pimples are inflammatory acne which involves more white blood cells rushing to the area and because there are more enzymes in that area, it leads to more destruction. The skin then tries to desperately heal itself which results in a scar.

There is a major difference between acne marks and scars.
People with darker skin often see post-inflammatory hyperpigmentation -- marks that appear brown. Those with lighter skin often develop post-inflammatory erythema -- which show up as purple or red marks.