4 Types of Acne Scars and Their Treatments

Boxcar, ice pick, rolling, and keloid scars

Acne scars can be frustrating aftereffects of an acne breakout. They're not difficult to treat, but treatment is not always 100 percent successful. Even with the most careful and conscientious treatment, scarring may still occur. However, not all scars are created equal.

Types of Acne Scars

Generally, acne scars fall into two categories: those caused by a loss of tissue (atrophic), and those caused by an excess of tissue (hypertrophic). Within these categories, acne scars fall into one of four types: ice pick, boxcar, rolling and keloid scars.

Discolorations are not true scars but rather post-inflammatory hyperpigmentation, which will fade over time. This is the skin's natural response to inflammation and presents itself as a flat area of discoloration on the skin ranging from pink to red, purple, brown or black, depending on your skin tone and depth of the discoloration. Post-inflammatory hyperpigmentation develops when a wound, rash, pimple, or other stimuli cause skin inflammation, which triggers the skin to produce too much melanin.

Here's a look at the different varieties of acne scars and their recommended treatments.

Ice Pick Scars

Themeparkphoto/Wikimedia Commons

Appearance: Ice pick scars are deep, very narrow scars that extend into the dermis. The skin looks as if it has been pierced by an ice pick or sharp instrument. Ice pick scars seem to make a small, deep hole in the skin. Some may look like a large, open pore.

Development: Ice pick scars develop after an infection from a cyst or other deep inflamed blemish works its way to the surface. Skin tissue is destroyed, leaving a long column-like scar.

Common treatments: Ice pick scars can be treated with punch excision or punch grafting.

Boxcar Scars

Boxcar Acne Scar Image
Angela Palmer

Appearance: Boxcar scars are round or oval depressions with steep vertical sides. Wider than ice pick scars, boxcar scars give the skin a pitted appearance.

Development: When an inflammatory breakout destroys collagen, tissue is lost. The skin over this area is left without support, and a depressed area is created. Boxcar scars may be superficial to severe, depending on the amount of tissue lost.

Common treatments: Treatments for boxcar scars include punch excision or elevation, dermal fillers, and laser resurfacing.

Rolling Scars

Rolling Acne Scars
Photo © Angela Palmer

 

Appearance: This type of scarring causes rolling or wave-like depressions across otherwise normal-looking skin.

Development: Rolling scars arise when fibrous bands of tissue develop between the skin and the subcutaneous tissue below. These bands pull the epidermis, binding it to deeper structures of the skin. It is this pulling of the epidermis from within that creates the rolling appearance of the skin.

Common treatments: Rolling scars are best treated with subcision, which is a simple surgical procedure that involves cutting the scar's base so that it can elevate to the level of the rest of the skin.

Hypertrophic or Keloid Scars

Hypertrophic Acne Scar
Photo © Angela Palmer

Appearance: A hypertrophic scar looks like a raised, firm mass of tissue. These types of scars often grow larger than the original wound. Hypertrophic scars caused by acne are most often found on the torso, especially in men.

Development: Unlike ice pick or boxcar scars, hypertrophic scars are not caused by a loss of tissue. Rather, they develop because of an overproduction of collagen.

Common treatments: Steroid (cortisone) creams, silicone gels, cryotherapy (freezing the scars with liquid nitrogen), tapes, pulsed dye laser treatments, or injections are used to help shrink and flatten the scar. Interferon injections are also used to soften scar tissue.

Sources:

Fabbrocini, G, Annunziata, MC, D'Arco, V, et al. Acne Scars: Pathogenesis, Classification and TreatmentDermatology Research and Practice. 2010;2010:893080. doi:10.1155/2010/893080.

Tosti, A, De Padova, MP, Beer, KR, eds. Acne Scars: Classification and Treatment. London: Informa UK Ltd.; 2010.

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