Types Of Acne Scars and How To Treat Them

Knowing what type of acne scars you have will help you figure out your acne scar treatment plan as different scar types respond to different types of treatment.

Acne scars are either raised, or indented and depressed scars. The depressed scars are the most common type of acne scarring that results from inflammatory acne. 

Below we'll explain the different types of acne scars along with photo examples and how to treat each acne scar type. 

Types Of Acne Scars

 

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• Ice Pick Scars
• Boxcar Scars 
• Rolling Scars
• Hypertropic Scars

 

1. Rolling scars

Rolling scars are relatively broad acne scars in the skin that have rounded, sloping edges.  When there are several of these types of acne scars in a region of skin gives it a rolling appearance, hence the name.

Rolling scars can have differing depths. They are common for individuals who have had patches of skin that have been afflicted by inflammatory acne.

Rolling scars tend to become more pronounced as skin ages and loses its elasticity.

How To Treat Rolling Scars

Because rolling scars have rounded, sloping borders, many of the available scar treatments can produce positive results.

• Laser resurfacing (ablative and non-ablative)
• intense pulsed light (IPL),
• chemical peels
• microneedling
• micro-dermabrasion
• Subcision

Red light therapy can produce improvements in the appearance of rolling scars.

Mild procedures, such as micro-needling are also used.  You can also try microneedling treatments at home with more shallow needle lengths. Make sure you purchase a high quality microneedling tool to safely reduce the look of rolling scars. 

Banish sells good quality microneedling kits for home use designed for acne scars.  

2. Boxcar scars 

Boxcar scars are a type of acne scar with broad depressions, but have steep and sharp defined edges.

Because boxcar scars have more clearly defined and steeper edges than rolling scars, it is more difficult to smooth them out and blend them into the surrounding skin.

How To Treat Boxcar Scars:

Boxcar scars often cover smaller areas than rolling scars and are better candidates for cosmetic fillers. Treatments for boxcar scars include:

• Microneedling
• Dermal Fillers
• Chemical peels
• Surgical Subcisions
• Punch out excisions

Shallow boxcar scars can be treated with chemical peels and/or micro-dermabrasion too, but these treatments are not very effective for deeper boxcar scars.

Surgical options include punch- out excisions, microneedling and surgical subcisions.

3. Icepick scars

Icepick scars,  as the name implies, are deep and narrow acne scars.  In many cases, they resemble a large, empty pore in the skin.  

How To Treat Ice Pick Scars:

Icepick scars are often the most difficult type of acne scar to treat without surgical intervention.

Icepick scars are often quite deep, making them very difficult to treat with standard resurfacing techniques and require more aggressive treatments.

Best treatments for ice pick scars include:

• Punch Excision
• Punch Grafting

Chemical peels, micro-dermabrasion and many types of laser resurfacing are unlikely to have a significant impact on icepick scars because those techniques do not remove enough tissue to be effective, but best to consult with a dermatologist experienced in treating ice pick scars.

Because ice pick scars are quite narrow, punch-out excisions are a popular, mildly invasive and effective treatment technique.

 

 

 

4. Hypertrophic or Keloid Scars

Raised acne scars are called hypertrophic or keloid scars.

Raised scars present a different problem than depressed acne scars. Hypertrophic scars form when excess scar tissue forms at the site of the injury, which presents as a raised region of firm scar tissue.

When the scar tissue forms excessively, that scar tissue that is known as a keloid.

Hypertrophic and keloid scars are usually not commonly formed from acne. 

How To Treat Hypertrophic Scars

Because hypertrophic and keloid scars are raised and usually due to excess of collagen, they will need treatments that do the opposite so you'd want to regulate and reduce collagen.

Common treatments include

• Silicone sheets
• Pressure Dressings

Both of these treatments work better on newer hypertrophic scars and they regulate the production of collagen and add downwards pressure on the scar to compress it. 

Raised scars can also be surgically removed.  

Are Dark Spots An Acne Scar?

The next two type of skin conditions aren't a true scar since they don't contain scar tissue.  Rather they are discolorations that tend to happen after acne. 

This discoloration post acne can fade away on its own over time, however it can take a very long time to fade or even darken more if you're not following the proper skin regimen.  

 

Hyperpigmentation

Perhaps the most common long-term form of acne scarring is the discoloration of the skin.

Hyperpigmentation is a condition where elevated levels of the pigment melanin accumulate in the skin. This creates the appearance of freckle-like spots or blotches. Hyperpigmentation occurs when melanocytes (the cells that produce the melanin pigment) begin to proliferate at the site of injury, or when an existing population of melanocytes begins to produce excess amounts of melanin. Both of these events can result from skin trauma caused by an inflammatory acne lesion. Hyperpigmentation is more likely in those with darker skin tones.

How To Fade Hyperpigmentation

• Microneedling
• Vitamin C
• Azeliac Acid
• Retinol
• Sunscreen
• Niacinimide
• Laser

You can buy skincare that contains Vitamin C, Retinol and try microneedling to speed the healing of hyperpigmentation.   

Sunscreen is also important since UV exposure can darken hyperpigmentation and a lot of skincare and cosmetic products lose effectiveness when exposed to the sun. 

Hyperpigmentation is often treated in office too with laser treatments that specifically target melanin, such as KTP and pulsed dye lasers, as well as intense pulsed light (IPL) therapy.

Hyperpigmentation is also addressed with prescription medications like hydroquinolone, which inhibits the production of melanin, and topical retinoids, which increase the rate of cellular turnover in the skin.

 

Hypo-pigmentation

Hypo-pigmentation occurs when melanocytes are depleted from the injury site or lose their ability to produce melanin. This is often the case in areas of skin that have been replaced with scar tissue, which tends to have a light, pinkish appearance. It can also occur in otherwise healthy looking regions of skin.

How To Treat Hypo-pigmentation:

Generally, this condition is more noticeable in those individuals with darker base skin tones. Vitiligo is a condition in which melanocytes lose the ability to produce melanin. There are not many effective treatments available for hypo-pigmentation.

 

Erythema

Erythema is a condition in which small capillaries near the surface of the skin become damaged or permanently dilated and erythema look like red marks. Occasionally, individual capillaries are visible.

It is common in acne patients with lighter skin tones.

How To Treat Erythema: Erythema may be treated with topical prescription medications to decrease vasodilation, but the results are usually temporary. Erythema generally responds well to laser and light-based treatments that selectively target hemoglobin, such as argon and pulsed dye lasers.  T

Topicals like vitamin c can also reduce the red marks from Erythema

Knowing the different types of scars is indeed helpful. From there, you will be able to identify which type of treatment would work for your types of acne scars. 

 

References

Desai SR. Hyperpigmentation therapy: a review. J Clin Aesthet Dermatol. 2014 Aug;7(8):13-7. PMID: 25161755; PMCID: PMC4142815.

Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol. 2017 Sep;10(9):12-23. Epub 2017 Sep 1. PMID: 29344322; PMCID: PMC5749614.

Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med. 2022 May 12;11(10):2744. doi: 10.3390/jcm11102744. PMID: 35628870; PMCID: PMC9147527.

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I first got acne in high school, and it came back in my early adulthood. I was able to struggle through those difficult times and come out of it a stronger, wiser, healthier person as a result. I'm here to help you do the same thing!

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