Knowing what type of acne scars you have will help you figure out your acne scar treatment plan.
After all, you cannot treat your acne scars if you don't know which types of scars you have.
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.
Common Types Of Acne Scars
- 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 are common for individuals who have had patches of skin that have been afflicted by long-term inflammatory acne.
Rolling scars tend to become more pronounced as skin ages and loses its original elasticity and fullness.
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
Red light therapy can produce improvements in the appearance of rolling scars.
Cosmetic fillers are also occasionally used, but many times rolling scars tend to come in clusters so the large area makes fillers an unappealing option.
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 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:
- 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.
Some forms of laser therapy may be effective at disrupting the underlying scar tissue. Because ice pick scars are quite narrow, punch-out excisions are a popular, mildly invasive and effective treatment technique.
In general, all types of indented scars rest on top of a patch of fibrous, collagen-rich scar tissue.
This fibrous tissue anchors the base (bottom) of the scar to the subcutaneous tissue, maintaining the depression and preventing the regrowth of healthy tissue.
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 fibrous and firm scar tissue.
When the scar tissue forms in great excess, it can become a large nodule of dense, rubbery scar tissue that is known as a keloid.
The development of hypertrophic and keloid scars is less common in acne patients than the development of depressed scars.
Many factors can potentially be involved in the process of raised scars forming, including acne severity and duration, genetics and secondary infections.
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. Hypertrophic scars are generally less responsive to treatments like chemical peels because the scar tissue is much more resistant to the ingredients in a chemical peel and irritation or inflammation may cause more raised scars if someone is prone to it.
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.
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
- Vitamin C
- Azeliac Acid
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 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 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
opicals 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: Hyperpigmentation Therapy: A review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142815/
Acne scar treatments: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/
Guest Blog By:
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!