Types Of Acne Scars and How To Treat Them

April 06, 2021 6 min read 0 Comments

types of acne scars

Knowing what type of acne scars you have will help you figure out your acne scar treatment plan. After all, you cannot treat your scars if you don't know which types of scars you have.

Depressed scars are the most common type of scar that results from inflammatory acne. Within this class of scars there are three main types that are common in acne sufferers.

Quiz To Find Your Acne Scar Type & Best Treatments

 

Common Types Of Acne Scars

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

 rolling scars

1. Rolling scars

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

Rolling scars are a type of scar that is common for individuals who have had patches of skin that have been afflicted by long-term inflammatory acne. They tend to become more pronounced as the 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 treatment techniques are capable of producing positive results.

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

Red light therapy can produce improvements in the appearance of rolling scars. Cosmetic fillers are also occasionally used, but many times the large size of the affected area makes fillers an unappealing option. Mild surgical procedures, such as micro-needling are also used.  You can also try microneedling treatments at home. 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.  

boxcar scars

2. Boxcar scars 

Boxcar scars are also relatively broad depressions, but have steep defined edges, and are easier to feel the defined areas. 

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. Laser resurfacing, particularly ablative resurfacing with an Er:YAG or CO2 laser, often produces good results, although many treatments may be necessary to achieve maximum improvement.

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, but these treatments are not very effective for deep scars. Surgical options include punch- out excisions, microneedling and surgical subcisions.

ice pick scars

3. Icepick scars

Icepick scars,  as the name implies, are deep and narrow 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. 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 icepick scars are quite narrow, punch-out excisions are a popular, mildly invasive and effective treatment technique.

In general, all types of depression 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.

Effective treatments for depressed acne scars usually involve disrupting or removing this scar tissue to allow its replacement with functional, healthy tissue.

 hypertrophic scars

 

4. Hypertrophic or Keloid Scars

Commonly called hypertrophic or keloid scars, raised scars present a different problem than depressed scars. Hypertrophic scars are those in which 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. A number of factors can potentially be involved in the process, 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 of regulating and reducing 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.  They 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. 

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 it's 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 

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
  • 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.  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. Hyper-pigmentation 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.

 

hypopigmentation

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

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 somewhat common in acne patients and is most visible in 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.  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. 

 

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Guest Blog By:

profile veganacnesufferers

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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