For people who have moderate to severe acne, acne scars are a common concern. These marks can vary in appearance, depth, and texture, depending on how the skin healed after inflammation. Understanding the types of acne scars is an important step in identifying suitable management options and setting realistic expectations.
This article explains the different forms of acne scars, including deep acne scars, how they develop, and how they differ from temporary acne marks.
Types of Acne Scars
Boxcar acne scars
Boxcar acne scars are a form of atrophic scar, meaning they involve a loss of tissue. These scars appear as shallow to deep depressions with defined edges. They are often wider than ice pick scars and may give the skin an uneven surface.
Boxcar scars are commonly seen on the cheeks and temples. When these scars extend deeper into the skin, they may be classified among deep acne scars.
Ice pick scars
Ice pick scars are narrow, and they extend into the deeper layers of the skin. They often resemble small puncture marks and are typically difficult to manage.
Because of their depth, ice pick scars are considered one of the severe forms of deep acne scars. They usually develop after cystic acne and may not improve without targeted medical procedures.
Rolling scars
Rolling scars are characterised by broad depressions with sloping edges. These scars create a wave-like or uneven texture across the skin. They are caused by fibrous bands that pull the skin downward during healing.
Rolling scars often become noticeable under certain lighting conditions and are commonly found on the lower cheeks and jawline.
Hypertrophic and keloid scars
These two types of acne scars are shown as raised scars. They can form when the body produces excess collagen during healing.
- Hypertrophic scars remain within the original boundary of the acne lesion
- Keloid scars extend beyond the original area and may continue to grow over time
These scars are common on the chest, shoulders, jawline, and back, and may be influenced by genetic factors.
Treatment for Atrophic Scars
Atrophic scars include ice pick scars, boxcar scars, and rolling scars. These scars are caused by a loss of collagen during the healing process. Treatment options for atrophic scars may include:
- Procedures that stimulate skin repair responses, including the use of energy-based devices such as lasers, microneedling RF, and collagen biostimulator injectables.
- Techniques that release fibrous tissue beneath depressed scars, such as subcision treatment.
- Targeted treatments based on scar depth and distribution
Fractional CO2, Pico Laser, and injectable treatments may be considered for rolling and boxcar scars, as these approaches can support the skin’s natural repair responses.
Treatment for Hypertrophic and Keloid Scars
Raised scars require a different approach from atrophic scars. Management may focus on reducing scar thickness and limiting further growth. Common approaches may include:
- Injectable medications to reduce inflammation
- Pressure-based therapies
- Other procedures guided by a healthcare professional
Because keloid scars may recur, long-term follow-up is often part of management.
What’s the Difference Between Acne Marks and Acne Scars?
Acne marks and acne scars are often confused, but they are not the same. Acne marks refer to flat areas of discoloration that remain after acne heals. These marks may fade over months. But acne scars involve permanent changes to skin texture caused by collagen loss or excess collagen formation.
Identifying whether a concern is a mark or a scar helps determine whether medical treatment may be helpful.
How to Prevent Future Acne Scars
Preventing acne scars focuses on reducing inflammation and supporting proper skin healing.
Key steps include:
- Seeking early treatment for persistent acne
- Avoid picking or squeezing acne lesions
- Following a consistent skincare routine
- Protecting the skin from excessive sun exposure
- Consulting with the professionals for ongoing acne concerns
Conclusion
There are several types of acne scars, each with distinct characteristics and causes. Atrophic scars, including boxcar, ice pick, and rolling scars, result from tissue loss, while hypertrophic and keloid scars are caused by excess collagen. Understanding these differences helps guide appropriate care and manage expectations when addressing deep acne scars.
Frequently Asked Questions
How do I identify my acne scar type?
Identifying the type of acne scar involves examining the texture and appearance of the skin. Depressed scars may indicate atrophic scars, while raised scars suggest hypertrophic or keloid scars.
Can you 100% remove acne scars?
Complete removal of acne scars may not be possible in all cases. Some scars may improve in appearance with treatment, while others may remain visible. Outcomes vary depending on scar type and individual healing response.
Which acne scar is hard to remove?
Deep acne scars, such as ice pick scars, are often challenging to manage due to their depth. These scars may require specialised medical procedures and may not respond to topical treatments alone.
