Types of Acne Scarring

Types of Acne Scarring

Having acne scars can be frustrating and stressful, to say the least. If you have acne scars, you know that they can unfortunately affect the self-esteem of those who are affected by them. 

Many people will have acne multiple times throughout their life, whether it be mild or severe. And while many people experience acne scarring, some have an excess amount of scarring.

There are a few different types of acne scars. These different types of acne scars will require different types of treatment. Keep reading to learn the types of acne scarring, what causes them, and more. 

Types of acne scarring

close up image of acne scars

When it comes to acne scars, there are two primary categories that each type will fall under – atrophic or hypertrophic and keloid scars. 

Atrophic scars are the most common type of scarring. Within this atrophic category are three types of acne scars. These types include ice pick scars, boxcar scars, and rolling scars. 

Atrophic scars occur when the skin experiences a loss of tissue. These acne scar types appear as depressions or indentations in the skin. 

Alternatively, hypertrophic or keloid scars are the result of excess tissue on the face or body. This typically happens when the body produces too much new tissue or collagen as it tries to heal acne, wounds, or other skin conditions.  

Different types of acne scars can have different causes, as well as different treatments. It is also possible for you to have more than one type of scarring. 

While you may be tempted to try at-home remedies or use over-the-counter treatments, these will not be sufficient or strong enough to produce any noticeable changes in your scarring. It is important to see a professional for help with scarring and for frequent breakouts. 

Ice pick acne scars

Ice pick scarring is the most common type of acne scar seen, making up between 60% and 70% of acne scarring. You will typically see ice pick scars form on your cheeks. 

These appear as small but deep and v-shaped indentations in the skin. Ice pick scars are actually the deepest type of acne scarring, usually going past the first layer of skin and into the second layer, the dermis, and it can even extend into the subcutaneous tissue. They may also appear as large and open pores on the face. 

Ice pick scars are the result of deeply inflamed acne, infection, or cystic acne. As your body tries to heal the acne, the skin tissue becomes damaged, and the scar appears where the acne once was. This is common when your body cannot create enough protein or collagen to heal the deep acne or the damaged skin barrier. 

You are more likely to experience ice pick scars from frequent inflammatory acne as well as from cystic acne. 

Boxcar acne scars

This type of acne scarring is the second most common, appearing in 20% to 30% of people. This type of acne scarring is usually found on your cheeks and along your jawline. 

Boxcar scars are shallower than ice pick scars but are wider and more uneven scars as well. They are usually box, oval, or round shaped with distinguishable edges. 

Similar to ice pick scars, boxcar scars are a result of extensive and inflamed acne that destroys the collagen in the skin. Without collagen, the skin cannot heal itself properly and becomes damaged, resulting in scarring. 

Boxcar scars can vary in their severity. It can range from mild scarring to severe scarring, depending on how much damage has been done to the skin and how much tissue has been lost. This means that the treatment you require for boxcar scars will vary greatly as well.

Although these scars are typically a result of acne they can also be caused by chickenpox, also known as varicella. This virus irritates the skin and can result in the same kind of damage as acne, causing the same kind of scarring. 

Rolling acne scars

Rolling acne scars are also a shallower kind of scarring, although they can be different depths depending on the amount of damage done to the skin. This type of acne scar affects 15% to 25% of people. 

Rolling acne scars tend to be the widest of the scars and have sloped and less defined edges. This will create a rolling appearance, causing an uneven surface and texture across your skin. 

Frequent inflammatory acne is the culprit behind rolling acne. If your skin cannot create enough collagen to heal this acne, then the tissue will become damaged.

This damaged tissue will turn into bands that form between the skin and subcutaneous tissue. These bands will pull the top layer of skin towards the dermis, anchor it, and thus create this wavy uneven scarring. 

Hypertrophic scars

Hypertrophic scars differ from the previously mentioned scar types because they form as raised scars on the skin rather than depressions. 

These acne scars are often firm lumps and can be commonly found on areas such as your chest, back, shoulders, and arms. Although, these scars can form anywhere. 

Shallow acne or wounds that do not reach your dermis do not usually cause hypertrophic scarring. It is believed that these scars come from damage to deeper skin layers. 

Hypertrophic scars may result from acne but are also typically the result of an injury or wound. Skin trauma such as burns, piercings, insect bites, skin conditions, and surgery may be the cause of your hypertrophic scar. 

Unlike the other scar types with insufficient collagen, hypertrophic scars come from an excess of collagen. This surplus of collagen will cause your skin to form scars from the excess tissue. Hypertrophic scars will replace the spot where inflammatory or cystic acne was.

Keloid scars

Keloid scars are also raised scars formed from damaged tissue. However, keloid scars are a worse variety of scarring than hypertrophic scarring. 

While hypertrophic scars will take over the spot where acne or a wound occurred, keloid scars will grow past the original spot and become larger. This type of scarring can continue to grow after the acne or injury has healed. 

This continued growth happens because the skin continues to produce collagen even after the skin has healed. 

Like hypertrophic scars, your keloid scars can also be the result of either acne, injury, or skin conditions. Prolonged inflamed acne can create an overgrowth of keloids on your skin.  

Keloids also frequently affect the chest and other parts of the upper body; however, they may also appear on your jawline.

Hyperpigmentation from acne

Hyperpigmentation from acne is not the same as an acne scar. This issue is a discoloration on the skin after acne has healed. This discoloration may also occur when your skin and acne are frequently picked at.

Unlike scarring, the surface of your skin will still be smooth even when discolored. Hyperpigmentation can be seen on your skin as pink, red, brown, or even purple coloring. 

Skin hyperpigmentation occurs after acne has healed. The discoloration is a result of your skin overproducing melanin during the healing of acne or a kind of injury. 

Hyperpigmentation will typically clear up on its own over time. Although, you can use over-the-counter topical treatments to help get rid of the discoloration. 

What treatment will I need for my acne scars?

woman getting a dermatoligist treatment microdermabrasion

The type of treatment you will need for your acne scars depends on a few factors. The main factor is the type of scarring you have. 

A dermatologist can help you to create a treatment plan for your acne scars. They will also help to treat any current breakouts to reduce the likelihood of more scarring and speed up the overall healing process. 

It’s also important to mention that many of these procedures may leave scars as well, but they are typically less noticeable than the acne scarring you may already have.

Here we have a quick breakdown of the common types of treatment used for each type of acne scar. 

Ice pick scar treatment

The most common forms of treatment for ice pick scars are punch excision and punch grafting. Both are outpatient procedures that can be performed under local anesthesia.

Punch excision is a procedure in which your physician will use small tools to cut the scars out. The hole is then closed with a suture and left to heal. 

Punch grafting is very similar to punch excision. A small tool is used to remove the scar. Although rather than closing the hole, skin is grafted over it to help it to close and heal. The skin is commonly taken from behind the ear. This treatment is more common for deeper ice pick scars.

Laser resurfacing can also be used for ice pick scarring. This procedure uses a laser on your face to remove layers of skin. This will cause your skin to produce collagen and begin to heal itself and any current scarring you have. However, some ice pick scars may be too deep for this to work. 

Boxcar scar treatment

Dermal filler is the most popular method used for boxcar scars. This procedure is usually quick and easy and can also be done as an outpatient procedure. 

Dermal fillers are gel-like substances that are injected into the skin with a needle. These substances are used to fill up the space under boxcar scars, raising the indentation to create an even surface. 

If you have boxcar scars, you may also benefit from laser resurfacing to heal your scars and smooth out your skin texture. 

Rolling scar treatment

For rolling scars, the most common treatment is subcision. This is another process that can be done quickly and under local anesthesia.  

This procedure involves a hypodermic needle being inserted into the skin. The physician will then cut the fibrous tissue that is binding the epidermis to deeper skin layers. This will help to create a smoother skin tone. 

Hypertrophic and keloid scar treatment

Hypertrophic scars are usually treated with corticosteroid injections into the scar tissue. This helps to lower the inflammation in the scarring, allowing it to heal.

Laser treatments and topical creams are also common treatments for hypertrophic scars. Others use cryotherapy to treat these scars. In cryotherapy, liquid nitrogen is used to destroy scar tissue and even out the skin. 

In more extreme cases or when other options have failed, surgery may be used to remove your hypertrophic scars. 

Keloid scars may need to be handled before other types of scarring because they will continue growing. 

How can I prevent acne scarring?

Using preventative measures is the best way to avoid acne scars. Having a consistent skincare routine, washing your pillowcase and bedsheets regularly, and not picking at any blemishes or acne on your face are the most important ways to prevent acne scars. 

However, even those who take great care of their skin can experience acne scarring. You should always consult a dermatologist if you continue to have frequent breakouts or scarring. 

Will my acne scars become worse as I age?

Current acne scars may not become worse over time, although they may appear to worsen as the skin loses fat and elasticity, and as collagen production slows. However, keloid scars may worsen over time, therefore seeing a professional for these types of scars is the best thing you can do. 

Are acne scars permanent?

Acne scars may not be permanent, although some types of scarring are easier to treat than others. The type of treatment and the amount of treatment needed will depend on the type of scarring as well as the severity of the scarring.  

To learn more about this topic, read our article about whether acne scars are permanent.

Final Words

Having any kind of issue with your skin can be challenging and make your day-to-day seem harder. But there are ways to prevent and treat these issues, including acne scarring.  We hope you find this post helpful and feel better able to take on your acne scars and give yourself the beautiful skin you deserve! 

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