Types of Acne Scars
Unlike atrophic scars, hypertrophic and keloid scars form as raised lumps of scar tissue where the acne once was. This happens when scar tissue builds up, sometimes from previous acne spots.
So if you got here, you’re probably wondering if there’s anything you can do to get rid of your acne scars. You’ve also probably discovered that there’s tons and tons of information out there, and it’s not as easy as just putting on a creme and calling it goodnight either. Some dermatologists even suggest that you don’t even use home products as they can be dangerous!
Essentially, acne scarring is a byproduct of healing, naturally or otherwise, and for many people it’s completely unavoidable. Almost everyone deals with acne scars at some point in their lives, and the types of scarring you can expect depends on the acne type and how you treat it. In general, moderate acne involves red bumps and pus-filled pimples, whereas severe acne, like cystic acne, leaves pus filled bumps, or cysts, beneath the skin.
When these cysts heal bright red or brown marks are left on the skin, and these fade away by themselves over time. However, in severe cases, permanent scarring usually develops as the skin heals, especially if the acne was picked or squeezed instead of being treated.
Atrophic Acne Scars
What is Atrophic Scarring
Atrophic scarring usually occurs while cystic acne is being healed and is caused by destruction or loss of collagen. These scars are best described by flat, shallow depressions or ‘craters’ that heal below the skin. They are the most common kind of scarring and can be classified into three different types: Rolling, Boxcar, and Icepick.
Rolling Acne Scars
What are rollings scars
Rolling scars are the most common type of scars that form when long-term inflammatory acne is healing. Furthermore, rolling scars are best described as oval, uneven scars of varying size that form on the cheeks and chin. However, they can form anywhere on the body.
What causes rolling scars
Rolling scars form when the proteins that provide structure to the skin are destroyed. While there are open wounds on the skin, the body does its best to heal and close these wounds. This can cause uneven skin in the lack or buildup of collagen.
How to treat rolling scars
There is no one definitive way to treat rolling scars, but most treatment plans can be classified into stages. In the first stage, effort will be made to make sure that there is no skin discoloration. This is usually accomplished with creams or medication.
The next stage involves making sure that scar depth or height is more or less equal. That is, the scarring is made less deep and becomes flat. This stage is where more surgical methods are appropriate. These surgical methods include:
- In rolling scars, scars are dragged down by residual fibers left in the skin. In the subscision process, tools are used to separate the two planes of skin and release the scars, helping the skin level out in the process.
- This is the process whereby the scar is literally cut from the skin, and stitched back together. This forms a new scar, usually smaller and more even that the previous rolling scar.
- This treatment is sometimes known as collagen induction therapy. It works by using a special tool to create several, tiny injuries within a scar. These injuries usually heal within two days and new collagen is formed inside of the scar. When this treatment is coupled with Radio Frequency, appropriately called RF MIcroneedling, collagen production is greatly enhanced.
- This method is less effectiv than others at remove deep scaring because it involves removing the top layers of skin, much like sanding paper. The point is to strip enough layers of skin to stimulate collagen production.
- Laser Therapy
- Ablative laser therapy uses high energy lasers to remove outer layers of skin whilst encouraging new collagen production in the lower layers of skin. Non-ablative laser therapy uses heat to encourage new collagen production in the skin without damaging the outer layer by disrupting those underneath it.
The next stage in the treatment involves making sure that there is no skin discoloration, and to further even out the skin. These are generally less invasive or even non-invasive, and actually might just be continued versions of the treatments listed above. However, chemical peels and other treatments, such as the Hydrafacial, are very beneficial to restoring the skins luster.
Icepick scars are deep and narrow scars develop from more severe types of acne. They are also more difficult to treat than most other types of acne scars, which is why most people seek professional help. Even though professional help may not completely cure these scars, it will at least reduce the severity of the scarring and make them less obvious.
What causes icepick scars
Icepick scars are created when more severe types of acne, such as cystic acne, are healing. This is because cysts and other papulae tend to develop much deeper in the skin than normal acne, causing a scar that extends much further into the skin.
Boxcar Acne Scars
Boxcar scars are our last type of acne scar. They are scarring that occurs in between rolling and icepick scars-- not as wide as rolling scars but not as deep as icepick scars. When they form, they usually have a flat bottom, and it looks like a ‘box’ has been pressed into the skin. However, this can be slightly misleading as the edges of the scar do not have to be straight.
What causes boxcar scars?
Boxcar scars are caused by widespread acne, chickenpox, or varicella, a virus causing a red, itchy rash with blisters. They are more common than icepick scars, but less common than rolling scars. In total, 20-30% of acne scars are usually boxcar scars!
How to get rid of boxcar scars?
Like rolling scars, the treatment methods depend mainly on the severity and depth of the scarring. All of the treatments for rolling scars can also be used to treat boxcar scars as they are very similar in nature.
Hypertrophic scars vs. keloid scars
Hypertrophic scars and keloid scars are a different type of scarring than Atrophic scars all together. If atrophic scars form beneath the skin, then hypertrophic scars form above the skin. Moreover, these scars tend to form from any minor injury, such as a small pimple or a big gash. They form because of overactive responses to the wound, where extra collagen and granulation tissue is formed.
In general, hypertrophic scars do not have edges that spill over, but do raise upwards. Keloids tend to be larger scars than the wound edges themselves and usually ‘spill over.’
Hypertrophic Acne Scars
What is a hypertrophic scar?
When collagen is overproduced in the healing process of a wound, a hypertrophic scar may form. These scars can develop in any part of the body, and usually have a red/pink color and are slightly raised.
Hypertrophic scars tend to develop in places where a wound is placed under consistent tension or duress, such as when a wound is open for a long time, infected, or in an area that moves a lot such as the knee. However, mild injuries such as acne, small cuts, or even piercings can cause hypertrophic scars too.
How to get rid of hypertrophic acne scars
Although these scars are benign in nature, they are not very pretty sometimes. To alleviate the scarring, and in some cases remove it completely, many treatments can be performed. All of the treatments listed above are very effective for treating hypertrophic scars. Moreover, massages and corticosteroid injections can also be used to break up the collagen buildups in locations other than the face.
Corticosteroid injections into hypertrophic scars is a treatment highly recommended by many dermatologists. These agents break up collagen bonds and reduce inflammation-- the two main symptoms of hypertrophic scars.
Massages also work well for hypertrophic scars, and they are performed in many treatment centers for burns and wound recovery. By stretching the skin out, collagen can be broken up and scars can be released. However, it can be difficult to massage the face.
What is a Keloid Scar
Sometimes confused with hypertrophic scars, keloids are scars that are generally much bigger than the original wound. This gives the scar the appearance of ‘slipping over.’ Keloids are more likely develop on the ears, shoulders, neck, chest, and back-- and usually are pink/purple. Unlike hypertrophic scars, however, keloid scars can grow over time.
What Causes Keloid Scarring
The full causes of keloid scarring are not entirely understood yet. However, in cases where keloids form instead of hypertrophic scars, people generally tend to have higher concentrations of melanin, or darker skin. Moreover, people with a family history of keloid scarring tend to form more keloids, which leads us to believe individuals have a genetic predisposition to keloid scarring.
How to treat keloid scars
Keloid scars benefit from the full array of treatments listed above, as well as corticosteroid injections, massages, and cryotherapy, where liquid nitrogen is used to freeze the scar and force the collagen to break into smaller portions. However, there is no one blanket treat for all keloid ointment. Instead, patients should have a discussion with a licensed skin care provider, where all treatment options can be organized and discussed in a professional setting.