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Types of Acne Scars: Pictures, Diagnosis and Treatments 

 November 5, 2020

By  Mikey Almeida

For most people, acne is a fact of life, albeit an unpleasant one. More than 90% of people, across the globe, will experience acne at some point in their life.

 

If you are someone currently experiencing acne or struggling with acne scars from acne in your past, you are not alone! Dealing with acne or acne scars can sometimes feel isolating. While it is a common condition, acne, and the resulting, long-lasting scars, can have a profound effect on your self-esteem and other areas of your life. 


But it's important for you to know: acne scars are treatable. And the key to finding the right treatment is starting with the right diagnosis. So what are the types of acne scars? Where can you learn more about the different types of acne scars?


Here at Miami Skin Spa, we promise to provide you with holistic, non-invasive, medical aesthetic services.

This includes offering high-quality information you can trust to guide your treatment decisions. Read on to learn more about the different types of acne scars, and what we can do about them, together.


What Is an Acne Scar?


First things first: what is an acne scar? Essentially, an acne scar is the leftover evidence of the body's healing process.


A combination of factors cause acne. Pores on your skin get clogged up with bacteria and natural oils produced by the body. When this happens, sometimes the pore can swell, creating redness or inflammation, and the accumulation of debris.


This is the pimple that most of us are all too familiar with! The body responds to a clogged pore by attempting to do some damage control. The body will make a new type of skin fiber called collagen, in an attempt to 'clean up' from the inflammation caused by the pimple.


So what's the problem? Unfortunately, the new collagen fibers made by the body don't look exactly the same as the original skin. This is why we see acne scars, where pimples have come before.


An infographic explaining the different causes of acne. that then breaks down the 4 types of acne scars (Boxcar acne scars, icepick acne scars, rolling acne scars, and hypertrophic/keloid acne scars). For each types of acne scarring the cause of the scar and the recommended treatment is listed. At the bottom a description of all the different acen scarring tretaments available are clearly defined.


Why Do Some People Scar and Others Don't?

Different people may scar in different ways. It depends on what type of acne they had and for how long. Treatment type matters too.

Moderate or mild acne usually involves small red bumps and pimples full of white pus.

There may be tiny lesions with black centers, called blackheads.

Some people who have this type of acne, for a short period of time, won't scar - others may experience scarring.

In contrast, more severe acne, such as cystic acne, creates deep craters or cysts beneath the skin.
 

This type of acne is more difficult to treat.

A Diagram of the different types of acne and how likely each is to cause acne scars and acne scarring


Typically people have a longer time course with this variant of the condition. As a result, cystic acne scars are common. Genetics and skin type also play a role in whether or not you will scar.
 

When you pick or pop or squeeze a pimple, instead of getting a medical consultation for treatment, you are more likely to get a permanent scar.


Types of Acne Scars


Now that we understand what acne scars are, it's important to know the different types of acne scars.

We'll review some of the most common acne scars.
 

We will also share some of the treatment options available for helping you to move forward and beyond the limitations of your acne scars.

Illustrations and pictures of the 4 different types of acne scars: keloid acne scars, rolling acne scars, icepick acne scars, boxcar acne scars

Atrophic Scars

A graphic illustrating how the three types of atrophic scarring form

Atrophic scars are the most common type of acne scar. They form during the healing process of cystic acne.

When skin tissue is lost or destroyed during skin regeneration, atrophic scars can form.
 

They are primarily caused by the loss of collagen, which the skin makes as part of its healing processes.

For this reason, atrophic scars form below the top layer of the skin.

Without collagen, the skin can't fully rebuild to what it was before.

The result? Atrophic scars look like holes or gaps in the skin, where the collagen has been lost.

They also may look like shallow depressions or craters.


What Are The Types of Atrophic Acne Scars

Atrophic scars come in three different kinds. These are rolling, icepick, and boxcar scars.

What do acne scars look like? Read on for descriptions of these atrophic scars.

A womans face with each of the different types of acne scars highlighted and circled so the difference between each type of acne scar becomes clear

Rolling Acne Scars

Rolling scars look like waves across the surface of the skin. They are not well defined, but instead, make the entire surface of the skin look bumpy and uneven.

A woman who has rolling acne scars on her cheeks

What Causes Rolling Scars

Rolling scars form when collagen tries to close the wound left by the pimple.
 

When the body tries to heal the wound, strings or bands of protein stretch between the outermost layer of the skin (the epidermis) and the deeper layers of the skin (the subcutaneous tissue).

The epidermis gets pulled down and attached to a deeper layer where it doesn't belong. This creates the rolling effect seen in rolling acne scars.


Icepick Acne Scars

Icepick scars are deep and narrow. Usually, they develop after cysts or infections in the pores. 

A man with ice pick acne scars on his cheeks

What Causes Icepick Scars?

Because these processes destroy the skin around them, the resulting scar that forms is a long hole in the skin.


Boxcar Acne Scars

A womans face with apparent boxcar acne scars on her cheek and face


Boxcar scars have well-defined edges. They are distinguishable from icebox scars because they are wider and have 'boxier,' edges.

You may hear the term 'pitted skin,' used to describe someone with boxcar scars.


What Causes Boxcar Scars

Boxcar scars develop when inflammation causes collagen to be destroyed, similar to other atrophic scars.


How to Treat Atrophic Scars


Once we know what type of scar we're dealing with, we can start to make a treatment plan. Atrophic scars have multiple treatment methods, and what works best for one patient, may not work well for another.

That's why it's important to find a medical team you can trust; practitioners who will guide you toward the right treatment for you.

Treating Rolling Scars

Treating a rolling scar happens in 2 stages. To begin, it's important to eliminate skin discoloration as much as possible. 

Your skincare professional may recommend lightening creams and other medications. You will use these before starting more invasive treatments.
 

This will help to reduce changes in skin tone that may have occurred during the scarring process. The second stage of treatment addresses the depth of the scar, or how far down it goes into the layers of the skin.
 

Treating rolling scars involves smoothing out that wave-like pattern and making the skin more even and flat.

There are lots of methods to help accomplish this! These include:

A diagram of the approach that Miami Skin Spa uses for removing acne scars and acne scarring. When it comes to hypertrophic acne scars, keloid acne scars, atrophic acne scars, boxcar acne scars, ice pick acne scars.


Subcision

Remember how rolling scars are formed by the top layer of the skin (the epidermis) getting dragged down to a lower level?

During a subcision procedure, your skincare professional will use specialized tools to separate these layers of skin. This evens out the overall skin tone and texture.

Excision

This process is just what it sounds like; the old scar tissue is 'excised,' or cut from the skin, and then stitched back together. This makes a new scar, but one that is smaller and more cosmetically appealing than the original scar.

Microneedling

This is a technique used to encourage the body to make its own collagen. By creating little injuries inside the scar, the process of new, healthy collagen production is begun.

At Miami Skin Spa Radiofrequency microneedling is our go-to treatment for acne scar removal and scar removal.


Microdermabrasion

Microdermabrasion involves smoothing the skin to even out its tone.
 

By stripping off the top layers of the skin, where the rolling effect occurs, new collagen production is encouraged to begin.

Laser Therapy

In laser therapy, providers use high-energy lasers to remove the outer layers of the skin and to create heat in the lower layers of the skin. This is another way to promote the development of collagen.

There are many different types of laser treatments that are a great option for mild acne scarring. The best type of laser resurfacing treatment is called Laser Genesis, and its a go-to for treating all types of acne scarring.



Chemical Peels

Another popular acne scar treatment is through peels like the VI Peel chemical peels. These treatments are also great for acne maintenance and can be performed regularly to keep acne at bay. Chemical peels are quite strong, and as the name suggests, the top layer of your skin will literally peel off.
 

It's best to do this treatments at a dermatologist office or at a med spa to prevent any side effects.


Before any peel make sure you don't do any physical exfoliation at least 24 hours before and after the treatment. Also make sure to not use Retin-A and other acne clearing products 5 days before and after use. Lastly avoid applying the product to inflamed skin.


Finally, in the last stage of treatment, restoring the skin's health and vibrancy is the main goal. Creams and medications are useful here too. Other treatments include chemical peels and specialized facials like the Hydrafacial facial.


These can help restore skin to its original tone and beauty.

Treating Icepick Scars

Icepick scars are very hard to treat. They require professional help and a lot of patience.

While icepick scars may never heal completely, it is possible to reduce their appearance substantially with a specific treatment for ice pick scars.


Be sure to ask your skincare provider about fillers, laser therapy, chemical peels, and excision therapy.

These treatments are similar to the treatments for rolling scars.

 

With some time and persistence, they can make a difference in the appearance of your icebox scars.


Treating Boxcar Scars

Boxcar scars often respond to laser therapy or different types of micro-needling, just like rolling scars.

There are some creams and other treatments that can help diminish the appearance of these scars as well.


Hypertrophic vs. Keloid Scars


Keloid and hypertrophic scars are scars that form above the top layer of the skin. Remember how atrophic scars form because of too little collagen? In hypertrophic and keloid scars, the opposite problem is true.


Think of hypertrophic or keloid scars as the body's healing process 'overreacting.'

The body makes too much collagen, and this protein builds up on top of the original wound.

So what's the difference between hypertrophic scars and keloids?

Hypertrophic Acne Scars

Hypertrophic scars form when too much collagen is produced during wound healing.

This collagen piles up, forming a heap on the skin. If you run your hand over the scar, a hypertrophic scar may feel raised or bumpy.

It usually looks pink or red.

What Causes Hypertrophic Scars

Hypertrophic scars can happen in places where wounds or injuries aren't able to completely heal.

They might happen if a wound can't close for some reason.

Perhaps the area moves a lot, like an elbow or a knee, or the wound gets infected. These scars can form after acne as well.

Keloid Scars

Just like hypertrophic scars, keloids occur when too many different skin proteins build up on top of each other.

Unlike hypertrophic scars, however, keloids can go rogue, and collagen can build up outside the borders of the original injury.

While hypertrophic scars tend to grow 'up,' keloids grow 'out,' and can be much bigger than the original injury.

Keloids are usually pink or purple.

What Causes Keloid Scars

It's not yet known what really causes and develops keloids.

Keloid scars often run in families and people who have more pigmented and dark skin are more prone to keloids.

Treating Hypertrophic and Keloid Scars

Hypertrophic and keloid scars are some of the most challenging scars to treat. 

This can be frustrating for people who experience them. Fortunately, there are some great options to try for reducing the appearance of these scars!

Treating Hypertrophic Scars

Hypertrophic scars can be reduced through treatments that break up collagen build-up. One technique to do this is massage. During massage, skin stretches. In this way, collagen is broken up and the scar's appearance can be reduced.


Another option is steroid injections. Corticosteroids are medications that reduce hypertrophic scarring through two main methods. The first way they do this is by breaking up the bonds between all those extra collagen molecules.  They also reduce inflammation, one of the key components of hypertrophic scars.



Treating Keloid Scars

Keloid scars can be tricky to treat, but steps can be taken for preventing keloids from developing.

Removal can be dangerous because sometimes the treatment can cause new keloids to form in the old scar's place. That said, steroid injections and massages are also good options for keloid treatment!


Cryotherapy is another potential option. During a cryotherapy procedure, liquid nitrogen is applied to the scar.

This causes damage to the collagen, which breaks the scar into smaller pieces.



What Type of Acne Scar is Most Difficult to Treat?

The most difficult type of acne scars to treat is icepick acne scarring.  Ice pick scars are narrow, V-shaped scars that go deep into the skin. They often look like small oval holes, similar to a chicken pox scar. 


Because of these characteristics they are the most difficult acne scars to treat. As the deeper under the skin they go the harder it is to heal them.

Next Steps: For You and Your Future

While managing your acne scars can feel daunting, you have options for treatment. By understanding the types of acne scars, you can feel empowered to take control of your health and appearance.


And you don't have to go through treatment for the different types of acne scars alone. You have a whole team of talented, dedicated professionals at your service at the Miami Skin Spa.


You can find information about appointments and images of our patients before and after treatment on our website.


When you're ready, book a free consultation online. We'll help you find confidence and clear skin after acne scar treatment.


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