Even with the most careful and conscientious treatment, acne may still cause scarring. But not all scars are created equal. Generally, acne scars fall under two categories: those caused by a loss of tissue (atrophic), and those caused by an excess of tissue (hypertrophic). Within these categories, acne scars fall into one of four types: ice pick, boxcar, rolling and keloid scars.
Discolorations are not true scars but rather post-inflammatory hyperpigmentation, which will fade over time.
Ice Pick Scars
2007 A. PalmerDevelopment: Ice pick scars develop after an infection from a cyst or other deep inflamed blemish works its way to the surface. Skin tissue is destroyed, leaving a long column-like scar.
Common treatments: Ice pick scars can be treated with punch excision or punch grafting.
Boxcar Scars
2007 A. PalmerDevelopment: When an inflammatory breakout destroys collagen, tissue is lost. The skin over this area is left without support, and a depressed area is created. Boxcar scars may be superficial to severe, depending on the amount of tissue lost.
Common treatments: Treatments for boxcar scars include punch excision or elevation, dermal fillers, and laser resurfacing.
Rolling Scars
2007 A. PalmerDevelopment: Rolling scars arise when fibrous bands of tissue develop between the skin and the subcutaneous tissue below. These bands pull the epidermis, binding it to deeper structures of the skin. It is this pulling of the epidermis from within that creates the rolling appearance of the skin.
Common treatments: Rolling scars are best treated with subcision.
Hypertrophic or Keloid Scars
2007 A. PalmerDevelopment: Unlike ice pick or boxcar scars, hypertrophic scars are not caused by a loss of tissue. Rather, they develop because of an overproduction of collagen.
Common treatments: Steroid (cortisone) creams, tapes, or injections are used to help shrink and flatten the scar. Interferon injections are also used to soften scar tissue.
Sources:
Alam M, Dover JS. "Treatment of Acne Scarring." Skin Therapy Letter. Dec 2006-Jan 2007; 11(10).
Goodman GJ, Baron JA. "The management of post-acne scarring." Dermatologic Surgery. Oct 2007; 33(10):1175-1188.
Jacob CI, Dover JS, Kaminer MS. "Acne scarring: a classification system and review of treatment options." Journal of the American Academy of Dermatology. 2001; 45(1): 109-117.
