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Types of Acne Scars Explained

Kristina Cadwell  
April 2, 2021  

Acne affects most people, usually during their teenage years. Some types of acne are severe and take a long time to heal. They are called cysts and nodules, and they may leave scarring.

Here we explain the main types of acne scars, how they form, and how to treat them. 

Acne scars may develop depending on the type of acne, and can be treated with various cosmetic treatments.

Types of Acne Scars

Types of acne scars differ depending on the type of acne that causes them and how the acne was treated. Popping and squeezing acne increase the chance of scars developing.

The three main types of acne scars are:

  • hypertrophic,
  • keloid,
  • atrophic.

Hypertrophic and keloid scars are raised lumps on the skin. Atrophic scars are either flat or depressions of varied sizes beneath the skin. Atrophic scars are further categorized into icepick, rolling, and boxcar scars.

Icepick Acne Scars

Icepick acne scars example

Icepick acne scars are a type of atrophic scars. They are small and deep-set, with rigid edges, and look like the skin was broken by an icepick – hence, the name. Icepick scars are usually the size of the acne that caused them. They appear on the cheeks and the jawline.

How Are Icepick Scars Developed?

Icepick scars form after very inflamed cystic or nodular acne damages the cellular walls deep in the dermal layers. If you don't treat severe acne properly, and if the body produces too little collagen to fight skin inflammation, an atrophic scar develops.

Icepick Scars Treatments

Icepick scars are the most severe type of acne scars. The treatment involves removing damaged skin, filling up the scar pit with collagen, and treating any discolored skin left by the scar.

Skin discoloration is usually addressed separately as the second stage of the treatment.

The most effective treatments for icepick scars are as follows:

  • Chemical peels are cosmetic procedures that use chemicals to peel off the damaged layers of the skin. TCA and CROSS techniques are the most effective chemical peels for icepick scars. They use different concentrations of Trichloroacetic acid (TCA) to destroy damaged skin layers and then fill up the depressed scar with collagen.
  • Fractional photothermolysis is a laser treatment that creates small wounds in dermal layers, stimulating the skin to produce collagen.
  • Punch excision is a surgical procedure that removes the scar by creating a punch that is slightly bigger than the acne scar. The linear closure that remains after the scar ideally fades with time.
  • Punch replacement grafting is like the punch excision procedure, except the icepick scar is replaced with a skin graft that heals at the skin’s surface level or is slightly elevated.
  • Microneedling is a method of puncturing the skin using a device with many tiny needles, stimulating collagen production in the process.

The most effective second-stage skin discoloration treatments are:

Rolling Acne Scars

Rolling acne scars example

Rolling acne scars are a type of atrophic scars that have a wave-like texture on the skin. They are wider than icepick scars, usually with sloping edges. They appear on the cheeks or jawline.

How Are Rolling Scars Developed?

Rolling scars form as severe acne heals. Like icepick acne scars, they develop due to untimely acne treatment and loss of collagen. Picking at acne may also cause rolling scars.

Rolling Scars Treatments

Rolling scars may require several treatments. The most effective procedures for this type of treatment are as follows:

  • Fractional phototehrmolysis
  • Microneedling
  • Laser resurfacing is a dermal heating method that creates tiny wounds in dermal layers, resulting in collagen and tissue remodeling.
  • Tissue augmentation techniques are procedures that use soft-tissue fillers injected under scars. Dermal fillers are commonly used soft-tissue filler injectables for rolling scars. They are made with hyaluronic acid, calcium hydroxylapatite, or poly-L-lactic acid.
  • Subcision is a surgical procedure where a needle is punctured into the skin to make small cuts and remove the scar from the connective tissue and level it up with the rest of the skin. After the subcision procedure, the patient usually requires a stage-two treatment for skin discoloration.

Boxcar Acne Scars

Boxcar acne scars example

Boxcar acne scars are shallow depressions with well-defined edges, often resembling a square or a box. They usually appear on the cheeks, jaw, and temples.

How Are Boxcar Scars Developed?

Boxcar scars are most commonly the result of untreated cystic or nodular acne. Like other atrophic acne scars, boxcar scars form when the body produces less collagen than needed to heal scars.

Boxcar Scar Treatments

The most effective boxcar scar treatments are:

  • TCA and CROSS technique chemical peels
  • Laser resurfacing
  • Fractional phototehrmolysis
  • Microneedling
  • Microdermabrasion removes dead skin cells using tiny crystals that sandpaper the top skin layer, stimulating collagen production.
  • Punch elevation is a surgical procedure where the bottom of the scar is removed and reattached to the scar sides to even up the skin.

Keloid Acne Scars

Keloid acne scars example

Keloid scars are red, lumpy scars on the surface of the skin. They usually appear on the jawline, chest, shoulders, neck, and back.

How Are Keloid Scars Developed?

Keloid scars are the result of the body's overproduction of collagen in the attempt to heal an acne breakout. The overproduction of collagen causes a thick tissue to grow on the healing skin, making the scar bigger than the acne. Keloids affect darker skin more.

Keloid Scars Treatments

There are no fully effective treatments for keloid acne scars, but they can reduce their size and minimize their appearance. The most common keloid scar treatments are as follows:

  • Steroid injections are shots of a corticosteroid medicine injected into the scar tissue. Several injections are needed at four-to-six-week intervals.
  • Cryotherapy is a method of freezing the keloid scar to reduce its appearance. The treatment may be combined with steroid injections to make them more effective.
  • Laser therapy also shrinks the keloid scar and is frequently combined with steroid injection treatments.

Hypertrophic Acne Scars

Hypertrophic acne scar example

Hypertrophic acne scars are red or pink raised lumps on the skin that form after acne heals. Unlike keloid scars, they are the same size as acne and may grow smaller with time.

How Are Hypertrophic Scars Developed?

Like keloid scars, hypertrophic acne scars form due to acne healing and the body's overproduction of collagen.

Hypertrophic Scars Treatments

Hypertrophic scars are treated with:

  • Steroid injections
  • Laser therapy
  • Cryotherapy
  • Silicone gel sheeting is silicon sheets applied on the scar tissue for six to 12 months to reduce their size and soften them.

Conclusion

Seek professional advice on how to treat different types of acne. If you don't treat severe acne properly, you may develop acne scars. Some scars fade away with time, but others are permanent. For teenagers with acne problems, you can also check out our article on how to treat teenage acne.

Luckily, different acne scar treatments are available, but their effectiveness depends on correctly identifying the type of acne scar.

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About the Author:
Kristina Cadwell
PA Kristina Cadwell graduated from Arizona State University with a Bachelor of Science degree in Biology. She then completed the Physician Assistant program at A.T. Still University graduating with a Masters of Medical Science degree. Kristina has been working in the Aesthetic Medical field for over 10 years. She is certified in neurotoxin cosmetic injection, dermal fillers, Plasma Pen skin tightening, chemical peels, and laser therapy. She is known for producing natural results and has extensive knowledge in diet and exercise allowing her to help you achieve vibrant skin from the inside out.
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