Acne takes you and your skin on quite a rollercoaster ride of a journey. It comes and goes, varies in severity, and unfortunately, not all acne episodes leave us unscarred. Acne scars can be frustrating and challenging to treat, often requiring the help of skin professionals, especially if you want to see real and long-lasting improvement. However, similar to how there’s no one uniform experience of acne, scar treatments aren’t one size fits all and will often rely on the type of scarring that you have. To help you kickstart your skin journey and map out a game plan, here’s a guide to the different types of acne scars, their causes, and possible treatments.

What are the different types of acne scars?

Atrophic Acne Scars
‍Atrophic acne scars, or depressed scars, are the most common type of scars. If you’ve ever popped a pimple or happened to be the victim of a particularly big, cystic spot, the resulting loss of collagen damages the skin, leaving a depression, crater, or hole on the surface.This type of acne scar forms when the skin is unable to regenerate or rebuild tissue resulting in imbalanced scarring.

Ice Pick Scars
Ice pick scars are the most commonly occurring atrophic scar, making up 60 to 70 percent of all depressed scarring. These scars are characterized by the small, narrow imprints on the skin, often measuring less than 2mm and having a V-like shape. Ice pick scars most often occur on the cheeks or the forehead because the skin on these areas is relatively thin, making them more susceptible to indentation. Because of their depth, this type of scar is often more challenging to treat, requiring persistent and aggressive efforts.

Treatments: Punch excision, punch grafting, microneedling, microdermabrasion, chemical peels

Boxcar Scars
As the name suggests, boxcar scars look like an open boxcar, with a shallow depth and a wider diameter measuring anywhere from 1.5mm to 4mm across. They’re often round or oval in shape, have sharp, defined edges, and give the skin an uneven, craggy appearance. Boxcar scars are less common than ice pick scars, accounting for 20 to 30 percent of depressed acne scarring. They often vary in-depth, but the deeper they are, the easier they are to treat.

Treatments: Subcision, dermal fillers, punch excision, microdermabrasion, dermabrasion, chemical peels, laser resurfacing

Rolling Scars
Rolling scars are the widest atrophic scars, measuring as much as 5 mm across. This type of scar often varies in-depth, giving the skin rolling or wave-like indentations, hence the name. Unlike ice pick and boxcar scars, rolling scars aren’t as sharply defined, appearing to have smooth and sloping edges. This type of scarring commonly occurs on the lower cheek and jaw area, where the skin is relatively thicker. Rolling scars are the least common among the three types of atrophic scars, making up around 15 to 25 percent of depressed acne scarring.

Treatments: Microdermabrasion, microneedling, chemical peels, dermal fillers, surgical treatments (e.g., punch excision, skin grafting, laser therapy)

Hypertrophic and Keloid Scars
Whereas scars of the atrophic kind leave indents in the skin, hypertrophic and keloid scars are the opposite. These scars are firm and raised, growing above the skin’s surface, and often found on the chest, back, shoulders, jawline, and torso. Keloid scars are a more severe type of raised scar and can grow even more prominent than the original wound it’s covering. Unlike atrophic acne scars, these types of scars aren’t caused by tissue loss. Instead, they develop because of an overproduction of collagen around the wound during the pimple process. These scars often itch or feel painful, developing due to deep wounds or trauma on the skin, such as an acne lesion. It’s crucial that you don’t scratch at them.

Treatments: Laser therapy, surgical extraction, corticosteroid treatments

Why do acne scars occur?

Aside from the obvious answer of acne scars being caused by acne, their development has more to do with the severity of the inflamed area and the healing process that follows. Acne develops when the skin’s pores become clogged with sebum, dead skin cells, forming comedones—bumps that give the skin a rough texture. The bacteria inside the blocked pores can then develop into inflamed and infected acne. When it develops deeper into the skin, this is what we call cystic acne, where large, inflamed cysts form under the skin’s surface. The deeper the acne occurs in the skin, the more damage it can cause and the more likely it will leave behind some form of scarring.

Let’s say that the acne breakout has passed, the inflammation period is over, and your skin is now beginning to clear. The skin begins to rebuild and heal by producing new collagen that will serve as the base for skin tissue to regenerate. However, it’s in this process where results may vary. Some people leave acne episodes unscarred (good for them!), and sometimes the skin produces a bit too little or too much collagen, forming acne scars. Too much collagen results in hypertrophic or elevated scars, and not enough produces atrophic or depressed scars.

Why do acne scars occur?

Each type of scarring requires its own version of TLC, with the longevity and type of acne scar treatment varying. Scars are stubborn and won’t always disappear completely. However, if you want to see genuine and long-lasting skin improvement, topical treatments and home remedies may not be the way to go. Our advice? Talk to your dermatologist! They’ll know what treatments your skin needs to achieve your desired results.

The most common acne scar treatments include the following:

• Lasers reduce inflammation, treat red marks, and correct abnormal blood vessels.
• Chemical peels treat dark spots, hyperpigmentation, and exfoliate the outer layers of the skin to remove dead skin cells.
• Microneedling triggers the skin’s repair mechanisms and stimulates collagen production, reducing the depth of atrophic scars.
• TCA Cross remodels scar tissues, helping form extra collagen to raise depressed scars.
• Subcision breaks down the fibers that tie acne scars down to the skin.

Solutions that go beyond the cure

The acne journey can be frustrating and mentally and emotionally draining. Acne scars are tough to fade and repair, but you’re tougher! Equipping yourself with sufficient knowledge on what type of scarring you have and getting a grasp on the situation is the first step to dealing with scarring.

The next? Well, that’s where we come in. From preventing acne to dealing with the aftermath, we’ve got your back. We all want to feel confident in our skin, to be able to walk out the door, head held high, and visibly glowing. As an acne-specialty clinic, dealing with acne scars is kind of our thing. We’re committed to expert-backed advice and technology, customized acne scar treatment plans, and empowering you with knowledge on skin health that’ll have your skin looking its best.

Book an appointment today! Contact us at +63 917 873 6339 / +63 2 7975 7984, Instagram (@remedy.ph), Facebook (@remedyph), and www.remedy.ph.