Acne scars are like any other type of scar in that they are a mark left behind after the skin has healed from a wound. What makes acne scars unique is that they are formed within the layers of skin after acne has disappeared, rather than from an external force on top of the skin. This difference makes acne scars difficult to remedy quickly or easily. When contemplating treatment, it is helpful to be informed about what types of acne scars you are facing so that you can make the right decision about an appropriate course of action.
After a deep inflamed cyst or blemish has had its way with your skin, it leaves behind a long and narrow hole in its place. It usually has jagged edges and reaches deep into the dermis. This column type of acne scar is then termed an “icepick scar.” Its name is derived from the way it looks on the skin, almost as if an icepick has been inserted there. It may also give the appearance of an enlarged pore.
Because icepick scars reach so far into the skin and are so very narrow, they do not respond well to resurfacing treatments such as chemical peels or dermabrasion. There does not appear to be a good way to eliminate icepick scars altogether, but a procedure called punch excision may decrease their appearance. Punch excision includes cutting out the original scar and then suturing it shut so that it can heal more evenly. The resulting scar is often smaller and less noticeable than the original one.
Boxcar scars are an atrophic type of acne scar, meaning that they are the result of a loss of tissue. These scars are often wider than icepick scars and form as depressions on the skin after acne has destroyed the collagen, leaving no support. As described in its name, these types of acne scars appear with firm boxed edges and can be either deep or shallow, depending on the damage that its predecessor acne caused.
Depending on the depth of this type of acne scar, boxcar scars can be treated either superficially with a chemical peel or more deeply with fractionated lasers. There are other options available as well, including over-the-counter creams, subcision and excision. Because boxcar scars are so varied in size and depth, the treatment options are diverse and depend largely upon what you can tolerate for recovery time, as well as how much your wallet can withstand.
The type of acne scar that appears as rolling, wavelike undulations across the skin is appropriately called a “rolling scar.” These types of acne scars develop within the skin as fibrous bands and pull the upper level epidermis down deeper into the lower levels of the skin. If you can picture bands pulling portions of skin from beneath, then you will understand how rolling scars get their wavelike appearance.
Perhaps the most logical solution for rolling scars is subcision. Subcision is a surgical procedure in which the bands that are pulling the upper dermis below to the lower levels of the skin are snipped and separated. Once the two layers of skin are freed from each other, the scars are no longer bound down and can lift up even with the surrounding skin. This procedure requires some local anesthesia and may cause bruising for a short time.
Of the four types of acne scars, hypertrophic scars are the only ones that result from an excess of tissue. Hypertrophic scars replace acne wounds and appear as elevated, round masses. They remain about the same size as the originating acne. Keloid scars are often described interchangeably with hypertrophic scars as they are also a raised excess of collagen. However, keloid scars have the not-so-wonderful attribute of being larger than the original acne wound that caused it and are often found on the torso rather than the face.
As far as treatment options go for the hypertrophic type of acne scars, the options that work best are those aimed at softening the skin’s surface and decreasing the mass. A first line of treatment for hypertrophic scars includes softening the tissue with interferon injections and decreasing the tissue size with corticosteroid creams, tapes or injections. Other remedies include over-the-counter creams with silicone, freezing the scar through cyrotherapy or addressing it with lasers, such as the pulsed-dye laser. Your preferred treatment should be comprised of those options that best fit the needs of your particular condition.
At the end of the day, after you and your practitioner have assessed your unique situation, the destiny of any types of acne scars should hinge on how strongly you feel about correcting them and what you are willing to do to get there. Being informed about what you are dealing with is essential to helping you determine how to accomplish your goal.