How to Identify Different Types of Acne Scars and the Best Treatment for Each

Acne is a common skin condition, affecting nearly 80% of population between 11 and  30 years of age. While many cases heal without leaving skin blemishes, 1 in 5 people will sustain skin scarring. This can be a cause of significant concern for many individuals, affecting their confidence and self esteem negatively.

Acne scars can vary significantly in appearance based on their type and severity. Identifying the type of scarring is essential for choosing the most effective treatment plan. In this article, we will discuss the common types of acne scars and the treatment options best suited for them.

What Causes Acne Scars?

After acne clears, your skin begins to heal the affected area. Most of the time, this area heals without leaving blemishes, but acne scars can develop:

• If you don’t get timely treatment.
• If you pick or pop your breakouts.
• If you have a family member with acne scarring
• If your acne was deep, forming nodules or cysts in your skin.

 During the healing process, new collagen is formed and deposited in the skin. If your skin produces too little collagen, the scars will be indented. In people with darker skin tones, excessive collagen production may cause raised scars. 

Types of Acne Scars

Depending upon the appearance, the acne scars are divided into two main categories.

• Depressed acne scars: These include ice pick scars, boxcar scars, and rolling scars.
• Raised acne scars: These include the keloid and hypertrophic scars.

Additionally, some people may experience Post-inflammatory hyperpigmentation (PIH). These are flat dark spots on areas where you have acne, and they usually disappear over time without any treatment. 

Ice Pick Scars

These are small, deep, narrow scars with tapering bases as they penetrate the skin layers. They are the most common type of acne scars and mostly occur on the forehead and upper cheeks, where the skin is thinner. Treating them is very challenging due to their deeper penetration into the skin layers.

Boxcar Scars

These are shallower but broader scars with defined edges. They appear like round or oval-shaped skin dents or craters. They are common on lower cheeks and jaws and are linked to nodular and cystic acne.

Rolling Scars

These are broad skin depressions with sloped edges giving the skin an uneven texture. They are also common on the lower cheeks and jaws. They form when fibrous bands of scar tissue pull at the skin surface during the healing process of acne, giving it a wavy appearance.

Hypertrophic and Keloid Scars

These are raised scars formed due to the overproduction of collagen during the healing process. Hypertrophic scars are firm to the touch and start appearing 1 to 3 months after the acne breakout clears. Keloid scars are slower to develop and appear 3 to 12 months after the breakouts. These types of scars are common on the chest and back. They can be itchy and painful.

What facial treatments help with acne scars?

As discussed earlier, the mechanism of scar formation varies based on the amount of collagen deposited in the scar area. So do the treatment options, as each type of scar needs a different approach to management. 

Below, we will discuss some of the commonly used face acne scar treatments.

Treatments for depressed acne scars

• Chemical peels: Exfoliate the top layer of skin and boost collagen production. The new skin that grows has a smoother appearance with less noticeable scars.
• Microneedling: Fine needles are used to create micro-injuries in the skin, stimulating collagen production and reducing scar visibility.
• Laser skin resurfacing: Removes old skin layers, promotes new skin growth and collagen synthesis to smoothen out depressed scars.
• Dermal fillers: Add volume to indented scars and boost collagen production. The results are depend on how long the dermal filler lasts and a series of treatment sessions are often needed.
• Subcision: Treats acne scars by releasing the tissue that pulls the scar down via a needle or cannula inserted under the scar. This cuts the fibrotic strands that tether the scar to the deeper tissues. This allows the skin to lift and fill in naturally over time. 
• Punch excision: a minor surgery in which a punch tool is utilized to diminish scars by removing the scar and closing the area with stitches or a skin graft.
• Radiofrequency microneedling: Combines radiofrequency waves with microneedling for deeper collagen synthesis and improved scar appearance.

Treatments for raised acne scars

• Steroid injections: Reduce the size of the scar by softening and thinning the fibrous tissue through collagen breakdown.  Additionally, they reduce redness, itching, and swelling in the scar.
• Cryotherapy: Freezes raised scars, causing the scar tissue to die and fall off.
• Laser therapy: Targets blood vessels in the scar, thereby shutting down its blood supply and thus reducing the scar's size. Lasers can also lighten the red or pink color of scars, and help to reduce pain, itchiness and hardness in the scar.

How to Choose the Right Treatment

Consult a dermatologist to get a professional evaluation of  your skin type as well as the type and severity of your scars. The dermatologist will then discuss with you the treatment options best suited for you. For better results, a combination of multiple treatments and/or multiple sessions may be recommended by your doctor. While choosing your options, consider the cost and downtime required for each.

Tips for Preventing Future Acne Scars

Here are some useful tips for avoiding acne scars:

• Treat acne early, as soon as you first notice it. This is especially important if you have a parent or sibling affected by acne scarring.
• Never pick, pop, or scratch your pimples, as this increases inflammation and scarring.
• Wear sunblock, as excessive sun exposure can darken scars.
• Avoid touching your acne, as it can make it worse.
• Consult a dermatologist for guidance on skin care for acne-prone skin.

Final Thoughts: Achieving Confidence Beyond Scars

Acne is a common skin condition that can potentially lead to scarring. Treating these scars is often challenging and requires expert input from a dermatologist. The appearance of scars varies, and treatment largely depends on the type of scars you have. Obtain a customized management plan for your acne scars after a thorough consultation with your doctor. Remember, achieving scar-free skin requires time, patience, and proper care.