Acne Scars
The 3 types of acne scars include atrophic scars, hypertrophic and keloid scars, and post-inflammatory hyperpigmentation.

Acne, also called acne vulgaris, is a common skin problem seen among 11- to 30-year olds. 

A scar is a mark left on the skin due to the formation of fibrous tissue during the process of healing. New collagen fiber is laid down to cure full-thickness skin damages.

The three types of acne scars include:

What are atrophic scars?

Atrophic scars appear as a depressed region on a person's skin that is often pitted. When the skin is unable to repair tissue properly, an atrophic scar is formed.

Atrophic scars are frequently created by collagen degradation due to inflammatory conditions, such as acne or chickenpox. Accidents, surgeries, and genetic illnesses can all result in scars.

Atrophic scars are subdivided into the following three types:

  1. Ice pick scar
    • Ice pick scars are often small, deep indentations that appear on the cheeks and account for 60 to 70 percent of atrophic scars.
    • These V-shaped epithelial tracts are less than 2-mm wide and have a sharp border that continues vertically to the deep dermis or subcutaneous tissue. They may resemble a scar created with a small ice pick.
    • They are one of the more difficult scars to cure (but it is possible) because they are deep and resist to skin resurfacing options.
  2. Boxcar scar
    • Boxcar scars are wider than ice pick scars and account for 20 to 30 percent of all atrophic scars.
    • These scars are round to oval depressions with strongly defined outlines that are 1.5 to 4.0 mm broad.
    • They are often a larger indentation in the skin and can resemble a chickenpox scar.
    • Wider scars are more difficult to cure than narrower scars.
  3. Rolling scar
    • Rolling scars are frequently the broadest of the atrophic scars and may lack definite boundaries.
    • They typically have variable depths, curved edges, and a more uneven appearance.
    • Rolling scars account for 15 to 25 percent of atrophic scars.
    • These are the largest scars, measuring up to 5 mm in diameter.

What are hypertrophic and keloid scars?

Hypertrophic scars:

  • are lifted from the skin as a result of an excess of collagen generated during healing.
  • are less prevalent than the other type and are usually connected with body acne.

Keloid scars:

  • are the same as hypertrophic scars, but they are bigger than the initial spot, whereas hypertrophic scars are the same size as the pimples that created them.
  • look like small bumps or may be severe and present with bubble-like skin swellings. 

A keloid tends to grow for weeks or years and stops growing on its own. You may remove a keloid surgically, but there are high chances of reappearance.

What is post-inflammatory hyperpigmentation?

Although acne may have been cured, the inflammation may leave a mark. This mark is due to excess pigment from the skin's production of extra melanin during recovery.

Hyperpigmentation can affect everyone. However, it is more frequent in those with darker skin tones who have more melanin in their skin.

These darker spots of skin may fade with time and appropriate sun protection.

9 treatment options for acne scars

The treatment of acne scar depends on the type and severity of the scar. Various treatment options can either be used for all types or restricted to one type of acne scar.

The 9 treatment options for acne scars include:

  1. FAST treatment:
    • Focal acne scar treatment (FAST) uses a CO2 laser to create microscopic holes in the skin and fill them with new collagen (the connective tissue of the skin).
    • This procedure is very beneficial for atrophic acne scars, such as ice pick and boxcar scars.
  2. Derma fillers:
    • To enhance the look, a material, such as hyaluronic acid or calcium hydroxylapatite, is injected into the skin.
  3. Steroid injections:
    • Steroids are injected directly into the scar tissue to soften it and reduce its height.
    • You may require multiple steroid injections, each with an interval of several weeks in between.
  4. Laser resurfacing:
    • High-energy laser light exfoliates the skin's surface layers while stimulating collagen formation in the skin's interior layers. This is referred to as ablative laser treatment.
    • Heat is used in nonablative treatment to stimulate collagen formation in the skin's inner layers.
  5. PRP:
    • Platelet-rich plasma (PRP) is a minimally invasive therapy that uses the natural growth factors in the blood to mend the skin.
    • A dermatologist will extract the blood, turn it into a platelet-rich fibrin matrix (PRFM) and inject it into the acne scar.
    • PRFM stimulates healing and the production of new collagen, which fills in and smoothens out scars.
  6. Microneedling:
    • Microneedling is a procedure where the top layer of the skin is punctured with fine needles. This creates an environment of skin damage and stimulates the body's natural healing processes and the production of new collagen. 
    • Microneedling is most effective to repair atrophic scars although it can be used to alleviate pigmentation disorders.
  7. Punch excision:
    • Punch excision is a procedure where the skin with a scar is cut out and the adjacent skin is pulled together and sutured.
  8. Punch grafting:
    • The scar is removed from the skin, and the lost skin is replaced with a small skin graft taken from other parts of the body.
  9. Chemical peels:
    • Chemical peels cure hyperpigmentation by exfoliating the skin with a chemical solution. This is an excellent approach to renew the skin and remove any dark spots.

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Medically Reviewed on 11/30/2021
References
Image Source: iStock Images

Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol. 2017;10(9):12-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/

DermNet New Zealand. Acne scarring. https://dermnetnz.org/topics/acne-scarring