Scarring refers to a permanent textural change to the skin. Acne scarring often appears with areas of depression in the skin leading to inconsistencies and irregularities of the skin surface.
Four main types of acne-scarring exist which include rolling and atrophic scars, boxcar scars, ice pick scars, and keloidal scars.
Patients with acne may also be concerned about persistent red or dark marks on the skin once acne lesions heal
Rolling and Atrophic Scars
Rolling and atrophic scars are seen as broad valleys caused by tethering of superficial structures of the skin to deeper components. The terms rolling and atrophic scar are often used to describe the same type of scar occurring in different parts of the body. When these types of scars appear on the face, they are termed rolling scars. When they occur in other areas of the body such as the back or chest, they are referred to as atrophic scars.
Rolling and atrophic scars can be tricky to treat and requires experience. Such scars can be improved with subcisions, radiofrequency micro-needling, dermal fillers and ablative laser resurfacing.
Boxcar scars have well-defined edges with a flat and broad base. Such scars can appear dark as the surrounding skin casts a shadow in the valley of the scar. Boxcar scars do not disappear when the skin is stretched out.
Boxcar scars can be improved by a form of chemical peel applied to the scar called TCA CROSS. Radiofrequency micro-needling, dermal filler injections, punch excision/elevation, and ablative laser resurfacing are also used to treat boxcar scars.
Ice-pick scars are deep, narrow, and sharp scars with angled edges. Ice-pick scars do not improve when the skin is stretched and can also appear dark in the center due to the shadow cast by the surrounding skin. Ice pick scars can be confused with prominent pores which some patients with severe acne suffer from.
Ice-pick scars treated with lasers and needling alone will not improve. The main methods used to treat ice-pick scars include TCA CROSS and punch excision or elevation. Radiofrequency micro-needling and ablative laser resurfacing can bleed scars in with surrounding skin.
Scars that thicken up and becoming bumpy are referred to as keloid scars. Keloidal scars due to acne occur mostly on the chest and back. Such scars are often itchy and can appear discolored, either darker or more red than surrounding skin.
Keloidal acne scars often require injections with cortisone or similar solutions. Thin keloidal scars can also be improved with cortisone creams and silicone gel sheets and silicone-based creams. Surgical intervention is sometimes required however the risk of repeated keloid scars after surgery is high if preventative measures are not taken.
In most cases, once an acne lesion clears, it leaves behind a red mark. This mark is referred to as post-inflammatory erythema and can take anywhere between weeks to years to fade. In some cases, red marks associated with other forms of acne scarring can persist for life unless treated.
Sun protection is essential to avoid worsening and aid in the healing of post-inflammatory erythema due to acne.
In darker skin individuals, once an acne lesion clears, it can leave behind a darker brown mark. This is referred to as post-inflammatory hyperpigmentation (PIH) and can take months to years to fade. When associated with other forms of acne scarring, PIH can persist indefinitely unless the acne scar is treated.
Sun protection is essential to prevent and avoid the worsening of PIH. Treating acne early and reducing inflammation is paramount in darker skin individuals. Various topical (cream) treatments are available to reduce PIH. Whilst some of these treatments can be utilized while treating active acne, others are used when the active acne has been successfully treated. Laser Genesis may aid in reducing pigmentation and even out discoloration.
Taking the Next Step
If you have questions, or would like to schedule a consultation, call Innova Aesthetics at +92 321 5428888, or complete the following form to request your consultation today.
Have A Question? Lets Talk!