A discussion of acne scars should begin with the fact that they are very difficult to treat. Patients are often given unrealistic expectations. How well you will do depends on what type of acne scars you have, so let’s start by classifying the types of acne scars.
SCARS VS. “BLEMISHES”
It is preferable to reserve the term “scar” for something that is permanent unless treated. An acne “scar” is a change in the texture or contour of the skin left by an acne lesion. It is something that you can feel with your eyes closed. A “blemish” is simply a change in color of the skin and you cannot feel it with your eyes closed. Acne “blemishes” are red or brown discolorations of the skin. These generally fade over time without treatment and are not considered true scars. A topical bleaching cream can be used to speed up the fading of the brown discoloration. And a pulsed-dye laser or an IPL can do the same for the red discoloration.
WHICH ACNE SCARS DO YOU HAVE?
Acne scarring can be divided into 4 basic types*: icepick scars, rolling scars, hypertrophic scars, and boxcar scars. Boxcar scars can be further subdivided into shallow or deep.
Icepick scars:
Icepick scars are narrow (<2mm) and deep. Their name derives from their appearance: the skin looks as if it were stabbed with an icepick.
View example
Rolling scars:
Rolling scars are those shallow wide scars with a gentle slope. They have a rolling or undulating appearance.
View example
Hypertrophic scars:
Hypertrophic scars are raised acne scars. They have a firm, rubbery feel to them. Injections with cortisone and some of the lasers mentioned below may help to flatten these scars.
Boxcar scars:
Boxcar scars are round to oval or sometimes rectangular depressions with sharply demarcated vertical edges. They are more “punched out” appearing than rolling scars and very much resemble chicken pock scars. They may be shallow or deep and are most often 1.5 to 4.0 mm in diameter. Shallow boxcar scars may respond to a resurfacing laser such as the Fraxel laser, while deep boxcar scars must be cut out and sutured. View example
Jacob C, Dover J, and Kaminer M. Acne Scarring: A classification system and review of treatment options. J Am Acad Dermatol 2001; 45: 109-117.