Not all acne scars are the same: How to identify your scar type and understand what your skin needs

From ice-pick to rolling scars, here’s how to identify your acne scar type and understand your treatment options.

Although acnecan be a transitory skin problem, the resulting scars could lead to a persistent problem. Mismanagement of acne scars occurs through the assumption that all scars have a similar treatment approach. In the field of clinical cosmetology, acne scars are classified based on morphology, depth, and whether they are atrophic scars or hypertrophic scars. Identification is, therefore, the first critical step in the treatment of this condition. Dr Ajay Rana, president of the Indian Society of Aesthetic Medicine (ISAM) and founder and director of ILAMED, explains how to identify your acne scar type.

Ice-pick scars

Dr Rana highlighted that ice-pick scars are scars with deep pits that go down to the dermis. Due to the fact that they are deep with a tiny surface opening, regular shallow resurfacing will offer little results. Based on their depth and morphology, TCA CROSS (chemical reconstruction of skin scars), punch excision, or punch elevation are some of the approaches recommended by experts in this field.

Ice-pick scars are scars with deep pits that go down to the dermis. (Pexel)

Boxcar scars

Boxcar scars have wider pits that usually have vertical walls and are much defined. Their depths differ depending on the type of scar. “Depending on the specific scar, treatment might involve the following approaches: fractional CO₂ and ER lasers, microneedling, radiofrequency microneedling, punch techniques, or combination therapy,” said Dr Rana.

Rolling scars

However, the depressions in rolling scars are soft and undulating and are partially due to fibrous bands attaching the skin to deep tissue layers. According to Dr Rana, subcision becomes very beneficial in properly chosen patients since it breaks the fibrous attachments underlying the scar. Further, it may be followed by other methods like microneedling, fractional laser resurfacing, or collagen remodelling techniques to correct any residual texture irregularities.

The depressions in rolling scars are soft and undulating and are partially due to fibrous bands attaching the skin to deep tissue layers. (Pexel)

Difference between scars and post-acne pigmentation

There is a significant difference between scars and post-acne pigmentation. “Dark brown or grey spots following an acne break-out are usually post-inflammatory hyperpigmentation instead of scarring,” said Dr Rana. Similarly, reddish or pink spots are post-inflammatory erythema. These conditions need a completely different treatment plan than aggressive scar correction techniques.

In addition, treatment for raised scars, including hypertrophic and keloid scars, requires a completely different technique. Treatment options will be intralesional corticosteroids, intralesional 5-fluorouracil, silicone-based therapy, and selective lasers according to the diagnosis.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.