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What is Acne Scar Treatment?

Each type of acne scar has its own unique characteristics and features. Because of these differences, the available treatments for acne scars are not one size fits all. It is important to carefully choose the treatment that best matches your needs in order to achieve optimal results. Acne scars can be classified into three main groups: Depressed (pitted scars), Raised (keloid scars) and Discoloration scars.

Depressed scars are the most common type of scarring that results from inflammatory acne.  Generally, all the depression scars rest on top of a patch of fibrous, collagen rich scar tissue.  This fibrous tissue anchors the base (bottom) of the scar to the sub-cutaneous tissue, maintaining the depression and preventing the regrowth of healthy tissue.

Ice pick Scar: deep but small pits. Ice pick scars are often the most difficult type of acne scar to treat without surgical procedures. Ice pick scars are often quite deep, making them very difficult to treat with standard resurfacing techniques. Chemical peels, micro-dermabrasion and many types of laser resurfacing are unlikely to have a significant impact on ice pick scars because those techniques do not remove enough tissue to be effective.

Boxcar Scar: sharp angles and edges; can be shallow or deep Because box car scars have steeper edges than rolling scars, it is more difficult to smooth them out and blend them into the surrounding skin. Laser resurfacing, particularly ablative laser resurfacing (eg. Er:YAG, Nd:YAG, CO2) often produces good results. However, many laser treatments may be necessary to achieve maximum improvement.

Rolling Scar: tend to be wide and shallow (a wavy look) caused by damage under the surface. Rolling scars are common for in individuals who have had patches of skin that have been afflicted by long-term inflammatory acne. They tend to become more pronounced as the skin ages and loses its original elasticity and fullness.

Hypertrophic and Keloid Scars: Keloids are raised, reddish nodules that develop at the site of an injury. After a wound has occurred to the skin both skin cells and connective tissue cells (fibroblasts) begin multiplying to repair the damage. A scar is made up of ‘connective tissue’, gristle-like fibers deposited in the skin by the fibroblasts to hold the wound closed. With keloids, the fibroblasts continue to multiply even after the wound is filled in. Thus keloids project above the surface of the skin and form large mounds of scar tissue.
Because hypertrophic acne scars are raised, they are can often be effectively treated with ablative laser resurfacing and micro-dermabrasion. They can also be surgically removed. Hypertrophic scars are generally less responsive to treatments like chemical peels, because the scar tissue is much more resistant to the ingredients in a chemical peel than healthy tissue.