Depressed and Raised Acne Scars

Types of Acne Scars

Acne outbreaks followed by scarring can happen to anyone and this includes adults. The scars can appear in various shapes, sizes and even colors and are classified into two primary groups: depressed and raised. Since the appearance of acne scars can vary, there are different treatments available. Knowing the type of acne scar can help you determine which treatment may work best for you.

Depressed Scars

Depressed or pitted scars are the most common form of acne scars which result from inflammatory acne and a loss of tissue. Persistent outbreaks of severe inflammatory acne can significantly damage the tissue due to large regions of affected skin as the frequency of the outbreaks does not allow the skin adequate time to heal. Depression scars get their appearance because the base of the fibrous scar tissue is anchored down into the subcutaneous tissue which prevents the regrowth of healthy tissue. In general, depressed scars are classified into three main types:

  1. Rolling Acne Scars:

  • Characterized by fairly broad depressions in the skin which have curved, sloping edges
  • Called rolling scars because several scars in any region give the skin a rolling appearance
  • Commonly occurs in people with long-term inflammatory acne
  • Becomes more pronounced with age as the skin loses its elasticity and fullness
  • Effective treatments include needling, microdermabrasion, chemical peels and laser treatments
  1. Boxcar Acne Scars:

  • Characterized by relatively broad depressions with steep, distinct edges
  • More difficult to smooth out than rolling scars due to their steep edges
  • Effective treatments include cosmetic fillers and laser resurfacing and, in particular, ablative resurfacing
  • Multiple laser treatments may be necessary for optimal results
  • Shallow scars can be treated with chemical peels or microdermabrasion
  • Surgical options include needling, surgical subcisions and punch-out excisions
  1. Icepick Acne Scars:

  • Deep, narrow scars which often resemble a large empty pore
  • The most difficult acne scar to treat without surgery due to their depth
  • Microdermabrasion, chemical peels and laser resurfacing techniques do not remove enough tissue to be effective
  • The most effective treatment is punch-out excisions

Raised Scars

Hypertrophic and keloid scars are the most common type of raised scars and occur less often with acne than depressed scars. Hypertrophic scars occur due to excess scar tissue that forms at the injury site. The scar tissue is fibrous and firm but raised above the surrounding healthy tissue. Scar tissue that forms excessively and becomes a large lump of thick and rubbery tissue is called a keloid scar. Keloid scars form due to the severity and duration of the acne, secondary infections and even genetics. These scars are usually red or pink in color due to hyper-pigmentation but, as time passes, they generally become flatter and obtain a lighter color on their own. Vitamin E, Aloe Vera and silicone sheets are some of the treatment options for hypertrophic scars. Special laser and light treatments such as KTP Lasers, Pulsed Dye Lasers or Intense Pulsed Light therapy may help to tone down the discoloration of a scar. Raised scars are not very responsive to treatments such as chemical peels because the tissue is more resistant to the ingredients in the peel. However, these scars can effectively be treated with microdermabrasion, ablative laser resurfacing or surgical removal.