How Does Acne Scarring Form?
I’ve Got Chronic Acne… Now What?
Acne is a complex inflammatory disorder of the skin. It occurs when hair follicles become clogged with oil and dead skin cells. The resulting buildup of oil and dead skin cells can form acne blemishes such as blackheads, whiteheads, pimples and cysts.
Most people have experienced acne at some point in their lives, making it one of the most common skin disorders in the world. In fact, up to 85 percent of teenagers get acne at some point, according to the American Academy of Dermatology (AAD).
While most people experience acne breakouts during puberty and adolescence, there are certain factors that can cause someone to develop chronic acne throughout adulthood. These factors include stress, hormones and diet. However, some people are more genetically predisposed to getting acne than others.
Unfortunately, acne can leave behind scars on the skin long after it has cleared up. This type of scarring occurs when there is inflammation in the deeper layers of your skin (dermis). This inflammation causes collagen fibers to become damaged or destroyed leading to tissue loss beneath the surface of your skin. This tissue loss can result in visible depressions or div
Acne scarring is a common problem for those who have suffered from acne in the past. Acne scars are often indented (“ice pick”) or raised (“keloid”). In some cases, the scars are a combination of both. The causes of acne scars are not fully understood, but it is presumed that the skin attempts to “repair” itself following the loss of tissue from pimple eruptions by generating new collagen fibers. These repair attempts may result in too much or too little tissue (hypertrophy or atrophy) and create an undesirable change to the skin’s appearance and texture.
The good news is there are several treatment options available to help reduce and even eliminate acne scars. Which treatment option is right for you will depend on your type of acne scarring, your budget and your general health.
Fortunately, most acne scars can be effectively treated with one or more of the following treatments:
Acne scars are the result of inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris. The scar is created by abnormal healing following this dermal inflammation. Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris.
Acne scars are classified based on whether or not they cause an actual change in the texture of the skin. These include atrophic (depressed), hypertrophic (raised), rolling, boxcar, ice-pick and keloid scars.
Atrophic Scars
The most common types of atrophic scars are ice-pick, boxcar and rolling scars. Ice-pick scars are narrow, V-shaped indentations in the skin with steep edges that extend into the dermis. Boxcar scars resemble chickenpox scars and have sharp vertical edges with a defined width that is wider than ice-pick scars. Rolling scars are shallow and give the skin a wave-like appearance.
Acne scars are the result of inflammation within the dermis brought on by acne. The scar is created by the wound trying to heal itself resulting in too much collagen in one spot.
The overproduction of collagen is what results in the formation of acne scars. The body attempts to “patch” the wound by sending collagen to the affected area. As a result, thickened tissue forms, creating a raised scar on top of the skin.
There are four different types of acne scars: ice pick, boxcar, rolling and hypertrophic.
Ice pick scars are very deep acne scars that look like the skin has been punctured with an ice pick. These scars form when infected cysts or nodules rupture underneath the skin and cause damage to the surrounding tissues. They can be difficult to treat and often require surgery.
Boxcar scars are round or oval depressions with sharp vertical edges. They are usually found on the temple and cheeks, and can be either superficial or deep, requiring more invasive treatment such as a chemical peel for deeper boxcar scars.
Rolling scars appear as smooth undulations in the skin’s surface. They are caused by bands of scar tissue that develop between skin tissue and muscle below as a result of severe inflammation from cystic acne lesions
Acne scars are the result of active acne lesions, including papules, pustules, nodules and cysts, which damage the collagen fibers of the skin. Acne scarring can appear as either raised (hypertrophic) or indented (atrophic) scars. Atrophic scars are the most common type of acne scarring and include boxcar and rolling scars.
In fact, most atrophic scars are a combination of these two types. Boxcar scars are characterized by sharp vertical edges with an uneven or pitted surface. Rolling scars have sloping edges and appear more like small depressions in the skin.
A third type of acne scar is hypertrophic scarring, which is less common than atrophic scarring but can be more difficult to treat. Hypertrophic scars tend to be firm, raised and flesh-colored. They can also occur on the back and chest in addition to the face.
Acne scars are the result of inflammatory acne lesions, such as papules (pink raised bumps), pustules (pink bumps with white pus), or cysts. According to Dr. Whitney Bowe, there are four different types of acne scars: ice pick, boxcar, rolling and hypertrophic. Ice pick scars are narrow (less than 2 mm across), deep scars that extend into the dermis. Boxcar scars are round or oval depressions, while rolling scars are wider indentations that have a wave-like pattern of depth. Finally, hypertrophic scars take the form of a keloid, which is an overgrowth of tissue that occurs when the body tries to recover from an injury. If you have darker skin, you may also experience post-inflammatory hyperpigmentation (dark spots) in addition to scarring.
People with red and pink marks left over from acne may have post-inflammatory hyperpigmentation (PIH) or acne scars. These marks are usually flat, but some may be slightly raised. PIH can fade on its own after several months, but it can also be treated with a variety of dermatological procedures, including the use of skin lighteners and chemical peels. Acne scars are deeper than hyperpigmentation marks, and are caused when inflammation damages the tissue beneath the skin’s surface. There are many types of acne scars, which can vary in shape and tone. Some appear as shallow depressions in the skin; these are often called icepick scars because they look like tiny punctures made by an ice pick. Some have a rounded appearance, while others are deep and narrow at their base, which may make them look like tunnels formed under the skin (these are known as rolling scars). As you might guess from their name, boxcar scars have sharp edges that give them a square or rectangular shape.
Hypertrophic (raised) scars occur when excess collagen is produced around a wound site; untreated hypertrophic scars can become keloids, which are raised scars that spread beyond the initial wound site. Keloids grow when cells produce too much