Acne scars can develop with any type of acne and are seen more in acne-prone areas such as the forehead, face, chin, neck, back, and the buttocks.
About 95% of the people who develop acne develop acne scars – that’s how common scars are. They can have a profound impact on the psyche of the adolescent, in a boy, and more so in a girl, because it mars the appearance of the individual.
As you are aware, acne develops because the hair follicles are clogged by the excess secretion of sebum, which blocks the skin pores and causes the hair follicles to engorge due to the accumulation of sebum, dead skin cells and skin bacteria.
The bacteria cause infection to set in, which at times can be deep-seated. It damages the dermal layer of the skin, which is situated below the epidermal layer.
Due to damage to the deeper skin tissues, it takes a longer time to heal and in the process of healing, scarring takes place over the site of the acne.
Types of Acne Scars
You can have depressed or raised acne scars depending on how much collagen or scar tissue your skin produces during skin repair.
Depressed types of acne scars form when your body produces less collagen.
Raised types of acne scars form when your body produces more collagen than required. Depressed acne scars are more common than raised scars.
(A) Depressed or atrophic acne scars
Depressed acne scars are the most common scars seen as a sequel to acne. They are further subdivided according to their size, shape, and depth.
Ice pick acne scars
The ice pick is the most common type of acne scars. As the name implies, ice pick scars are deep and narrow (less than 2 mm across). The surface opening is wider than its deeper end below.
In cross-section, they are V-shaped and extend up to the dermis. They give the appearance of being caused by the insertion of a sharp thin object.
They are commonly seen on the cheeks, the nose, and the glabella (the skin between the eyebrows and above the nose). They worsen with age due to the increasing laxity of the skin and make the person look older than his real age.
This is treated with acne scar surgery and may be followed by laser surfacing to improve the look of the skin.
Boxcar acne scars
Boxcar acne scars are wide round or oval depressions and U-shaped in cross-section. Their walls are box type and well-defined. They may be shallow (0.1 to 0.5 mm) or deep (more than 0.5 mm) and can measure 1.5 to 4 mm across.
They are more likely to develop on the cheeks and the temples. The treatment option depends on how deep the scarring is.
Rolling acne scars
Rolling acne scars are a result of long-term inflammatory acne. They are wide (4 to 5 mm across), formed by bands of scar tissue, and give the skin a wavy texture. They commonly appear on the lower cheeks and the mandibular area.
Your dermatologist may use a combination of treatment options for this type of scar. Injection of a filler may make them less noticeable. Acne laser surgery and laser therapy are other treatment options.
(B) Raised acne scars
Scarring of the deep-seated infected acne that rises above the skin surface is classified in this group. These types of acne scars develop due to excess collagen produced by the body during the process of healing.
Hypertrophic acne scars
Hypertrophic acne scars are dome-shaped, fibrotic in nature, and elevated above the skin due to the formation of extra scar tissue and are of the same size as the original acne lesion. They are more common in males and tend to form on the chest and the back.
Keloid acne scars
Keloid acne scars are also elevated above the skin due to the formation of excessive scar tissue, but they extend beyond the margins of the original acne lesion. Keloid scars have irregular borders and are more common in men and appear on the trunk of the body rather than on the face. They can be itchy and painful.
Hypertrophied types of acne scars and keloids are resistant to treatments like chemical peels. They respond well to laser ablation and micro-dermabrasion. Acne scar surgery is also an option if required.