Skin Journal
The 5 types of acne scars, explained
Author:
Imogen Kars
Reviewed by:

Pimples tend to come and go but for some, acne scars are an uphill battle that can take skin worries to a whole new level.

Acne scarring can affect your confidence and in some cases, can be a reminder of acne you experienced years before, which is downright annoying.

If you're familiar with acne scarring, chances are you're away that there are a number of different types of acne scars.

And, just like the many variations of acne, acne scars take different forms and in turn, often need various types of treatments.

Whether the scars are a distant memory of acne from a past life or a more recent occurrence, seeking treatment for acne scarring is understandable and there's nothing wrong with wanting to fade these scars.

The good news is that acne scars are treatable — that's where Software comes in.

But first, let's start by diving deep into what acne scars are, and how they form, and then, we'll explain how you can conquer them once and for all.

What are acne scars?

Acne scars might be the bane of your existence, but what exactly are they?

Simply put, scars from pimples occur when there's a boatload of inflammation in your acne lesions.

When your body makes a move to try and heal the lesion with wound healing enzymes that urge collagen to jump into the mix, a few things can go wrong — and this is what an acne scar is.

While all kinds of acne can cause scarring if you're predisposed to it, cystic acne is most likely to leave you with a scar.

Cystic or pustular acne usually pertains to an infection, which means your skin is dealing with a load of inflammation.

Why does acne cause scarring?

Acne scars are shrouded in mystery for many people — why do some blemishes cause scar tissue while others seemingly heal well?

It all comes down to the way that the pore heals.

Acne scars are usually the end result of an inflamed blemish that has filled the pore to the brim with excess oil, dead skin cells and bacteria.

When acne forms, pores swell and cause a break in the follicle wall, and shallow lesions will usually form quickly and heal well.

But when there's a deeper break in the follicle wall, the infected contents of your blemish can spill into the surrounding tissues, digging deeper to cause lesions that move more intensely through your skin tissue.

After a blemish, your skin will work hard to repair lesions in your tissue by boosting collagen production.

Despite the mountains your skin moves to heal blemishes over, the repairs are usually never as smooth and clear as your original skin, especially if your body produces too little or too much collagen.

So now you know why acne causes scarring, let's dig a little deeper into the types of acne scars.

Common types of acne scars and causes

There are a number of different types of acne scars and it can be helpful to identify what type you're experiencing when it comes to acne scar treatment options.

Here are the most common types of acne scars:

Atrophic scars

Atrophic acne scars form when your skin can't regenerate tissue properly.

Atrophic scars are indented in appearance due to the mismatched healing that goes on within the skin and this type of acne scar is formed because of a loss of tissue.

It presents as round or oval-shaped dents on the skin and atrophic acne scars are quite similar in appearance to chickenpox scar tissue.

There are three separate types of atrophic acne scars:

  • Icepick scars: These have the appearance of a deep pore and can leave the skin with a linear depression.
  • Boxcar scars: These closely resemble chickenpox scar tissue in appearance. Boxcar scars leave a wider, depressed acne scar.
  • Rolling scars: These can be identified by their lack of distinct edges. Rolling scars are usually located around the cheeks, and form when the skin heals with an uneven, wavy contour after moderate to severe acne.

Hypertrophic and keloid scars

Keloid scars and hypertrophic scars appear as raised lesions of scar tissue that is a result of an overgrowth of fibrous tissue.

Most commonly located on the chest, back and shoulders (where the skin is thicker), these types of acne scars tend to form on those whose skin is predisposed to hypertrophic scars or keloid scars.

If you tend to scar easily, or the inflammation from your acne lesions is quite deep, you're more likely to come up against hypertrophic scars or keloid scars when your skin is healing.

Picking or squeezing your pimples can also damage your skin and lead to an increased chance of scarring with hypertrophic scars or keloid scars.

This is why it's universally recommended to leave your pimples alone — no matter how tempting it might be to squeeze them!

Smokers and those with darker skin types are also more at risk of developing thicker keloid scars or hypertrophic scars.

What is post-inflammatory hyperpigmentation?

Post-inflammatory hyperpigmentation is a temporary change in pigmentation following an injury like acne.

When the acne lesions run deep into your skin tissue and the epidermis or dermis layer of your skin is disturbed, melanin can be deposited into the skin cells.

Cutting the science talk, when trauma occurs in the skin tissue, inflammatory cells are released. These cells cause melanocytes (pigment cells) to produce more pigment in the skin. 

Post-inflammatory hyperpigmentation looks like flat, brown, tan or black spots on the skin following an acne lesion.

They can occur anywhere across your body, including the mouth, your genitals and even your nails.

While it might look like an acne scar, post-inflammatory hyperpigmentation isn't considered to be true scarring — rather it's a temporary discolouration of the skin during the healing process, which can be brought on by acne.

Why do some people scar and others don't?

There's a whole range of reasons why some people scar after dealing with acne while others don't.

First things first: we all scar, some folks just bear the brunt worse than other people.

In fact, all mammals scar but various factors make scars appear for some but not others. Scarring has more to do with your genetics than your overall health or the state of your acne.

Some people scar a lot more easily than others in the same situation purely because of their genetic background and predisposition to scarring.

For example, those with dark skin tones are more likely to experience scarring due to their genes, while those with lighter skin tones tend to encounter less scarring.

In some cases, people are just genetically disposed to healing deep acne lesions without dealing with the long-term consequences of a scar.

It's also important to note that the same person can scar differently in different areas of the body. Chests, for example, are renowned for healing poorly, as are the higher parts of our ears where cartilage is abundant.

How to treat acne scarring

There are a few ways to tackle acne scarring, with certain methods best for atrophic acne scars and others suited to the treatment of hypertrophic scars.

Here's are some of the options available when it comes to treating acne scars:

Laser therapy

Laser therapy is commonly used to treat both atrophic acne scars, like rolling scars, boxcar scars and icepick scars, and hypertrophic and keloid scars.

It works by removing the outer layers of the skin to fade the scar while also promoting collagen production.

It's important to note that laser therapy doesn't remove acne scars but rather fades the raised appearance of the scar so it may not fully disappear depending on the severity of the scar.

Keep in mind that you'd also need a number of sessions to treat the scar, with appointments costing around $200 or more, so it can become quite pricey in the long run.

Prescription treatment

At Software, we offer prescription skincare formulas that are personalised to your skin needs and goals.

One of our most common treatment options is for acne and in turn, acne scars.

Our customised formulas contain medical-grade, prescription ingredients like retinoids, niacinamide and hyaluronic acid to stimulate the growth of new skin cells and increase the rate that old skin cells are shed, while also strengthening the skin barrier and preventing the formation of new breakouts.

Not only can you target scarring but you can also actively prevent acne from popping up in the future. It's a win-win!

Simply complete our text-based quiz and upload a few selfies of your skin and our local Software doctors will create a customised prescription formula for you.

This is compounded and delivered straight to your door and you can access ongoing follow-up support from your doctor as you use your treatment.

Skin needling

Skin needling, also known as microneedling, involves creating tiny punctures across the skin with microneedles in order to create collagen.

It's often used in the treatment of astrophic scars.

The idea behind skin needling is that wounding the skin prompts a healing response and encourages collagen production in the area, which can help treat acne scarring and renew the texture of your skin.

While skin needling can be done at home, we recommend seeking professional treatment from a dermatologist or skin specialist.

Microneedling can cost anywhere from $200 to $350 per session, depending on the surface area being treated.

Steroid injections

When treating hypertrophic scars, steroid injections may be recommended. Dermatologists can inject a steroid solution directly into the scar in order to reduce the size and appearance.

Keloid scars often respond to this treatment as the steroid solution helps break down the bonds connecting the collagen fibres, which in turn reduces the scar tissue under the skin.

Steroids also have anti-inflammatory qualities that can reduce the redness and swelling associated with hypertrophic scars.

Chemical peels

Chemical peels can help reduce the appearance of acne scars by sloughing away the top layer of skin with ingredients like glycolic acid and salicylic acid.

The end result is a more even skin tone and texture and less noticeable scarring.

Chemical peels work best on atrophic scars and should be performed by a skin professional for best results but keep in mind that severe or raised scars don't often respond to chemical peels.

The cost for chemical peels can range from $100 to $250 for one appointment.

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